使用相位分辨功能性肺（PREFUL）-MRI对慢性血栓栓塞性肺动脉高压进行围手术期监测
Chronic Thromboembolic Pulmonary Hypertension Perioperative Monitoring Using Phase-Resolved Functional Lung (PREFUL)-MRI.
作者信息
Pöhler Gesa H, Klimes Filip, Voskrebenzev Andreas, Behrendt Lea, Czerner Christoph, Gutberlet Marcel, Cebotari Serghei, Ius Fabio, Fegbeutel Christine, Schoenfeld Christian, Kaireit Till F, Hauck Erik F, Olsson Karen M, Hoeper Marius M, Wacker Frank, Vogel-Claussen Jens
机构信息
Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.
German Centre for Lung Research, BREATH, Hannover, Germany.
出版信息
J Magn Reson Imaging. 2020 Aug;52(2):610-619. doi: 10.1002/jmri.27097. Epub 2020 Feb 24.
BACKGROUND
The translation of phase-resolved functional lung (PREFUL)-MRI to routine practice in monitoring chronic thromboembolic pulmonary hypertension (CTEPH) still requires clinical corresponding imaging biomarkers of pulmonary vascular disease.
PURPOSE
To evaluate successful pulmonary endarterectomy (PEA) via PREFUL-MRI with pulmonary pulse wave transit time (pPTT).
STUDY TYPE
Retrospective.
POPULATION
Thirty CTEPH patients and 12 healthy controls were included.
FIELD STRENGTH/SEQUENCE: For PREFUL-MRI a 2D spoiled gradient echo sequence and for DCE-MRI a 3D time-resolved angiography with stochastic trajectories (TWIST) sequence were performed on 1.5T.
ASSESSMENT
Eight coronal slices of PREFUL-MRI were obtained on consecutive 13 days before and 14 days after PEA. PREFUL quantitative lung perfusion (PREFUL ) phases over the whole cardiac cycle were calculated to quantify pPTT, the time the pulmonary pulse wave travels from the central pulmonary arteries to the pulmonary capillaries. Also, perfusion defect percentage based on pPTT (QDP ), PREFUL (QDP ), and V/Q match were calculated. For DCE-MRI, pulmonary blood flow (PBF) and QDP were computed as reference. For clinical correlation, mean pulmonary arterial pressure (mPAP) and 6-minute walking distance were evaluated preoperatively and after PEA.
STATISTICAL TESTS
The Shapiro-Wilk test, paired two-sided Wilcoxon rank sum test, Dice coefficient, and Spearman's correlation coefficient (ρ) were applied.
RESULTS
Median pPTT was significantly lower post PEA (139 msec) compared to pre PEA (193 msec), P = 0.0002. Median pPTT correlated significantly with the mPAP post PEA (r = 0.52, P < 0.008). Median pPTT was distributed more homogeneously after PEA: IQR pPTT decreased from 336 to 281 msec (P < 0.004). Median PREFUL (P < 0.0002), QDP (P < 0.0478), QDP (P < 0.0001) and V/Q match (P < 0.0001) improved significantly after PEA. Percentage change of PREFUL correlated significantly with percentage change of 6-minute walking distance (ρ = 0.61; P = 0.0031) 5 months post PEA.
DATA CONCLUSION
Perioperative perfusion changes in CTEPH can be detected and quantified by PREFUL-MRI. Normalization of pPTT reflects surgical success and improvement of PREFUL predicts 6-minute walking distance changes.
LEVEL OF EVIDENCE
3 TECHNICAL EFFICACY STAGE: 2 J. Magn. Reson. Imaging 2020;52:610-619.
背景
将相位分辨功能性肺（PREFUL）-MRI应用于慢性血栓栓塞性肺动脉高压（CTEPH）监测的常规实践中，仍需要肺血管疾病的临床相应影像学生物标志物。
目的
通过PREFUL-MRI及肺脉搏波传导时间（pPTT）评估肺动脉内膜剥脱术（PEA）的成功率。
研究类型
回顾性研究。
研究对象
纳入30例CTEPH患者和12名健康对照者。
场强/序列：在1.5T设备上，对PREFUL-MRI采用二维扰相梯度回波序列，对动态对比增强磁共振成像（DCE-MRI）采用三维随机轨迹时间分辨血管造影（TWIST）序列。
评估
在PEA术前连续13天和术后14天获取8个PREFUL-MRI冠状位切片。计算整个心动周期的PREFUL定量肺灌注（PREFUL）相以量化pPTT，即肺脉搏波从中央肺动脉传导至肺毛细血管的时间。此外，计算基于pPTT的灌注缺损百分比（QDP）、PREFUL（QDP）和通气/灌注匹配度。对于DCE-MRI，计算肺血流量（PBF）和QDP作为参考。为进行临床相关性分析，在PEA术前和术后评估平均肺动脉压（mPAP）和6分钟步行距离。
统计检验
应用夏皮罗-威尔克检验、配对双侧威尔科克森秩和检验、戴斯系数和斯皮尔曼相关系数（ρ）。
结果
与PEA术前（193毫秒）相比，PEA术后pPTT中位数显著降低（139毫秒），P = 0.0002。PEA术后pPTT中位数与mPAP显著相关（r = 0.52，P < 0.008）。PEA术后pPTT中位数分布更均匀：四分位间距pPTT从336毫秒降至281毫秒（P < 0.004）。PEA术后PREFUL中位数（P < 0.0002）、QDP（P < 0.0478）、QDP（P < 0.0001）和通气/灌注匹配度（P < 0.0001）均显著改善。PEA术后5个月，PREFUL变化百分比与6分钟步行距离变化百分比显著相关（ρ = 0.61；P = 0.0031）。
数据结论
PREFUL-MRI可检测并量化CTEPH围手术期灌注变化。pPTT正常化反映手术成功，PREFUL改善可预测6分钟步行距离变化。
证据级别
3级 技术效能阶段：2级 《磁共振成像杂志》2020年；52：610 - 619。
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