疑似慢性血栓栓塞性肺动脉高压患者相位分辨功能肺部 MRI 的多中心标准化。
Multicenter Standardization of Phase-Resolved Functional Lung MRI in Patients With Suspected Chronic Thromboembolic Pulmonary Hypertension.
机构信息
Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.
Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Germany.
出版信息
J Magn Reson Imaging. 2024 Jun;59(6):1953-1964. doi: 10.1002/jmri.28995. Epub 2023 Sep 21.
BACKGROUND
Detection of pulmonary perfusion defects is the recommended approach for diagnosing chronic thromboembolic pulmonary hypertension (CTEPH). This is currently achieved in a clinical setting using scintigraphy. Phase-resolved functional lung (PREFUL) magnetic resonance imaging (MRI) is an alternative technique for evaluating regional ventilation and perfusion without the use of ionizing radiation or contrast media.
PURPOSE
To assess the feasibility and image quality of PREFUL-MRI in a multicenter setting in suspected CTEPH.
STUDY TYPE
This is a prospective cohort sub-study.
POPULATION
Forty-five patients (64 ± 16 years old) with suspected CTEPH from nine study centers.
FIELD STRENGTH/SEQUENCE: 1.5 T and 3 T/2D spoiled gradient echo/bSSFP/T2 HASTE/3D MR angiography (TWIST).
ASSESSMENT
Lung signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were compared between study centers with different MRI machines. The contrast between normally and poorly perfused lung areas was examined on PREFUL images. The perfusion defect percentage calculated using PREFUL-MRI (QDP) was compared to QDP from the established dynamic contrast-enhanced MRI technique (QDP). Furthermore, QDP was compared between a patient subgroup with confirmed CTEPH or chronic thromboembolic disease (CTED) to other clinical subgroups.
STATISTICAL TESTS
t-Test, one-way analysis of variance (ANOVA), Pearson's correlation. Significance level was 5%.
RESULTS
Significant differences in lung SNR and CNR were present between study centers. However, PREFUL perfusion images showed a significant contrast between normally and poorly perfused lung areas (mean delta of normalized perfusion -4.2% SD 3.3) with no differences between study sites (ANOVA: P = 0.065). QDP was significantly correlated with QDP (r = 0.66), and was significantly higher in 18 patients with confirmed CTEPH or CTED (57.9 ± 12.2%) compared to subgroups with other causes of PH or with excluded PH (in total 27 patients with mean ± SD QDP = 33.9 ± 17.2%).
DATA CONCLUSION
PREFUL-MRI could be considered as a non-invasive method for imaging regional lung perfusion in multicenter studies.
LEVEL OF EVIDENCE
3 TECHNICAL EFFICACY: Stage 1.
背景
肺灌注缺陷的检测是诊断慢性血栓栓塞性肺动脉高压（CTEPH）的推荐方法。目前，这是在临床环境中使用闪烁扫描术来实现的。相分辨率功能肺（PREFUL）磁共振成像（MRI）是一种替代技术，可在不使用电离辐射或造影剂的情况下评估区域通气和灌注。
目的
在疑似 CTEPH 的多中心环境中评估 PREFUL-MRI 的可行性和图像质量。
研究类型
这是一项前瞻性队列子研究。
人群
来自九个研究中心的 45 名疑似 CTEPH 的患者（64±16 岁）。
磁场强度/序列：1.5T 和 3T/2D 扰相梯度回波/bSSFP/T2 HASTE/3D MR 血管造影（TWIST）。
评估
比较了具有不同 MRI 机器的研究中心之间的肺信噪比（SNR）和对比噪声比（CNR）。在 PREFUL 图像上检查正常和灌注不良的肺区域之间的对比度。使用 PREFUL-MRI 计算的灌注缺陷百分比（QDP）与使用既定动态对比增强 MRI 技术（QDP）计算的 QDP 进行比较。此外，还比较了 QDP 在确诊 CTEPH 或慢性血栓栓塞性疾病（CTED）的患者亚组与其他临床亚组之间的差异。
统计检验
t 检验，单因素方差分析（ANOVA），Pearson 相关。显著性水平为 5%。
结果
研究中心之间的肺 SNR 和 CNR 存在显著差异。然而，PREFUL 灌注图像显示正常和灌注不良的肺区域之间存在显著的对比度（归一化灌注的平均差值为-4.2%，SD 为 3.3），且各研究点之间无差异（ANOVA：P=0.065）。QDP 与 QDP 呈显著相关（r=0.66），在 18 例确诊为 CTEPH 或 CTED 的患者中明显更高（57.9±12.2%），而在其他原因引起的 PH 或排除 PH 的亚组中（共有 27 例患者的平均 QDP±SD 为 33.9±17.2%）。
数据结论
PREFUL-MRI 可被视为一种在多中心研究中成像区域性肺灌注的非侵入性方法。
证据水平
3 技术功效：1 级。
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