自由呼吸非对比流动无关的心血管磁共振血管造影术使用心脏门控、磁化准备 3D Dixon 方法：先天性心脏病的胸血管评估。

Free-breathing non-contrast flow-independent cardiovascular magnetic resonance angiography using cardiac gated, magnetization-prepared 3D Dixon method: assessment of thoracic vasculature in congenital heart disease.

机构信息

Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.

Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany.

出版信息

J Cardiovasc Magn Reson. 2021 Jul 19;23(1):91. doi: 10.1186/s12968-021-00788-3.

BACKGROUND

To evaluate a non-contrast respiratory- and electrocardiogram-gated 3D cardiovascular magnetic resonance angiography (CMRA) based on magnetization-prepared Dixon method (relaxation-enhanced angiography without contrast and triggering, REACT) for the assessment of the thoracic vasculature in congenital heart disease (CHD) patients.

METHODS

70 patients with CHD (mean 28 years, range: 10-65 years) were retrospectively identified in this single-center study. REACT-CMRA was applied with respiratory- and cardiac-gating. Image quality (IQ) of REACT-CMRA was compared to standard non-gated multi-phase first-pass-CMRA and respiratory- and electrocardiogram-gated steady-state-CMRA. IQ of different vessels of interest (ascending aorta, left pulmonary artery, left superior pulmonary vein, right coronary ostium, coronary sinus) was independently assessed by two readers on a five-point Likert scale. Measurements of vessel diameters were performed in predefined anatomic landmarks (ascending aorta, left pulmonary artery, left superior pulmonary vein). Both readers assessed artifacts and vascular abnormalities. Friedman test, chi-squared test, and Bland-Altman method were used for statistical analysis.

RESULTS

Overall IQ score of REACT-CMRA was higher compared to first-pass-CMRA (3.5 ± 0.4 vs. 2.7 ± 0.4, P < 0.001) and did not differ from steady-state-CMRA (3.5 ± 0.4 vs. 3.5 ± 0.6, P = 0.99). Non-diagnostic IQ of the defined vessels of interest was observed less frequently on REACT-CMRA (1.7 %) compared to steady-state- (4.3 %, P = 0.046) or first-pass-CMRA (20.9 %, P < 0.001). Close agreements in vessel diameter measurements were observed between REACT-CMRA and steady-state-CMRA (e.g. ascending aorta, bias: 0.38 ± 1.0 mm, 95 % limits of agreement (LOA): - 1.62-2.38 mm). REACT-CMRA showed high intra- (bias: 0.04 ± 1.0 mm, 95 % LOA: - 1.9-2.0 mm) and interobserver (bias: 0.20 ± 1.1 mm, 95 % LOA: - 2.0-2.4 mm) agreements regarding vessel diameter measurements. Fat-water separation artifacts were observed in 11/70 (16 %) patients on REACT-CMRA but did not limit diagnostic utility. Six vascular abnormalities were detected on REACT-CMRA that were not seen on standard contrast-enhanced CMRA.

CONCLUSIONS

Non-contrast-enhanced cardiac-gated REACT-CMRA offers a high diagnostic quality for assessment of the thoracic vasculature in CHD patients.

背景

评估一种基于磁化准备 Dixon 法（无对比剂和触发的弛豫增强血管造影术，REACT）的非对比呼吸和心电图门控 3D 心血管磁共振血管造影（CMRA），用于评估先天性心脏病（CHD）患者的胸血管。

方法

在这项单中心研究中，回顾性地确定了 70 名 CHD 患者（平均年龄 28 岁，范围：10-65 岁）。应用呼吸和心脏门控进行 REACT-CMRA。比较 REACT-CMRA 的图像质量（IQ）与标准非门控多期首过 CMRA 和呼吸及心电图门控稳态 CMRA。两名读者分别对感兴趣的不同血管（升主动脉、左肺动脉、左上肺静脉、右冠状动脉口、冠状窦）的 IQ 进行五分制 Likert 评分评估。在预定的解剖学标志（升主动脉、左肺动脉、左上肺静脉）处进行血管直径的测量。两名读者评估了伪影和血管异常。采用 Friedman 检验、卡方检验和 Bland-Altman 法进行统计学分析。

结果

与首过 CMRA（2.7±0.4）相比，REACT-CMRA 的整体 IQ 评分更高（3.5±0.4，P<0.001），与稳态 CMRA（3.5±0.6）无差异（P=0.99）。在 REACT-CMRA 中，定义的感兴趣血管的非诊断性 IQ 发生率较稳态 CMRA（4.3%，P=0.046）或首过 CMRA（20.9%，P<0.001）更低（1.7%）。在 REACT-CMRA 和稳态 CMRA 之间观察到血管直径测量的高度一致性（例如升主动脉，偏差：0.38±1.0mm，95%置信区间（LOA）：-1.62-2.38mm）。REACT-CMRA 在血管直径测量方面具有较高的内（偏差：0.04±1.0mm，95% LOA：-1.9-2.0mm）和观察者间（偏差：0.20±1.1mm，95% LOA：-2.0-2.4mm）一致性。在 11/70（16%）名患者的 REACT-CMRA 上观察到脂肪-水分离伪影，但不限制诊断效用。在 REACT-CMRA 上检测到 6 种标准对比增强 CMRA 未见的血管异常。