Department of Cardiovascular Surgery, Nippon Medical School.
Department of Radiology, Nippon Medical School Musashi Kosugi Hospital.
Magn Reson Med Sci. 2022 Mar 1;21(2):327-339. doi: 10.2463/mrms.rev.2021-0046. Epub 2021 Sep 8.
Despite the recent technical developments, surgery on the thoracic aorta remains challenging and is associated with significant mortality and morbidity. Decisions about when and if to operate are based on a balance between surgical risk and the hazard of aortic rupture. These decisions are sometimes difficult in elective cases of thoracic aortic diseases, including aneurysms and dissections. Abnormal wall stress derived from flow alterations influences disease progression. Therefore, a better understanding of the complex hemodynamic environment inside the aortic lumen will facilitate patient-specific risk assessments of complications, which enable clinicians to provide timely prophylactic interventions. Time-resolved 3D phase-contrast (4D flow) MRI has many advantages for the in vivo assessment of flow dynamics. Recent developments in 4D flow imaging techniques has led to significant advances in our understanding of physiological flow dynamics in healthy subjects and patients with thoracic aortic diseases. In this clinically focused review of thoracic aortic diseases, we demonstrate the clinical advances acquired with 4D flow MRI from published studies. We provide a systematic overview of key evidences and considerations regarding normal thoracic aortas, thoracic aortic aneurysms, aortic dissections, and thoracic aortas with prosthetic graft replacement.
尽管最近取得了技术上的进展，但胸主动脉手术仍然具有挑战性，并且与显著的死亡率和发病率相关。是否进行手术的决策取决于手术风险和主动脉破裂的危险之间的平衡。在胸主动脉疾病（包括动脉瘤和夹层）的择期病例中，这些决策有时很困难。血流变化引起的异常壁应力会影响疾病的进展。因此，更好地了解主动脉管腔内复杂的血液动力学环境将有助于对并发症进行患者特异性风险评估，从而使临床医生能够及时进行预防性干预。时相分辨 3D 相位对比（4D 流）MRI 具有许多用于活体评估流动动力学的优势。4D 流成像技术的最新进展使我们对健康受试者和胸主动脉疾病患者的生理流动动力学有了更深入的了解。在本临床重点综述中，我们展示了 4D 流 MRI 在胸主动脉疾病方面的临床进展，这是从已发表的研究中获得的。我们对正常胸主动脉、胸主动脉瘤、主动脉夹层和带有人工移植物置换的胸主动脉的关键证据和考虑因素进行了系统概述。
