Gietzen Carsten, Pennig Lenhard, von Stein Jennifer, Guthoff Henning, Weiss Kilian, Gertz Roman, Thürbach Iris, Bunck Alexander C, Maintz David, Baldus Stephan, Ten Freyhaus Henrik, Hohmann Christopher, von Stein Philipp
Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Int J Cardiol. 2023 Nov 1;390:131203. doi: 10.1016/j.ijcard.2023.131203. Epub 2023 Jul 20.
To compare the measurement of aortic diameters using a novel flow-independent MR-Angiography (3D modified Relaxation-Enhanced Angiography without Contrast and Triggering (modified REACT)) and transthoracic echocardiography (TTE) in Marfan syndrome (MFS) patients.
This retrospective, single-center analysis included 46 examinations of 32 MFS patients (mean age 37.5 ± 11.3 years, 17 women, no prior aortic surgery) who received TTE and 3D modified REACT (ECG- and respiratory-triggering, Compressed SENSE factor 9 for acceleration of image acquisition) of the thoracic aorta. Aortic diameters (sinus of Valsalva (SV), sinotubular junction (STJ), and ascending aorta (AoA)) were independently measured by two cardiologists in TTE (leading-edge) and two radiologists in modified REACT (inner-edge, using multiplanar reconstruction). Intraclass correlation coefficient, Bland-Altman analyses, and Pearson's correlation (r) were used to assess agreement between observers and methods.
Interobserver correlation at the SV, STJ, and AoA were excellent for both, TTE (ICC = 0.95-0.98) and modified REACT (ICC = 0.99-1.00). There was no significant difference between TTE and modified REACT for diameters measured at the SV (39.24 ± 3.24 mm vs. 39.63 ± 3.76 mm; p = 0.26; r = 0.78) and the STJ (35.16 ± 4.47 mm vs. 35.37 ± 4.74 mm; p = 0.552; r = 0.87). AoA diameters determined by TTE were larger than in modified REACT (34.29 ± 5.31 mm vs. 30.65 ± 5.64 mm; p < 0.01; r = 0.74). The mean scan time of modified REACT was 05:06 min ± 02:47 min, depending on the patient's breathing frequency and heart rate.
Both TTE and modified REACT showed a strong correlation for all aortic levels; however, at the AoA, diameters were larger using TTE, mostly due to the limited field of view of the latter with measurements being closer to the aortic valve. Given the excellent interobserver correlation and the strong agreement with TTE, modified REACT represents an attractive method to depict the thoracic aorta in MFS patients.
比较使用新型非血流依赖型磁共振血管造影（3D改良无对比剂触发的弛豫增强血管造影（改良REACT））和经胸超声心动图（TTE）测量马方综合征（MFS）患者主动脉直径的情况。
这项回顾性单中心分析纳入了32例MFS患者（平均年龄37.5±11.3岁，17名女性，均未接受过主动脉手术）的46次检查，这些患者接受了TTE和胸部主动脉的3D改良REACT检查（心电图和呼吸触发，使用压缩感知因子9加速图像采集）。两位心脏病专家在TTE中（前沿法）以及两位放射科医生在改良REACT中（内缘法，使用多平面重建）独立测量主动脉直径（主动脉瓣窦（SV）、窦管交界（STJ）和升主动脉（AoA））。组内相关系数、Bland-Altman分析和Pearson相关系数（r）用于评估观察者之间以及两种方法之间的一致性。
TTE（ICC=0.95-0.98）和改良REACT（ICC=0.99-1.00）在SV、STJ和AoA处的观察者间相关性均极佳。在SV处测量的直径，TTE与改良REACT之间无显著差异（39.24±3.24mm对39.63±3.76mm；p=0.26；r=0.78），在STJ处亦无显著差异（35.16±4.47mm对35.37±4.74mm；p=0.552；r=0.87）。TTE测定的AoA直径大于改良REACT测定的直径（34.29±5.31mm对30.65±5.64mm；p<0.01；r=0.74）。改良REACT的平均扫描时间为05:06分钟±02:47分钟，具体取决于患者的呼吸频率和心率。
TTE和改良REACT在所有主动脉水平均显示出很强的相关性；然而，在AoA处，TTE测量的直径更大，这主要是由于TTE视野有限，测量更靠近主动脉瓣。鉴于观察者间相关性极佳且与TTE一致性强，改良REACT是描绘MFS患者胸主动脉的一种有吸引力的方法。
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