大动脉调转术患者术后的血流动力学评估：4D 血流和二维相位对比心血管磁共振成像与多普勒超声心动图的比较
Hemodynamic evaluation in patients with transposition of the great arteries after the arterial switch operation: 4D flow and 2D phase contrast cardiovascular magnetic resonance compared with Doppler echocardiography.
作者信息
Jarvis Kelly, Vonder Marleen, Barker Alex J, Schnell Susanne, Rose Michael, Carr James, Robinson Joshua D, Markl Michael, Rigsby Cynthia K
机构信息
Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL, 60611, USA.
Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, USA.
出版信息
J Cardiovasc Magn Reson. 2016 Sep 22;18(1):59. doi: 10.1186/s12968-016-0276-8.
BACKGROUND
Peak velocity measurements are used to evaluate the significance of stenosis in patients with transposition of the great arteries after the arterial switch operation (TGA after ASO). 4D flow cardiovascular magnetic resonance (CMR) provides 3-directional velocity encoding and full volumetric coverage of the great arteries and may thus improve the hemodynamic evaluation in these patients. The aim of this study was to compare peak velocities measured by 4D flow CMR with 2D phase contrast (PC) CMR and the gold standard Doppler echocardiography (echo) in patients with TGA after ASO.
METHODS
Nineteen patients (mean age 13 ± 9 years, range 1-25 years) with TGA after ASO who underwent 2D PC CMR and 4D flow CMR were included in this study. Peak velocities were measured with 4D flow CMR in the aorta and pulmonary arteries and compared to peak velocities measured with 2D PC CMR and Doppler echo. 2D PC CMR data were available in the ascending aorta, main, right and left pulmonary arteries (AAO/MPA/RPA/LPA) for 19/18/17/17 scans, respectively, and Doppler echo data were available for 13/9/6/6 scans, respectively. Peak velocities were measured with: 1) a single cross section for 2D PC CMR, 2) velocity maximum intensity projections (MIPs) for 4D flow CMR and 3) Doppler echo.
RESULTS
Significantly higher peak velocities were found with 4D flow CMR than 2D PC CMR in the AAO (p = 0.003), MPA (p = 0.002) and RPA (p = 0.005) but not in the LPA (p = 0.200). No difference in peak velocity was found between 4D flow CMR and Doppler echo (p > 0.46) or 2D PC CMR and echo (p > 0.11) for all analyzed vessel segments.
CONCLUSIONS
4D flow CMR evaluation of patients with TGA after ASO detected higher peak velocities than 2D PC CMR, indicating the potential of 4D flow CMR to provide improved stenosis assessment in these patients.
背景
峰值流速测量用于评估大动脉调转术（ASO术后完全性大动脉转位，TGA）患者狭窄的严重程度。四维血流心血管磁共振成像（CMR）可提供三维流速编码以及大动脉的全容积覆盖，因此可能改善对这些患者的血流动力学评估。本研究的目的是比较ASO术后TGA患者中，四维血流CMR与二维相位对比（PC）CMR以及金标准多普勒超声心动图（超声）所测得的峰值流速。
方法
本研究纳入了19例接受过二维PC CMR和四维血流CMR检查的ASO术后TGA患者（平均年龄13±9岁，范围1 - 25岁）。使用四维血流CMR测量主动脉和肺动脉的峰值流速，并与二维PC CMR和多普勒超声所测得的峰值流速进行比较。二维PC CMR数据在升主动脉、主肺动脉、右肺动脉和左肺动脉（AAO/MPA/RPA/LPA）分别有19/18/17/17次扫描可用，多普勒超声数据分别有13/9/6/6次扫描可用。峰值流速的测量方法如下：1）二维PC CMR采用单个横截面测量；2）四维血流CMR采用流速最大强度投影（MIP）测量；3）多普勒超声测量。
结果
在AAO（p = 0.003）、MPA（p = 0.002）和RPA（p = 0.005）中，四维血流CMR测得的峰值流速显著高于二维PC CMR，但在LPA中并非如此（p = 0.200）。对于所有分析的血管节段，四维血流CMR与多普勒超声之间（p > 0.46）或二维PC CMR与超声之间（p > 0.11）的峰值流速均无差异。
结论
对ASO术后TGA患者进行四维血流CMR评估时，所检测到的峰值流速高于二维PC CMR，这表明四维血流CMR在改善这些患者的狭窄评估方面具有潜力。
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