法洛四联症矫正术后肺动脉血流动力学的四维血流MRI定量研究  

Four-dimensional flow MRI quantification study of the pulmonary artery hemodynamics in patients with repaired tetralogy of Fallot

作　　者：徐晶 喻诗琴 尹刚[1] 李守军[3] 赵世华[4] 陆敏杰[1] Xu Jing;Yu Shiqin;Yin Gang;Li Shoujun;Zhao Shihua;Lu Minjie(Key Laboratory of Cardiovascular Imaging,Chinese Academy of Medical Sciences,Department of Magnetic Resonance Imaging,Peking Union Medical College&Chinese Academy of Medical Sciences,Fuwai Hospital,National Center for Cardiovascular Diseases,Beijing 100037,China;Department of Radiology,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Cardiovascular Surgery,Peking Union Medical College&Chinese Academy of Medical Sciences,Fuwai Hospital,National Center for Cardiovascular Diseases,Beijing 100037,China;Department of Magnetic Resonance Imaging,Peking Union Medical College&Chinese Academy of Medical Sciences,Fuwai Hospital,National Center for Cardiovascular Diseases,Beijing 100037,China)

机构地区：[1]国家心血管病中心、北京协和医学院、中国医学科学院阜外医院磁共振影像科、中国医学科学院心血管影像重点实验室,北京100037 [2]四川大学华西医院放射科,成都610041 [3]国家心血管病中心、北京协和医学院、中国医学科学院阜外医院心脏外科,北京100037 [4]国家心血管病中心、北京协和医学院、中国医学科学院阜外医院磁共振影像科,北京100037

出　　处：《中华放射学杂志》2025年第3期277-285,共9页Chinese Journal of Radiology

基　　金：中央高水平医院临床科研业务费(2022-GSP-QZ-5);北京市自然科学基金(7254406,7242110);北京协和医学院2023年度本科教育教学改革项目(2023zlgl 026);中国医学科学院医学与健康科技创新工程项目(2022-I2M-C&T-B-052)。

摘　　要：目的使用四维血流(4D Flow)MRI技术综合评估法洛四联症矫正术后(rTOF)肺动脉内血流动力学的改变,并探讨黏性能量损失(EL)作为rTOF患者右心评估参数的应用价值。方法前瞻性纳入2017年10月至2019年11月就诊于阜外医院的30例rTOF患者,并于2023年3月前瞻性招募19例健康志愿者,入组受试者均接受4D Flow MRI综合评估。两组间对比指标包括右心室流出道(RVOT)、主肺动脉(MPA)、右肺动脉(RPA)及左肺动脉(LPA)共4个平面的定量血流分析、壁剪切力(WSS)及EL评估,并将EL与传统右心功能参数及WSS进行相关性分析。结果rTOF患者右心功能普遍降低,右心室射血分数为41.42(35.85,43.33)%。与健康对照组相比,rTOF患者在RVOT、MPA、RPA、LPA等4个平面的反向血流量、峰值流速及轴向、周向WSS显著增加(P均<0.05)。健康对照组血液流经肺动脉时EL极低,MPA-RPA和MPA-LPA段在心动周期内的最大EL分别为0.51(0.42,0.73)和0.68(0.40,0.94)mW,而rTOF患者则高达63.63(35.35,82.15)和56.41(34.96,88.76)mW。各段EL与右心室射血分数呈显著中度负相关,与右心室容积指数、各段反流分数、峰值流速呈中至高度正相关(P均<0.05);EL与轴向、周向WSS也存在显著正相关,在MPA处与WSS的相关系数可达0.67~0.88(P均<0.05)。结论rTOF患者肺动脉内的血流异常普遍存在且不容轻视,带来的大量EL与传统的右心功能参数及管壁WSS密切相关,EL有望成为rTOF患者右心功能评估的重要指标。ObjectiveTo comprehensively evaluate the changes in pulmonary artery hemodynamics in patients with repaired tetralogy of Fallot(rTOF)using four-dimensional flow(4D Flow)MRI,and to explore the value of viscous energy loss(EL)as an evaluation parameter of the right heart in patients with rTOF.MethodsA total of 30 rTOF patients who were prospectively admitted at Fuwai Hospital between October 2017 and November 2019,and 19 healthy controls who were prospectively recruited on March 2023,were enrolled in this study.All participants underwent a comprehensive 4D Flow MRI evaluation,and indicators of comparison between the two groups including quantitative flow analysis,wall shear stress(WSS)assessment,and EL evaluation in four planes:the right ventricular outflow tract(RVOT),main pulmonary artery(MPA),right pulmonary artery(RPA),and left pulmonary artery(LPA).The correlation between EL and traditional right ventricular(RV)function parameters,as well as WSS,was analyzed.ResultsThe RV function was generally decreased in rTOF patients,with an RV ejection fraction of 41.42(35.85,43.33)%.Compared with healthy controls,the volumes of backward flow,peak velocities,and both axial and circumferential WSS at the RVOT,MPA,RPA,and LPA were significantly increased in rTOF patients(all P<0.05).The EL in the pulmonary artery was extremely low in healthy controls,with the maximum EL values for the MPA-RPA and MPA-LPA segments during cardiac cycle being 0.51(0.42,0.73)and 0.68(0.40,0.94)mW,respectively.However,in rTOF patients,the EL values were as high as 63.63(35.35,82.15)and 56.41(34.96,88.76)mW,respectively.There was a significant moderate negative correlation between EL and RV ejection fraction,and a moderate to high positive correlation between EL with RV volume index,regurgitation fraction,as well as peak velocities(all P<0.05).Additionally,there was a significant positive correlation between EL and axial and circumferential WSS,with the correlation coefficients at MPA ranging from 0.67 to 0.88(all P<0.05).ConclusionsDisordered fl

关 键 词：法洛四联症 磁共振成像 四维血流 黏性能量损失 血流动力学 

分 类 号：R54[医药卫生—心血管疾病]