四维血流定量测量法洛四联症患者矫正术后肺动脉瓣反流的可重复性与一致性研究  

Four-dimensional flow MRI quantification of pulmonary regurgitation in patients with repaired tetralogy of Fallot:a study on reproducibility and consistency

作　　者：喻诗琴 陆敏杰[1] 尹刚[1] 杨新令[1] 崔辰[1] 陈秀玉[1] 赵世华[1] Yu Shiqin;Lu Minjie;Yin Gang;Yang Xinling;Cui Chen;Chen Xiuyu;Zhao Shihua(Department of MR,Fuwai Hospital,National Center for Cardiovascular Diseases of China,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院磁共振影像科,100037

出　　处：《中华放射学杂志》2019年第9期761-766,共6页Chinese Journal of Radiology

基　　金：国家自然科学基金(81620108015,81571647);首都临床特色应用研究(Z161100000516110).

摘　　要：目的探究四维血流(4D-Flow)MRI技术定量测量法洛四联症(TOF)矫正术后患者肺动脉瓣反流的可重复性,以及与常规二维血流(2D-Flow)技术、超声心动图的一致性.方法连续纳入2018年5月至8月于我院接受MR检查的TOF矫正术后患者共21例,采用3.0 T MR扫描仪,同时行2D-Flow及4D-Flow序列扫描,通过Circle CVI42工作站后处理分析图像,获得肺动脉瓣血流数据.所有患者于1周内行常规二维和多普勒超声心动图检查.采用组内相关系数及Bland-Altman分析比较4D-Flow与2D-Flow的可重复性及一致性,MR与超声心动图测量肺动脉瓣反流结果的一致性采用加权Kappa系数分析.采用Pearson相关分析探究反流分数与心功能的关系.结果纳入患者全部成功完成MR及超声检查.同一医师多次通过4D-Flow所测得的肺动脉前向血流体积、反向血流体积、反流分数ICC值分别为0.996、0.997、0.985(P值均<0.001),具有良好的一致性;不同医师通过4D-Flow测量同一患者肺动脉前向血流体积、反向血流体积、反流分数的ICC值分别为0.993、0.994、0.968(P值均<0.001),一致性较好.2D-Flow与4D-Flow测量前向血流体积、反向血流体积及反流分数一致性较好,ICC值分别为0.954、0.913、0.721(P值均<0.001).2D-Flow与4D-Flow所测得的反流分数转换为半定量结果后与超声检查结果比较均具有良好的一致性,加权Kappa系数分别为0.897(P<0.001)、0.710 (P=0.001).2D-Flow所测得反流分数与心功能参数的分析结果示右心室心指数(RVCI)、右心室舒张末期容量指数(RVEDVi)、右心室收缩末期容量指数(RVESVi)、左心室舒张末期容量指数(LVEDVi)、左心室收缩末期容量指数(LVESVi)均与反流分数存在较强的正相关关系,r值分别为0.600、0.788、0.683、0.578、0.687(P值均<0.05).4D-Flow所测得反流分数与RVCI、RVEDVi、RVESVi、LVEDVi、左心室质量指数均存在较强的正相关关系,r值分别为0.606、0.685、0.534、0.459、0.633(Objective To investigate the feasibility and consistency of four-dimensional flow (4D flow) quantification of pulmonary regurgitation in patients with repaired Tetralogy of Fallot (ToF) by comparing with conventional two-dimensional flow (2D flow) and echocardiography. Methods Both the 4D flow and 2D flow imaging were acquired with repaired ToF (a total of 21 patients) consecutively on 3.0 T MR scanner from May 2018 to August 2018. Pulmonary flow and regurgitant fraction were measured by a commercial post processing software Circle CVI42. All patients underwent echocardiography within one week after or before MR examination. The inter/intra-observer variability by 2D/4D f1ow and agreement between the two methods were investigated by interclass correlation coefficients (ICC) and Bland-Altman analyses. The agreement between MR and echocardiography were analyzed by weighted Kappa coefficient. The correlation between pulmonary regurgitation and cardiac function was also investigated by Pearson analysis. Results All patients were included and completed the examinations successfully. Both inter-observer and intra-observer agreement by 4D flow for total forward volume (ICC=0.993, 0.996, respectively, P<0.001), total backward volume (ICC=0.994, 0.997, respectively, P<0.001) and regurgitant fraction (ICC=0.968, 0.985, respectively, P<0.001) were good. The total forward volume, total backward volume and regurgitant fraction measured by 2D flow and 4D flow reached a good agreement (ICC=0.954, 0.913,0.721,respectively,P<0.001). The consistency was good for severity of regurgitation measured by 2D flow (weighted Kappa=0.897, P<0.001) and 4D flow (weighted Kappa=0.710, P=0.001) compared with echocardiography. Significant correlation was found among right ventricular cardiac index(r=0.600, P<0.05), right ventricular end-diastolic volume index(r=0.788, P<0.05), right ventricular end-systolic volume index(r=0.683, P<0.05) and left ventricular end-diastolic volume index(r=0.578, P<0.05), left ventricular end-systolic volume index(

关 键 词：磁共振成像 肺动脉瓣反流 法洛四联症 

分 类 号：R540.45[医药卫生—心血管疾病] R654.2[医药卫生—内科学]