1.5T 磁共振非对比血管造影在马凡氏综合征患者主动脉根部手术后主动脉监测中的应用。
Non-contrast MR angiography at 1.5 Tesla for aortic monitoring in Marfan patients after aortic root surgery.
机构信息
Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Bavaria, Germany.
出版信息
J Cardiovasc Magn Reson. 2017 Oct 30;19(1):82. doi: 10.1186/s12968-017-0394-y.
BACKGROUND
Contrast-enhanced cardiovascular magnetic resonance angiography (CE-CMRA) is the established imaging modality for patients with Marfan syndrome requiring life-long annual aortic imaging before and after aortic root replacement. Contrast-free CMRA techniques avoiding side-effects of contrast media are highly desirable for serial imaging but have not been evaluated in the postoperative setup of Marfan patients. The purpose of this study was to assess the feasibility of non-contrast balanced steady-state free precession (bSSFP) magnetic resonance imaging for aortic monitoring of postoperative patients with Marfan syndrome.
METHODS
Sixty-four adult Marfan patients after aortic root replacement were prospectively included. Fourteen patients (22%) had a residual aortic dissection after surgical treatment of type A dissection. bSSFP imaging and CE-CMRA were performed at 1.5 Tesla. Two radiologists evaluated the images regarding image quality (1 = poor, 4 = excellent), artifacts (1 = severe, 4 = none) and aortic pathologies. Readers measured the aortic diameters at defined levels in both techniques. Statistics included observer agreement for image scoring and diameter measurements and ROC analyses for comparison of the diagnostic performance of bSSFP and CE-CMRA.
RESULTS
Both readers observed no significant differences in image quality between bSSFP and CE-CMRA and found a median image quality score of 4 for both techniques (all p > .05). No significant differences were found regarding the frequency of image artifacts in both sequences (all p > .05). Sensitivity and specificity for detection of aortic dissections was 100% for both readers and techniques. Compared to bSSFP imaging, CE-CMRA resulted in higher diameters (mean bias, 0.9 mm; p < .05). The inter-observer biases of diameter measurements were not significantly different (all p > .05), except for the distal graft anastomosis (p = .001). Using both techniques, the readers correctly identified a graft suture dehiscence with aneurysm formation requiring surgery.
CONCLUSION
Unenhanced bSSFP CMR imaging allows for riskless aortic monitoring with high diagnostic accuracy in Marfan patients after aortic root surgery.
背景
对比增强心血管磁共振血管造影（CE-CMRA）是马凡综合征患者的既定成像方式，这些患者在主动脉根部置换前后需要终身每年进行主动脉成像。对于连续成像，人们非常希望使用无造影剂的对比自由 CMRA 技术，但尚未在马凡综合征患者的术后设置中进行评估。本研究的目的是评估非对比平衡稳态自由进动（bSSFP）磁共振成像用于马凡综合征术后患者主动脉监测的可行性。
方法
前瞻性纳入 64 例主动脉根部置换术后的成年马凡综合征患者。14 例患者（22%）在接受 A 型夹层手术后仍存在残余主动脉夹层。在 1.5T 上进行 bSSFP 成像和 CE-CMRA。两位放射科医生分别评估图像的质量（1=差，4=优）、伪影（1=严重，4=无）和主动脉病变。读者在两种技术中均在特定层面测量主动脉直径。统计学分析包括观察者对图像评分和直径测量的一致性，以及 ROC 分析用于比较 bSSFP 和 CE-CMRA 的诊断性能。
结果
两位读者均未观察到 bSSFP 和 CE-CMRA 之间的图像质量存在显著差异，并且两种技术的中位数图像质量评分为 4（均 p>.05）。两种序列的图像伪影频率均无显著差异（均 p>.05）。两位读者和两种技术对主动脉夹层的检测灵敏度和特异性均为 100%。与 bSSFP 成像相比，CE-CMRA 测量的直径更高（平均偏差，0.9mm；p<.05）。除了远端移植物吻合口（p=.001）外，直径测量的观察者间偏倚没有显著差异（均 p>.05）。使用两种技术，读者均正确识别出需要手术治疗的移植物缝线裂开伴动脉瘤形成。
结论
无增强 bSSFP CMR 成像可在主动脉根部手术后的马凡综合征患者中进行安全的主动脉监测，并具有高诊断准确性。
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