轻度瓣膜性心脏病的4D流动磁共振成像速度与湍流映射

4D Flow MRI Velocity and Turbulence Mapping in Mild Valvular Heart Disease.

作者信息

Bianchessi Tamara, Trenti Chiara, Carlhäll Carl-Johan, Ebbers Tino, Engvall Jan, Vanky Farkas, Viola Federica, Dyverfeldt Petter

机构信息

Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.

Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.

出版信息

J Magn Reson Imaging. 2025 Aug 20. doi: 10.1002/jmri.70087.

DOI:10.1002/jmri.70087

PMID:40833175

Abstract

BACKGROUND

Valvular heart disease (VHD) commonly leads to the development of turbulent blood flow. Turbulent kinetic energy (TKE), measured with 4D flow MRI, may be a complement to current metrics for early identification of VHD.

PURPOSE

To investigate TKE as a marker of VHD in relation to flow velocity and cardiovascular geometry.

STUDY TYPE

Retrospective observational cross-sectional.

POPULATION

Twenty controls and 106 subjects with VHDs, including mitral regurgitation, aortic regurgitation, pulmonary regurgitation, tricuspid regurgitation, and aortic stenosis.

FIELD STRENGTH/SEQUENCES: Four-dimensional flow MRI using a spoiled gradient-echo phase-contrast sequence with asymmetric 4-point motion encoding at 1.5 or 3 T.

ASSESSMENT

Time-resolved segmentations of the left and right ventricles (LV, RV), atria (LA, RA), and aorta were performed. Total and maximum TKE, maximum and average velocity, and diameters were evaluated in each. Correlations between TKE, velocity, and diameter were assessed, along with group differences between VHD subjects and controls.

STATISTICAL TESTS

Student's t-test, Wilcoxon rank-sum test, chi-squared test, Pearson's correlation, two-way analysis of covariance. A p value < 0.05 was considered significant.

RESULTS

Total and maximum TKE correlated significantly with maximum velocity (r = 0.45-0.76) and averaged velocity (r = 0.22-0.44) and less strongly with diameters for aorta, LV, LA, and RV (r = 0.18-0.37). Compared to controls, total and maximum aortic TKE were significantly higher in aortic stenosis (3.8 vs. 1.6 mJ; 291.7 vs. 133.7 J/m). Maximum LV TKE was significantly elevated in aortic regurgitation (106.6 vs. 91.8 J/m). Total TKE was significantly elevated in LA for mitral regurgitation (1.1 vs. 0.6 mJ), in RA for tricuspid regurgitation (1.6 vs. 0.7 mJ), and in RV for pulmonary regurgitation (1.7 vs. 1.0 mJ).

DATA CONCLUSION

TKE is elevated in mild VHD. When evaluated alongside velocity as a marker for VHD, TKE may be more discriminative. Consequently, it has potential to be a hemodynamic marker of early VHD conveying complementary information to velocity.

EVIDENCE LEVEL

TECHNICAL EFFICACY

Stage 1.

摘要

背景

心脏瓣膜病（VHD）通常会导致血流紊乱。用四维血流磁共振成像（4D flow MRI）测量的湍流动能（TKE）可能是当前用于早期识别VHD指标的一种补充。

目的

研究TKE作为VHD的一个标志物与流速和心血管几何结构的关系。

研究类型

回顾性观察性横断面研究。

研究对象

20名对照者和106名患有VHD的受试者，包括二尖瓣反流、主动脉瓣反流、肺动脉瓣反流、三尖瓣反流和主动脉瓣狭窄患者。

场强/序列：使用扰相梯度回波相位对比序列和非对称4点运动编码的1.5或3T四维血流MRI。

评估

对左、右心室（LV、RV）、心房（LA、RA）和主动脉进行时间分辨分割。评估每个区域的总TKE和最大TKE、最大流速和平均流速以及直径。评估TKE、流速和直径之间的相关性，以及VHD受试者与对照者之间的组间差异。

统计检验

学生t检验、Wilcoxon秩和检验、卡方检验、Pearson相关性检验、双向协方差分析。p值<0.05被认为具有统计学意义。

结果

总TKE和最大TKE与最大流速（r = 0.45 - 0.76）和平均流速（r = 0.22 - 0.44）显著相关，与主动脉、左心室、左心房和右心室的直径相关性较弱（r = 0.18 - 0.37）。与对照组相比，主动脉瓣狭窄患者的主动脉总TKE和最大TKE显著更高（3.8 vs. 1.6 mJ；291.7 vs. 133.7 J/m）。主动脉瓣反流患者的左心室最大TKE显著升高（106.6 vs. 91.8 J/m）。二尖瓣反流患者左心房的总TKE显著升高（1.1 vs. 0.6 mJ），三尖瓣反流患者右心房的总TKE显著升高（1.6 vs. 0.7 mJ），肺动脉瓣反流患者右心室的总TKE显著升高（1.7 vs. 1.0 mJ）。