From the Department of Diagnostic and Interventional Radiology (C.S., J.H., J.R., T.K., A.V., M.G., F.W., J.V.C.), Department of Cardiothoracic, Transplantation and Vascular Surgery (S.C., A.H.), and Department of Respiratory Medicine (K.M.O., M.M.H., T.W.), Hannover Medical School, OE 8220, Carl-Neuberg-Str 1, 30625 Hannover, Germany; and Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany (C.S., S.C., J.H., J.R., T.K., K.M.O., A.V., M.G., M.M.H., T.W., A.H., F.W., J.V.C.).
Radiology. 2016 Jun;279(3):925-34. doi: 10.1148/radiol.2015150765. Epub 2015 Dec 28.
Purpose To evaluate surgical success after pulmonary endarterectomy (PEA) by means of cardiopulmonary magnetic resonance (MR) imaging. Materials and Methods In this institutional review board-approved study, 20 patients with chronic thromboembolic pulmonary hypertension were examined at 1.5 T with a dynamic contrast material-enhanced three-dimensional fast low-angle shot sequence before and 12 days after PEA (25th-75th percentile range, 11-16 days). Lung segments were evaluated visually before PEA for parenchymal hypoperfused segments. Pulmonary blood flow (PBF), first-pass bolus kinetic parameters, and biventricular mass and function were determined. Mean pulmonary artery pressure (mPAP) and 6-minute walking distance were measured before and after PEA. The Shapiro-Wilk test, paired two-sided Wilcoxon rank sum test, Spearman ρ correlation, and multiple linear regression analysis were performed. Results Two weeks after PEA, regional PBF increased 66% in the total lung from 32.7 to 54.2 mL/min/100 mL (P = .0002). However, after adjustment for cardiac output, this change was not evident anymore (increase of 7% from 7.03 to 7.54 mL/min/100 mL/L/min, P = .1). Only in the lower lobes, a significant increase in PBF after cardiac output adjustment remained: a 16% increase in the right lower lobe from 7.53 to 8.71 mL/min/100 mL (P = .01) and a 14% increase in the left lower lobe from 7.42 to 8.47 mL/min/100 mL/L/min (P < .05). Right ventricular mass and function also improved. mPAP decreased from 46 to 24 mm Hg (P < .0001). Six-minute walking distance increased from 390 to 467 m (P = .02) 5 months after PEA. Percentage change of mPAP and PBF in the lower lobe tended to be significant predictors of percentage change in 6-minute walking distance (β = -1.79 [P = .054] and β = 0.45 [P = .076], respectively) in multiple linear regression analysis. Conclusion Improvement of PBF after PEA was observed predominantly in the lower lungs, and the magnitude of improvement of PBF in the lower lobes correlated with the improvement in exercise capacity, reflecting surgical success. (©) RSNA, 2016.
目的 通过心脏磁共振成像（CMR）评估肺动脉内膜剥脱术（PEA）后的手术效果。
材料与方法 本研究经机构审查委员会批准，20 例慢性血栓栓塞性肺动脉高压患者在 1.5T 扫描仪上使用动态对比增强三维快速小角度激发序列进行检查，分别在 PEA 术前（第 25-75 百分位数范围，11-16 天）和术后 12 天进行检查。PEA 术前，通过视觉评估肺实质灌注不足的肺段。确定肺血流量（PBF）、首过对比剂动力学参数、左右心室质量和功能。PEA 前后测量平均肺动脉压（mPAP）和 6 分钟步行距离。采用 Shapiro-Wilk 检验、配对双侧 Wilcoxon 秩和检验、Spearman ρ 相关和多元线性回归分析。
结果 PEA 后 2 周，全肺区域性 PBF 从 32.7 增至 54.2mL/min/100mL（P =.0002），增加 66%。然而，在调整心输出量后，这种变化不再明显（从 7.03 增至 7.54mL/min/100mL/L/min，增加 7%，P =.1）。只有在肺下叶，心输出量调整后的 PBF 仍有显著增加：右肺下叶增加 16%，从 7.53 增至 8.71mL/min/100mL（P =.01），左肺下叶增加 14%，从 7.42 增至 8.47mL/min/100mL/L/min（P <.05）。右心室质量和功能也得到改善。mPAP 从 46 降至 24mmHg（P <.0001）。PEA 后 5 个月，6 分钟步行距离从 390 增至 467m（P =.02）。多线性回归分析中，下叶 mPAP 和 PBF 的变化百分比与 6 分钟步行距离的变化百分比呈正相关（β = -1.79[P =.054]和β = 0.45[P =.076]）。
结论 PEA 后 PBF 的改善主要发生在肺下叶，下叶 PBF 的改善程度与运动能力的改善相关，反映了手术效果。（©）RSNA，2016 年。
