Hemodynamic features underlying pulmonary vein stump thrombus formation after left upper lobectomy: four-dimensional flow magnetic resonance imaging study
Hemodynamic features underlying pulmonary vein stump thrombus formation after left upper lobectomy: four-dimensional flow magnetic resonance imaging study
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DOI：
10.21037/qims-21-472
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发表时间：
2021-09-13
影响因子：
2.8
通讯作者：
Sato, Masami
中科院分区：
文献类型：
--
作者：
Umehara, Tadashi;Takumi, Koji;Sato, Masami
背景：我们既往报道左上肺叶切除术后肺静脉残端附近的血流往复现象较其他肺叶切除术尤为突出，这可能是左上肺叶切除术后肺静脉血栓易感性高的原因。本研究的目的是使用四维血流磁共振成像 (4D-MRI) 比较左上肺叶切除术后发生肺静脉血栓的患者与未发生肺静脉血栓的患者的血流动力学。 方法：这是对前瞻性收集的 37 例肺癌左上肺叶切除术后 7 天接受 4D MRI 的患者 (n=37) 的临床和放射学数据库的回顾性评估。我们通过4D MRI获得了两个参数：来回血液运动的等级和肺静脉残端周围的流动能量损失。还测量了肺静脉残端的长度，这是肺静脉血栓的已知危险因素。 结果：根据来回血液运动等级与血流能量损失的散点图，肺静脉血栓患者（n=15）集中在似乎存在“危险”血流动力学状况的区域。在这个“危险”区域，除了一名不幸出现迟发性肺静脉血栓和脑梗塞的患者外，没有肺静脉血栓的患者寥寥无几。我们基于逐步多元回归分析，使用 4D MRI 衍生参数提出了一个公式，该公式与肺静脉血栓的发生比肺静脉残端的长度关系更密切（接受者操作特征曲线下面积：0.918 vs. 0.705，P=0.0500）。结论：我们提出存在导致肺静脉血栓形成的“危险”血流动力学条件。肺静脉血栓形成前的 4D MRI 可能有助于识别需要针对肺静脉血栓和随后的血栓栓塞并发症进行预防性治疗的患者。
Background: We previously reported that to-and-fro blood movement near the pulmonary vein stump was particularly prominent after left upper lobectomy compared with other lobectomy, which may be the cause of the high susceptibility of pulmonary vein thrombus after left upper lobectomy. The aim of the present study was to compare the hemodynamics in patients who developed pulmonary vein thrombus after left upper lobectomy with those in patients who did not develop pulmonary vein thrombus using four-dimensional flow magnetic resonance imaging (4D-MRI).Methods: This was a retrospective evaluation of a prospectively collected clinical and radiological database of 37 patients who underwent 4D MRI 7 days after left upper lobectomy for lung cancer (n=37). We obtained two parameters by 4D MRI: the grade of to-and-fro blood movement and the flow energy loss around the pulmonary vein stump. The length of the pulmonary vein stump, a known risk factor for pulmonary vein thrombus, was also measured.Results: According to a scatterplot of the grade of to-and-fro blood movement versus the flow energy loss, patients with pulmonary vein thrombus (n=15) were concentrated in an area which appears to be a `dangerous' hemodynamic condition. There were few patients without pulmonary vein thrombus in this `dangerous' area, except for one who unfortunately developed delayed pulmonary vein thrombus and cerebral infarction. We proposed a formula using the 4D MRI-derived parameters based on a stepwise multiple regression analysis that was more closely associated with the development of pulmonary vein thrombus than the length of the pulmonary vein stump (area under the receiver operating characteristics curve: 0.918 vs. 0.705, P=0.0500).Conclusions: We proposed the existence of a 'dangerous' hemodynamic condition responsible for pulmonary vein thrombus formation. 4D MRI before the development of pulmonary vein thrombus may help identify patients requiring preventive therapy against pulmonary vein thrombus and subsequent thromboembolic complications.