Department of Cardiology, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 2TH, UK.
Department of Cardiology, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 2TH, UK.
Int J Cardiol. 2017 Oct 1;244:354-357. doi: 10.1016/j.ijcard.2017.05.125. Epub 2017 Jun 2.
Pregnancy is associated with an increased risk of aortic pathology. We sought to assess the feasibility of performing non-contrast 3D steady-state free-precession (SSFP) magnetic resonance angiography (MRA) in pregnant subjects with inherited aortopathy.
Fifteen pregnant subjects (age 27±4yr) with positive genotyping for aortopathy (Marfan, Loeys-Dietz, Ehlers-Danlos) and/or a family history of aortic dissection underwent non-contrast 3D-SSFP MRA at 1.5T (Avanto, Siemens Healthcare, Erlangen, Germany) using a modified ECG-triggered orientated in a sagittal-oblique plane with a respiratory navigator at the diaphragmatic level (mean acquisition time 4.1±1.9min). Imaging was performed during the mid-trimester (21±5weeks). Image analysis was performed off-line using Cvi42 software (Circle Cardiovascular Imaging, Calgary, Canada). An assessment of image quality (score 0-3) was made before performing inner edge to inner edge measurements of the thoracic aorta at 7 levels from the multiplanar reconstructions by two independent blinded observers.
Non-contrast 3D-MRA was successfully acquired in all 15 subjects. Image quality was deemed excellent in 87% (13/15) of cases after a mean acquisition time of 4.1±1.9min. There was a high level of agreement for aortic measurements, with low intra- and inter-observer variability (ICC ranges; 0.95-0.99 and 0.92-0.98, respectively). All pregnancies reached term (≥37/40) with a mean gestation at delivery of 38.0±0.5weeks. The mode of delivery was vaginal in 9 out of 15 subjects (60%).
Non-contrast SSFP MRA imaging provides a quick and reproducible method of assessing the thoracic aorta in pregnancy.
妊娠与主动脉病变的风险增加有关。我们旨在评估在患有遗传性主动脉病的孕妇中进行非对比 3D 稳态自由进动（SSFP）磁共振血管造影（MRA）的可行性。
15 名经基因检测为主动脉病（马凡氏综合征、Loeys-Dietz 综合征、埃勒斯-当洛斯综合征）阳性的孕妇（年龄 27±4 岁）和/或有主动脉夹层家族史的孕妇接受了非对比 3D-SSFP MRA 检查，在 1.5T（西门子医疗，德国埃朗根的 Avanto）上使用改良的心电图触发的矢状斜位定向，膈肌水平有呼吸导航（平均采集时间为 4.1±1.9 分钟）。成像在妊娠中期（21±5 周）进行。使用 Cvi42 软件（加拿大卡尔加里的 Circle Cardiovascular Imaging）离线进行图像分析。两名独立的盲法观察者从多平面重建中对 7 个水平的胸主动脉进行内缘到内缘测量之前，对图像质量（0-3 分）进行评估。
15 名受试者均成功获得非对比 3D-MRA。在平均采集时间为 4.1±1.9 分钟后，87%（13/15）的病例图像质量被认为是优秀的。主动脉测量具有很高的一致性，内-观察者间和观察者间的变异性均较低（ICC 范围分别为 0.95-0.99 和 0.92-0.98）。所有妊娠均足月（≥37/40），分娩时平均妊娠时间为 38.0±0.5 周。15 名受试者中有 9 名（60%）为阴道分娩。
非对比 SSFP MRA 成像提供了一种快速、可重复的方法来评估妊娠期的胸主动脉。
