Deutsch H J, Bachmann R, Sechtem U, Curtius J M, Jungehülsing M, Schicha H, Hilger H H
Klinik III für Innere Medizin, University of Cologne, Germany.
J Am Coll Cardiol. 1992 Jun;19(7):1500-7. doi: 10.1016/0735-1097(92)90610-y.
Gradient echo nuclear magnetic resonance (NMR) imaging and transesophageal two-dimensional color Doppler echocardiography are flow-sensitive techniques that have been used in the diagnosis and grading of valvular regurgitation. To define the diagnostic value of gradient echo NMR imaging in the detection of regurgitant flow in cardiac valve prostheses and the differentiation of physiologic leakage flow from pathologic transvalvular or paravalvular leakage flow, 47 patients with 55 valve prostheses were examined. Color Doppler transesophageal echocardiography was used for comparison. Surgical confirmation of findings was obtained in 11 patients with 13 valve prostheses. Gradient echo NMR imaging showed regurgitant flow in 37 of 43 valves with a jet seen on transesophageal echocardiography and it detected physiologic leakage flow in 4 additional valves. There was 96% agreement between the two methods in distinguishing between physiologic and pathologic leakage flow. The methods differed on jet origin of pathologic leakage flow in six prostheses. The degree of regurgitation was graded by both NMR imaging and transesophageal echocardiography, according to the area of the regurgitant jet visualized; gradings were identical for 75% of valve prostheses. Quantification of jet length and area showed a good correlation between the two methods (r = 0.85 and r = 0.91, respectively). Gradient echo NMR imaging is a useful noninvasive technique for the detection, localization and estimation of regurgitant flow in cardiac valve prostheses. However, because transesophageal echocardiography is less time-consuming and less expensive, gradient echo NMR imaging is unlikely to displace transesophageal echocardiography and should be used only in the occasional patient who cannot be adequately imaged by echocardiography.
梯度回波核磁共振（NMR）成像和经食管二维彩色多普勒超声心动图是对血流敏感的技术，已用于瓣膜反流的诊断和分级。为了确定梯度回波NMR成像在检测心脏瓣膜假体反流以及区分生理性漏血与病理性跨瓣或瓣周漏血方面的诊断价值，对47例患者的55个瓣膜假体进行了检查。采用彩色多普勒经食管超声心动图作为对照。对11例患者的13个瓣膜假体进行了手术结果确认。梯度回波NMR成像显示，在经食管超声心动图上可见射流的43个瓣膜中的37个存在反流，并且在另外4个瓣膜中检测到生理性漏血。两种方法在区分生理性和病理性漏血方面的一致性为96%。在6个假体中，两种方法对病理性漏血的射流起源判断不同。根据可视化反流束的面积，通过NMR成像和经食管超声心动图对反流程度进行分级；75%的瓣膜假体分级相同。射流长度和面积的定量分析显示两种方法之间具有良好的相关性（分别为r = 0.85和r = 0.91）。梯度回波NMR成像是检测、定位和评估心脏瓣膜假体反流的一种有用的非侵入性技术。然而，由于经食管超声心动图耗时更少且成本更低，梯度回波NMR成像不太可能取代经食管超声心动图，仅应偶尔用于无法通过超声心动图进行充分成像的患者。
