Dynamic MR Perfusion Imaging: Capability for Quantitative Assessment of Disease Extent and Prediction of Outcome for Patients with Acute Pulmonary Thromboembolism
Dynamic MR Perfusion Imaging: Capability for Quantitative Assessment of Disease Extent and Prediction of Outcome for Patients with Acute Pulmonary Thromboembolism
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DOI：
10.1002/jmri.22146
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发表时间：
2010-05-01
影响因子：
4.4
通讯作者：
Sugimura, Kazuro
中科院分区：
文献类型：
--
作者：
Ohno, Yoshiharu;Koyama, Hisanobu;Sugimura, Kazuro
目的：目的：比较多排螺旋CT（MDCT）和MRI对急性肺血栓栓塞症（APTE）患者病情严重程度的评估和预后预测的价值。肺血流量（PBF），肺血容量和平均通过时间图由灌注MRI生成，并通过使用感兴趣区域测量确定所有节段参数。受试者工作曲线分析用于确定诊断APTE节段的最准确参数。然后计算灌注MRI的APTE指数（PE（perfusion）（MRI）指数）、右心室/左心室（RV/LV）直径比以及MDCT和MR血管造影观察到的栓塞负荷的APTE指数（PE（CT）指数）和PE（MRA）指数。结果：PBF是区分死亡组（n = 8）和生存组（n = 42）的准确性显著高于其他参数（P < 0.05）。在可行阈值范围内，RV/LV直径比值和PE（perfusion）（MRI）指数的特异性和准确性均显著高于PE（CT）和PE（MRA）指数（P < 0.05）。Logistic回归分析显示，各指标均为显著性预测因子（P < 0.05）。结论：动态灌注MRI可有效评估APTE患者的病变程度，并可预测预后。
Purpose: To compare directly the capabilities of multi-detector-row computed tomography (MDCT) and MRI for disease severity assessment and outcome prediction for acute pulmonary thromboembolism (APTE) patients.Materials and Methods: Fifty consecutive APTE patients underwent MDCT, MR angiography, dynamic perfusion MRI, treatment and follow-up examination. Pulmonary blood flow (PBF), pulmonary blood volume, and mean transit time maps were generated from perfusion MRI, and all segmental parameters were determined by using region of interest measurements. Receiver operator curve analyses were used to determine the most accurate parameter for diagnosis of the APTE segment. Then, APTE index from perfusion MRI (PE(perfusion) (MRI) index), right ventricle/left ventricle (RV/LV) diameter ratio and APTE indexes from embolic burdens observed on MDCT (PE(CT) index) and MR angiography (PE(MRA) index) were calculated. Finally, ability to differentiate mortality (n = 8) from survival (n = 42) groups and to predict patient outcome were statistically assessed.Results: PBF was a significantly more accurate parameter than others (P < 0.05). When feasible threshold value was applied, specificity and accuracy of RV/LV diameter ratio and PE(perfusion) (MRI) index were significantly higher than those of PE(CT) and PE(MRA) indexes (P < 0.05). Logistic regression analysis demonstrated that each index was a significant predictor (P < 0.05).Conclusion: Dynamic perfusion MRI can be effective for disease extent assessment and outcome prediction for APTE patients.