Mukai Kanae, Burris Nicholas S, Mahadevan Vaikom S, Foster Elyse D, Ordovas Karen G, Hope Michael D
Division of Cardiology, University of California, San Francisco, CA, USA.
Division of Cardiothoracic Radiology, University of Michigan Health System, Ann Arbor, MI, USA.
Int J Cardiovasc Imaging. 2018 Feb;34(2):273-279. doi: 10.1007/s10554-017-1224-x. Epub 2017 Sep 8.
To evaluate the effect of MRI blood pool contrast agent on 4D flow image quality and ventricular volume measurements. Adult patients referred for clinical cardiac MRI (n = 22) were imaged with 4D flow. Patients with renal failure (n = 10) received ferumoxytol, and the remainder (n = 12) received gadofosveset trisodium. Image quality was assessed with (1) signal-to-noise ratio (SNR); (2) contrast-to-noise ratio (CNR); and (3) 5-point Likert scale based on endocardial border definition (1 = none; 2 = partial but unable to visualize; 3 = able to roughly estimate; 4 = visible for most of the cardiac cycle; 5 = excellent definition). A subset (n = 15) had short axis steady-state free precession (SSFP) cine imaging allowing for comparison of standard volumetric measurement technique with 4D flow derived volumetric measurements. 4D flow studies using ferumoxytol demonstrated a higher median Likert score of 5 (IQR, 5-5) versus 3 (IQR, 2-3). Median cavity SNR and CNR were higher for ferumoxytol compared to gadofosveset trisodium [65 (IQR, 50-74) versus 22 (IQR, 14-28), p < 0.001; and 40 (IQR, 32-49) versus 4 (IQR, 3-10), p < 0.001]. Good correlation (p < 0.001) was seen between SSFP and 4D flow measured ventricular volumes (ESV and EDV) with ferumoxytol (r = 0.998, mean difference = 1.2 mL, LOA = - 7.7-10.1 mL) and gadofosveset trisodium (r = 0.942, mean difference = - 2.7 mL, LOA = - 35.7-27.1 mL). Ferumoxytol used off-label as an MRI blood pool contrast agent offers an attractive alternative to gadofosveset trisodium in patients with renal failure, with excellent 4D flow image quality and good correlation of volumetric measurements compared to the CMR reference (SSFP).
评估磁共振成像（MRI）血池造影剂对四维血流图像质量和心室容积测量的影响。对因临床心脏MRI检查而转诊的成年患者（n = 22）进行四维血流成像。肾衰竭患者（n = 10）接受了铁羧麦芽糖，其余患者（n = 12）接受了钆布醇三钠。通过以下方式评估图像质量：（1）信噪比（SNR）；（2）对比噪声比（CNR）；以及（3）基于心内膜边界清晰度的5分李克特量表（1 = 无；2 = 部分可见但无法清晰显示；3 = 能够大致估计；4 = 在大部分心动周期可见；5 = 清晰度极佳）。一部分患者（n = 15）进行了短轴稳态自由进动（SSFP）电影成像，以便比较标准容积测量技术与四维血流衍生的容积测量结果。使用铁羧麦芽糖的四维血流研究显示，李克特评分中位数为5（四分位间距，5 - 5），而使用钆布醇三钠的为3（四分位间距，2 - 3）。与钆布醇三钠相比，铁羧麦芽糖的腔室SNR和CNR中位数更高[65（四分位间距，50 - 74）对22（四分位间距，14 - 28），p < 0.001；以及40（四分位间距，32 - 49）对4（四分位间距，3 - 10），p < 0.001]。使用铁羧麦芽糖时，SSFP和四维血流测量的心室容积（收缩末期容积和舒张末期容积）之间存在良好的相关性（p < 0.001）（r = 0.998，平均差异 = 1.2 mL，一致性界限 = - 7.7 - 10.1 mL），使用钆布醇三钠时也存在良好相关性（r = 0.942，平均差异 = - 2.7 mL，一致性界限 = - 35.7 - 27.1 mL）。在肾衰竭患者中，将铁羧麦芽糖作为MRI血池造影剂超说明书使用，与钆布醇三钠相比，它能提供具有吸引力的替代选择，具有出色的四维血流图像质量，且容积测量与心脏磁共振成像参考方法（SSFP）具有良好的相关性。
