Biko David M, Collins R Thomas, Partington Sara L, Harris Matthew, Whitehead Kevin K, Keller Marc S, Fogel Mark A
Department of Radiology, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA, 19104, USA.
University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Pediatr Cardiol. 2018 Feb;39(2):275-282. doi: 10.1007/s00246-017-1752-0. Epub 2017 Oct 24.
The purpose of this study was to assess the safety and indications for cardiac magnetic resonance (CMR) with myocardial perfusion imaging (MPI) in a cohort of children and young adults. A retrospective review of 178 children and young adults who underwent CMR with MPI was performed. Studies were categorized based on study protocols as MPI with resting perfusion only, adenosine stress MPI, exercise-induced stress MPI, and MPI for cardiac mass diagnosis. Relevant clinical history, exam indications, and adverse reactions following gadolinium-based contrast agent and adenosine administration were recorded. Studies were reviewed for the presence of myocardial perfusion defects, wall motion abnormalities, and delayed myocardial enhancement. The most common indications from MPI were congenital heart disease (CHD), Kawasaki disease, anomalous coronary artery, or myocardial mass characterization. Of these, 51% were protocoled with adenosine stress, 23% without stress, 6% with exercise stress, and 20% for cardiac mass evaluation. Excluding patients for myocardial mass evaluation, MPI defects were present in 16% (14 with adenosine stress, 1 with exercise stress, 8 on resting studies only). For cardiac mass evaluation, a mass was confirmed in 58%. No adverse reactions occurred with intravenous administration of a gadolinium-based contrast agent. Three self-limited adverse reactions, 2 patients with chest pain, and 1 patient with bradycardia, occurred following adenosine administration. MPI is a safe modality for the evaluation of pediatric and young adults with minimal adverse events. The most common indications for MPI were for the evaluation of CHD, Kawasaki disease, anomalous coronary artery, or myocardial mass characterization.
本研究的目的是评估在一组儿童和青年成人中进行心肌灌注成像（MPI）的心脏磁共振成像（CMR）的安全性和适应症。对178例接受CMR检查并进行MPI的儿童和青年成人进行了回顾性研究。根据研究方案，将研究分为仅静息灌注的MPI、腺苷负荷MPI、运动诱发负荷MPI以及用于心脏肿块诊断的MPI。记录相关临床病史、检查适应症以及使用钆基造影剂和腺苷后的不良反应。对研究进行评估，以确定是否存在心肌灌注缺损、壁运动异常和延迟心肌强化。MPI最常见的适应症是先天性心脏病（CHD）、川崎病、冠状动脉异常或心肌肿块特征分析。其中，51%的研究采用腺苷负荷方案，23%无负荷，6%采用运动负荷，20%用于心脏肿块评估。排除进行心肌肿块评估的患者后，MPI缺损的发生率为16%（14例为腺苷负荷，1例为运动负荷，8例仅为静息研究）。对于心脏肿块评估，58%的患者确诊有肿块。静脉注射钆基造影剂未发生不良反应。腺苷给药后发生了3例自限性不良反应，2例胸痛患者和1例心动过缓患者。MPI是评估儿童和青年成人的一种安全方法，不良事件最少。MPI最常见的适应症是评估CHD、川崎病、冠状动脉异常或心肌肿块特征。
