Parametric Hemodynamic 4D Flow MRI Maps for the Characterization of Chronic Thoracic Descending Aortic Dissection
Parametric Hemodynamic 4D Flow MRI Maps for the Characterization of Chronic Thoracic Descending Aortic Dissection
复制标题
用于慢性胸降主动脉夹层特征描述的参数化血流动力学四维流动磁共振成像图谱
DOI：
10.1002/jmri.26986
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发表时间：
2019-11-12
影响因子：
4.4
通讯作者：
Markl, Michael
中科院分区：
文献类型：
--
作者：
Jarvis, Kelly;Pruijssen, Judith T.;Markl, Michael
背景需要系统评价真腔和假腔（TL，FL）中的复杂血流，以更好地了解慢性降主动脉夹层（DAD）患者易发生并发症。目的应用4D Flow MRI建立定量血流动力学图，评价TL和FL血流特征。研究类型回顾性。总体而言，纳入了20例DAD患者（年龄= 60 +/- 11岁; 12例男性）（6例经药物治疗的B型AD [TBAD]，14例经修复的A型AD [rTAAD]，目前接受升主动脉移植物[AAO]或象鼻[ET 1]修复）和21例年龄匹配的对照组（年龄= 59 +/- 10岁; 13例男性）。场强/序列1.5T、3 T、4D Flow MRI。评估所有受试者的4D flow MRI。数据分析包括TL和FL的3D分割和正向流动、反向流动、流动停滞和动能的体素计算作为定量血流动力学图。进行方差分析（ANOVA）或Kruskal-Wallis检验以比较受试者组。对观察者间研究进行相关性和Bland-Altman分析。结果与对照组相比，rTAAD患者的TL反向血流增加（AAO修复：P = 0.004，ET 1：P = 0.018），TL动能增加（AAO修复：P = 0.0002，ET 1：P = 0.011）。此外，与TBAD患者相比，TL动能增加（AAo修复：P = 0.021，ET 1：P = 0.048）。与TBAD患者相比，rTAAD与较高的FL动能和较低的FL停滞相关（分别为AAo修复：P = 0.002，ET 1：P = 0.024和Ao修复：P = 0.003，ET 1：P = 0.048）。数据结论4Dflow MRI定量图显示了DAD患者与对照组之间的整体和局部血流动力学差异。rTAAD与TBAD患者的局部TL和FL血流动力学显著改变。这些发现表明，4D血流MRI衍生的血流动力学图有助于更好地评价DAD患者。证据等级3技术有效性阶段1
Background Systematic evaluation of complex flow in the true lumen and false lumen (TL, FL) is needed to better understand which patients with chronic descending aortic dissection (DAD) are predisposed to complications. Purpose To develop quantitative hemodynamic maps from 4D flow MRI for evaluating TL and FL flow characteristics. Study Type Retrospective. Population In all, 20 DAD patients (age = 60 +/- 11 years; 12 male) (six medically managed type B AD [TBAD], 14 repaired type A AD [rTAAD] now with ascending aortic graft [AAo] or elephant trunk [ET1] repair) and 21 age-matched controls (age = 59 +/- 10 years; 13 male) were included. Field Strength/Sequence 1.5T, 3T, 4D flow MRI. Assessment 4D flow MRI was acquired in all subjects. Data analysis included 3D segmentation of TL and FL and voxelwise calculation of forward flow, reverse flow, flow stasis, and kinetic energy as quantitative hemodynamics maps. Statistical Tests Analysis of variance (ANOVA) or Kruskal-Wallis tests were performed for comparing subject groups. Correlation and Bland-Altman analysis was performed for the interobserver study. Results Patients with rTAAD presented with elevated TL reverse flow (AAo repair: P = 0.004, ET1: P = 0.018) and increased TL kinetic energy (AAo repair: P = 0.0002, ET1: P = 0.011) compared to controls. In addition, TL kinetic energy was increased vs. patients with TBAD (AAo repair: P = 0.021, ET1: P = 0.048). rTAAD was associated with higher FL kinetic energy and lower FL stasis compared to patients with TBAD (AAo repair: P = 0.002, ET1: P = 0.024 and AAo repair: P = 0.003, ET1: P = 0.048, respectively). Data Conclusion Quantitative maps from 4D flow MRI demonstrated global and regional hemodynamic differences between DAD patients and controls. Patients with rTAAD vs. TBAD had significantly altered regional TL and FL hemodynamics. These findings indicate the potential of 4D flow MRI-derived hemodynamic maps to help better evaluate patients with DAD. Level of Evidence 3 Technical Efficacy Stage 1