对比 Ferumoxytol 和钆对比剂对先天性心脏病的小患儿 4D 血流心血管磁共振测量的影响。
Impact of ferumoxytol vs gadolinium on 4D flow cardiovascular magnetic resonance measurements in small children with congenital heart disease.
机构信息
Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA.
Division of Pediatric Cardiology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA.
出版信息
J Cardiovasc Magn Reson. 2022 Nov 10;24(1):58. doi: 10.1186/s12968-022-00886-w.
BACKGROUND
Cardiovascular magnetic resonance (CMR) allows for time-resolved three-dimensional phase-contrast (4D Flow) analysis of congenital heart disease (CHD). Higher spatial resolution in small infants requires thinner slices, which can degrade the signal. Particularly in infants, the choice of contrast agent (ferumoxytol vs. gadolinium) may influence 4D Flow CMR accuracy. Thus, we investigated the accuracy of 4D Flow CMR measurements compared to gold standard 2D flow phase contrast (PC) measurements in ferumoxytol vs. gadolinium-enhanced CMR of small CHD patients with shunt lesions.
METHODS
This was a retrospective study consisting of CMR studies from complex CHD patients less than 20 kg who had ferumoxytol or gadolinium-enhanced 4D Flow and standard two-dimensional phase contrast (2D-PC) flow collected. 4D Flow clinical software (Arterys) was used to measure flow in great vessels, systemic veins, and pulmonary veins. 4D Flow accuracy was defined as percent difference or correlation against conventional measurements (2D-PC) from the same vessels. Subgroup analysis was performed on two-ventricular vs single-ventricular CHD, arterial vs venous flow, as well as low flows (defined as < 1.5 L/min) in 1V CHD.
RESULTS
Twenty-one ferumoxytol-enhanced and 23 gadolinium-enhanced CMR studies were included, with no difference in age (2.1 ± 1.6 vs. 2.3 ± 1.9 years, p = 0.70), patient body surface area (0.50 ± 0.2 vs. 0.52 ± 0.2 m, p = 0.67), or vessel diameter (11.4 ± 5.2 vs. 12.4 ± 5.6 mm, p = 0.22). Ten CMR studies with single ventricular CHD were included. Overall, ferumoxytol-enhanced 4D flow CMR measurements demonstrated less percent difference to 2D-PC when compared to gadolinium-enhanced 4D Flow CMR studies. In subgroup analyses of arterial vs. venous flows (high velocity vs. low velocity) and low flow in single ventricle CHD, ferumoxytol-enhanced 4D Flow CMR measurements had stronger correlation to 2D-PC CMR. The contrast-to-noise ratio (CNR) in ferumoxytol-enhanced studies was higher than the CNR in gadolinium-enhanced studies.
CONCLUSIONS
Ferumoxytol-enhanced 4D Flow CMR has improved accuracy when compared to gadolinium 4D Flow CMR, particularly for infants with small vessels in CHD.
背景
心血管磁共振（CMR）允许对先天性心脏病（CHD）进行时间分辨的三维相位对比（4D Flow）分析。在小婴儿中提高空间分辨率需要更薄的切片，这会降低信号。特别是在婴儿中，对比剂（ferumoxytol 与钆）的选择可能会影响 4D Flow CMR 的准确性。因此，我们研究了在分流病变的小 CHD 患者中，ferumoxytol 与 gadolinium 增强的 4D Flow CMR 与金标准 2D 流相位对比（PC）测量相比，4D Flow CMR 测量的准确性。
方法
这是一项回顾性研究，包括体重小于 20kg 的复杂 CHD 患者的 CMR 研究，这些患者接受了 ferumoxytol 或 gadolinium 增强的 4D Flow 和标准二维相位对比（2D-PC）流量采集。使用 4D Flow 临床软件（Arterys）测量大血管、体循环静脉和肺静脉的流量。4D Flow 准确性的定义为与同一血管的常规测量（2D-PC）的百分比差异或相关性。对双心室 CHD 与单心室 CHD、动脉与静脉血流以及单心室 CHD 中的低流量（定义为 <1.5L/min）进行了亚组分析。
结果
纳入了 21 例 ferumoxytol 增强和 23 例 gadolinium 增强的 CMR 研究，两组患者的年龄（2.1±1.6 岁与 2.3±1.9 岁，p=0.70）、患者体表面积（0.50±0.2m2 与 0.52±0.2m2，p=0.67）或血管直径（11.4±5.2mm 与 12.4±5.6mm，p=0.22）无差异。纳入了 10 例单心室 CHD 的 CMR 研究。总体而言，与 gadolinium 增强的 4D Flow CMR 研究相比，ferumoxytol 增强的 4D Flow CMR 测量值与 2D-PC 的百分比差异较小。在单心室 CHD 的动脉与静脉血流（高速与低速）和低流量亚组分析中，ferumoxytol 增强的 4D Flow CMR 测量值与 2D-PC CMR 的相关性更强。ferumoxytol 增强研究的对比噪声比（CNR）高于 gadolinium 增强研究。
结论
与 gadolinium 4D Flow CMR 相比，ferumoxytol 增强的 4D Flow CMR 的准确性更高，特别是对于 CHD 中血管较小的婴儿。
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