Bastkowski Rene, Bindermann Robert, Brockmeier Konrad, Weiss Kilian, Maintz David, Giese Daniel
Institute for Diagnostic and Interventional Radiology (R. Bastkowski, K.W., D.M., D.G.) and Department of Pediatric Cardiology, Heart Centre (R. Bindermann, K.B.), University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany; and Philips Healthcare Hamburg, Hamburg, Germany (K.W.).
Radiol Cardiothorac Imaging. 2019 Oct 31;1(4):e190005. doi: 10.1148/ryct.2019190005. eCollection 2019 Oct.
To measure respiration-dependent blood flow in the total cavopulmonary connection (TCPC) of patients with Fontan circulation by using free-running, fully self-gated five-dimensional (5D) flow MRI.
From July to November 2018, 10 volunteers (six female volunteers, mean age, 25.1 years ± 4.4 [standard deviation]) and six patients with Fontan circulation (two female patients, mean age, 19.7 years ± 7.5) with a TCPC were examined by using a cardiac- and respiration-resolved three-directional and three-dimensional phase-contrast MRI sequence (hereafter, 5D flow MRI). This prospective study was conducted with approval of the local ethics committee, and written informed consent was obtained from all participants and/or their representative. 5D flow data were acquired during free breathing. Data were reconstructed into 15-20 heart phases and four respiratory phases: end-expiration, inspiration, end-inspiration, and expiration. Respiration-dependent stroke volumes (SVs) and particle traces were analyzed from the caval circulation of volunteers and patients with Fontan circulation. Statistical analysis was performed by using parametric tests and scatterplots.
The respiration dependency of caval blood flow was evaluated in all participants and was significantly elevated in patients with Fontan circulation as compared with volunteers. In patients, SV in the inferior vena cava (IVC) showed variations of 120% between inspiration and expiration ( = .002). The flow distribution in the IVC and superior vena cava among the four respiratory phases was differentiated by 20% (range, 9%-30%) and 4% (range, 0%-13%), respectively.
Hemodynamic parameters (volume flow and blood flow distribution) throughout the cardiac and respiratory cycle can be measured using a single scan, potentially providing further insights into the Fontan circulation.© RSNA, 2019
通过使用自由运行、完全自门控的五维（5D）血流磁共振成像（MRI）来测量采用Fontan循环的患者全腔肺连接（TCPC）中与呼吸相关的血流。
2018年7月至11月，对10名志愿者（6名女性志愿者，平均年龄25.1岁±4.4[标准差]）和6例采用TCPC的Fontan循环患者（2名女性患者，平均年龄19.7岁±7.5）进行了心脏和呼吸分辨的三维相控MRI序列（以下简称5D血流MRI）检查。本前瞻性研究在获得当地伦理委员会批准后进行，并获得了所有参与者和/或其代表的书面知情同意。在自由呼吸期间采集5D血流数据。数据被重建为15 - 20个心动周期相位和四个呼吸相位：呼气末、吸气、吸气末和呼气。分析了志愿者和Fontan循环患者腔静脉循环中与呼吸相关的每搏输出量（SVs）和粒子轨迹。采用参数检验和散点图进行统计分析。
评估了所有参与者腔静脉血流的呼吸依赖性，与志愿者相比，Fontan循环患者的呼吸依赖性显著升高。在患者中，下腔静脉（IVC）的SV在吸气和呼气之间显示出120%的变化（P = 0.002）。IVC和上腔静脉在四个呼吸相位之间的血流分布差异分别为20%（范围9% - 30%）和4%（范围0% - 13%）。
通过单次扫描可以测量整个心动周期和呼吸周期的血流动力学参数（容积流量和血流分布），这可能为Fontan循环提供进一步的见解。©RSNA，2019
