Goubergrits Leonid, Riesenkampff Eugenie, Yevtushenko Pavlo, Schaller Jens, Kertzscher Ulrich, Hennemuth Anja, Berger Felix, Schubert Stephan, Kuehne Titus
Biofluid Mechanics Laboratory, Charité-Universitätsmedizin, Berlin, Germany; Non-Invasive Cardiac Imaging in Congenital Heart Disease Unit, Charité-Universitätsmedizin, Berlin, and German Heart Institute, Berlin, Germany.
J Magn Reson Imaging. 2015 Apr;41(4):909-16. doi: 10.1002/jmri.24639. Epub 2014 Apr 11.
To reduce the need for diagnostic catheterization and optimize treatment in a variety of congenital heart diseases, magnetic resonance imaging (MRI)-based computational fluid dynamics (CFD) is proposed. However, data about the accuracy of CFD in a clinical context are still sparse. To fill this gap, this study compares MRI-based CFD to catheterization in the coarctation of aorta (CoA) setting.
Thirteen patients with CoA were investigated by routine MRI prior to catheterization. 3D whole-heart MRI was used to reconstruct geometries and 4D flow-sensitive phase-contrast MRI was used to acquire flows. Peak systolic flows were simulated using the program FLUENT.
Peak systolic pressure drops in CoA measured by catheterization and CFD correlated significantly for both pre- and posttreatment measurements (pre: r = 0.98, p = 0.00; post: r = 0.87, p = 0.00). The pretreatment bias was -0.5 ± 3.33 mmHg (95% confidence interval -2.55 to 1.47 mmHg). CFD predicted a reduction of the peak systolic pressure drop after treatment that ranged from 17.6 ± 5.56 mmHg to 6.7 ± 5.58 mmHg. The posttreatment bias was 3.0 ± 2.91 mmHg (95% CI -1.74 to 5.43 mmHg).
Peak systolic pressure drops can be reliably calculated using MRI-based CFD in a clinical setting. Therefore, CFD might be an attractive noninvasive alternative to diagnostic catheterization.
为减少各种先天性心脏病的诊断性心导管检查需求并优化治疗方案，提出了基于磁共振成像（MRI）的计算流体动力学（CFD）方法。然而，关于CFD在临床环境中准确性的数据仍然稀少。为填补这一空白，本研究在主动脉缩窄（CoA）的情况下，将基于MRI的CFD与心导管检查进行了比较。
13例CoA患者在进行心导管检查前接受了常规MRI检查。使用三维全心MRI重建几何结构，使用四维血流敏感相位对比MRI获取血流数据。使用FLUENT程序模拟收缩期峰值血流。
导管检查和CFD测量的CoA收缩期峰值压降在治疗前和治疗后测量中均具有显著相关性（治疗前：r = 0.98，p = 0.00；治疗后：r = 0.87，p = 0.00）。治疗前偏差为-0.5±3.33 mmHg（95%置信区间-2.55至1.47 mmHg）。CFD预测治疗后收缩期峰值压降从17.6±5.56 mmHg降至6.7±5.58 mmHg。治疗后偏差为3.0±2.91 mmHg（95%CI -1.74至5.43 mmHg）。
在临床环境中，使用基于MRI的CFD可以可靠地计算收缩期峰值压降。因此，CFD可能是一种有吸引力的诊断性心导管检查的非侵入性替代方法。
