Feilcke G, Münster F, Siglow V, Koschyk D H, Spielmann R P, Nienaber C A
Abteilung für Kardiologie, Universitäts-Krankenhauses Hamburg-Eppendorf.
Z Kardiol. 1993 Sep;82(9):585-97.
To evaluate the usefulness of cine-MRI for the quantitative assessment of aortic valve regurgitation, 31 patients (54 +/- 15 years of age; 22 M, 9 F) and 10 normal volunteers underwent a multi-modality imaging protocol comparing cine-MRI with color Doppler echocardiography and contrast aortography. Twenty-one patients had aortic regurgitation with an associated transvalvular gradient, 10 patients had pure valve incompetence. Aortic insufficiency as assessed by the signal void from regurgitant flow on cine-MRI was best analyzed on transversal tomograms. Both the volume of the signal void caused by turbulence above a threshold velocity, and the ratio of the diameters of the regurgitant jet and the outflow tract (dAL-Jet/DLVOT) were found to correlate closely with the (Seller's) angiographic regurgitant score by r = 0.86 each (p < 0.001), and the color Doppler echocardiographic index by r = 0.74 and 0.89, respectively (p < 0.001). Cine-MRI failed to differentiate the angiographic grades I and II, however, clearly separated grades II, III, and IV in contrast to other non-invasive imaging modalities. Moreover, a semiquantitative index derived from cine-MRI allowed a rapid assessment of the severity of regurgitation, similar to color Doppler echocardiography and the semiquantitative angiographic Seller's score. Thus, cine-MRI volumetric evaluation of transvalvular flow turbulences provides a useful and reproducible means to quantify aortic regurgitation. It also allows serial atraumatic investigations as a diagnostic alternative to color Doppler examination in patients less suitable for echocardiographic evaluation and may prove helpful in monitoring the natural course of aortic valve disease.
为评估电影磁共振成像（cine-MRI）在定量评估主动脉瓣反流中的作用，对31例患者（年龄54±15岁；男性22例，女性9例）和10名正常志愿者进行了多模态成像方案，比较cine-MRI与彩色多普勒超声心动图及对比主动脉造影。21例患者有主动脉反流并伴有跨瓣压差，10例患者有单纯瓣膜功能不全。电影磁共振成像上反流血流的信号缺失所评估的主动脉瓣关闭不全，在横断层图像上分析最佳。发现由高于阈值速度的湍流引起的信号缺失体积以及反流束与流出道直径之比（dAL-Jet/DLVOT）与（塞勒氏）血管造影反流评分密切相关，相关系数r均为0.86（p<0.001），与彩色多普勒超声心动图指数的相关系数分别为0.74和0.89（p<0.001）。然而，电影磁共振成像未能区分血管造影I级和II级，但与其他非侵入性成像方式不同，它能清晰区分II级、III级和IV级。此外，源自电影磁共振成像的半定量指数可快速评估反流严重程度，类似于彩色多普勒超声心动图和半定量血管造影塞勒氏评分。因此，电影磁共振成像对跨瓣血流湍流的容积评估为量化主动脉瓣反流提供了一种有用且可重复的方法。它还允许进行系列无创检查，作为对不太适合超声心动图评估的患者进行彩色多普勒检查的诊断替代方法，并且可能有助于监测主动脉瓣疾病的自然病程。
