Ohashi Ryoko, Nagao Michinobu, Ishizaki Umiko, Shiina Yumi, Inai Kei, Sakai Shuji
Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Department of Pediatric Cardiology, Division of Clinical Research for ACHD, Tokyo Women's Medical, Tokyo, Japan.
Pediatr Cardiol. 2020 Feb;41(2):389-397. doi: 10.1007/s00246-019-02272-3. Epub 2019 Dec 18.
We propose a novel method to quantify pulsatile liver deformation using the feature tracking method of cardiac cine magnetic resonance imaging (MRI) and investigate its association with liver dysfunction in long-term postoperative patients after Fontan and intracardiac repair for the tetralogy of Fallot (TOF). Standard cine MRI which was previously performed for cardiac evaluation of 85 patients who underwent Fontan operation (mean age, 22.9 years), 43 patients with TOF (mean age, 34.6 years), and 32 healthy controls (mean age, 42.3 years) were retrospectively analyzed. Pulsatile liver deformation in the craniocaudal direction was calculated using the feature tracking method of cardiac cine imaging derived from cine-balanced turbo field-echo sequences performed on a 1.5 Tesla MR scanner, and was defined as liver strain. The liver strain was compared across the three patient groups using one-way analysis of variance. Liver dysfunction by a liver strain were compared using the Mann-Whitney U test. Liver strain for patients who underwent Fontan operation and TOF patients was significantly lower than controls (Fontan, 13.3 ± 6.5%; TOF, 15.0 ± 11.2%; controls, 23.1 ± 10.2%, p < 0.0001). In Fontan and TOF patients, MELD score was significantly greater for patients with a liver strain < 15% than those with values > 15% (5.9 ± 5.8 vs. 2.9 ± 2.9, p < 0.001). Lower liver strain values were found in adolescent and adult patients after Fontan operation and TOF, and correlates with the severity of liver injury, expressed as MELD score. Our method can evaluate hepatic function in adult congenital heart disease, together with the assessment of cardiac function.
我们提出了一种使用心脏电影磁共振成像（MRI）的特征跟踪方法来量化搏动性肝脏变形的新方法，并研究其与法洛四联症（TOF）的Fontan手术和心内修复术后长期患者肝功能障碍的关系。对先前为85例行Fontan手术的患者（平均年龄22.9岁）、43例TOF患者（平均年龄34.6岁）和32名健康对照者（平均年龄42.3岁）进行心脏评估的标准电影MRI进行回顾性分析。使用在1.5特斯拉MR扫描仪上执行的电影平衡涡轮场回波序列得出的心脏电影成像的特征跟踪方法计算头足方向的搏动性肝脏变形，并将其定义为肝脏应变。使用单因素方差分析比较三组患者的肝脏应变。使用Mann-Whitney U检验比较肝脏应变导致的肝功能障碍。接受Fontan手术的患者和TOF患者的肝脏应变明显低于对照组（Fontan组为13.3±6.5%；TOF组为15.0±11.2%；对照组为23.1±10.2%，p<0.0001）。在Fontan和TOF患者中，肝脏应变<15%的患者的终末期肝病模型（MELD）评分明显高于应变值>15%的患者（5.9±5.8对2.9±2.9，p<0.001）。在Fontan手术和TOF术后的青少年和成年患者中发现较低的肝脏应变值，并且与以MELD评分表示的肝损伤严重程度相关。我们的方法可以在评估心脏功能的同时评估成人先天性心脏病患者的肝功能。
