Yoshida Takegawa, Chen Joseph J, Zhou Bill, Finn J Paul, Hu Peng, Nguyen Kim-Lien
Diagnostic Cardiovascular Imaging Research Laboratory, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA.
Division of Cardiology, David Geffen School of Medicine at University of California, Los Angeles and Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
Quant Imaging Med Surg. 2022 Sep;12(9):4377-4389. doi: 10.21037/qims-21-1243.
Quantitative ventricular volumetry and function are important in the management of congenital heart disease (CHD). Ferumoxytol-enhanced (FE) 4D multiphase, steady state imaging with contrast enhancement (MUSIC) enables high-resolution, 3D cardiac phase-resolved magnetic resonance imaging (MRI) of the beating heart and extracardiac vessels in a single acquisition and without concerns about renal impairment. We aim to evaluate the semi-automatic quantification of ventricular volumetry and function of 4D MUSIC MRI using 2D and 3D software platforms.
This HIPAA-compliant and IRB-approved study prospectively recruited 50 children with CHD (3 days to 18 years) who underwent 4D MUSIC MRI at 3.0T between 2013-2017 for clinical indications. Each patient was either intubated in the neonatal intensive care unit (NICU) or underwent general anesthesia at MRI suite. For 2D analysis, we reformatted MUSIC images in Digital Imaging and Communications in Medicine (DICOM) format into ventricular short-axis slices with zero interslice gap. For 3D analysis, we imported DICOMs into a commercially available 3D software platform. Using semi-automatic thresholding, we quantified biventricular volume and ejection fraction (EF). We assessed the bias between MUSIC-derived 2D 3D measurements and correlation between MUSIC . conventional 2D balanced steady-state free precession (bSSFP) cine images. We evaluated intra- and inter-observer agreement.
There was a high degree of correlation between MUSIC-derived volumetric and functional measurements using 2D 3D software (r=0.99, P<0.001). Volumes derived using 3D software platforms were larger than 2D by 0.2 to 2.0 mL/m whereas EF measurements were higher by 1.2-3.0%. MUSIC volumetric and functional measures derived from 2D and 3D software platforms corresponded highly with those derived from multi-slice SSFP cine images (r=0.99, P<0.001). The mean difference in volume for reformatted 4D MUSIC relative to bSSFP cine was 1.5 to 3.9 mL/m. Intra- and inter-observer reliability was excellent.
Accurate and reliable ventricular volumetry and function can be derived from FE 4D MUSIC MRI studies using commercially available 2D and 3D software platforms. If fully validated in multicenter studies, the FE 4D-MUSIC pulse sequence may supercede conventional multislice 2D cine cardiovascular MRI acquisition protocols for functional evaluation of children with complex CHD.
定量心室容积测定和功能评估在先天性心脏病（CHD）的管理中具有重要意义。铁羧麦芽糖增强（FE）4D多期、对比增强稳态成像（MUSIC）能够在单次采集中对跳动的心脏和心外血管进行高分辨率、3D心脏相位分辨磁共振成像（MRI），且无需担心肾功能损害。我们旨在使用2D和3D软件平台评估4D MUSIC MRI心室容积测定和功能的半自动定量分析。
这项符合HIPAA法规且经机构审查委员会（IRB）批准的研究前瞻性招募了50例CHD患儿（年龄3天至18岁），他们在2013年至2017年间因临床指征在3.0T磁场下接受了4D MUSIC MRI检查。每位患者要么在新生儿重症监护病房（NICU）插管，要么在MRI检查室接受全身麻醉。对于2D分析，我们将医学数字成像和通信（DICOM）格式的MUSIC图像重新格式化为心室短轴切片，层间间隙为零。对于3D分析，我们将DICOM图像导入商用3D软件平台。使用半自动阈值法，我们对双心室容积和射血分数（EF）进行了定量分析。我们评估了MUSIC衍生的2D和3D测量值之间的偏差以及MUSIC与传统2D平衡稳态自由进动（bSSFP）电影图像之间的相关性。我们评估了观察者内和观察者间的一致性。
使用2D和3D软件进行的MUSIC衍生的容积和功能测量之间存在高度相关性（r = 0.99，P < 0.001）。使用3D软件平台得出的容积比2D测量值大0.2至2.0 mL/m，而EF测量值高1.2 - 3.0%。从2D和3D软件平台获得的MUSIC容积和功能测量值与多层SSFP电影图像得出的测量值高度相关（r = 0.99，P < 0.001）。重新格式化的4D MUSIC相对于bSSFP电影图像的平均容积差异为1.5至3.9 mL/m。观察者内和观察者间的可靠性极佳。
使用商用2D和3D软件平台，可从FE 4D MUSIC MRI研究中准确可靠地得出心室容积测定和功能结果。如果在多中心研究中得到充分验证，FE 4D - MUSIC脉冲序列可能会取代传统的多层2D电影心血管MRI采集方案，用于复杂CHD患儿的功能评估。
