四维血流技术在主动脉缩窄术后血流动力学定量评估中的研究
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摘要
目的研究四维血流(4D Flow)分析对主动脉缩窄(CoA)术后患儿和正常儿童志愿者血流动力学参数的变化,探讨4D Flow在CoA术后的评估价值。资料与方法回顾性分析上海交通大学医学院附属上海儿童医学中心3例CoA术后患者(研究组),男2例,女1例,年龄(12±4)岁,术后随访时间1～11年;同时选取3名年龄匹配的正常儿童志愿者作为对照组,均为男性,年龄(13±3)岁。通过4D Flow技术计算脉搏波传导速度(PWV)、能量损失(EL)和切应力(WSS)血流动力学参数进行定量评价。采用Bland-Altman方法比较图像定量分析数据的偏差和95%置信区间(95%CI)。结果与对照组比较,研究组狭窄部位远端层面的切应力明显升高,分别为(0.78±0.12)Pa、(0.44±0.11)Pa。研究组的PWV高于对照组,分别为(13.39±6.31)Pa、(5.86±0.62)Pa。在可重复性评价中,PWV、EL、WSS偏差和95%CI较好,偏差分别为1.07、-1.00和-0.04,95%CI分别为-1.99～4.13、-6.54～4.54和-0.18～0.09。结论 4D Flow可用于定量评价CoA术后血流动力学变化。主动脉EL和狭窄段近端的涡流大小有关。狭窄段部位、涡流大小和WSS升高是早期影响CoA术后血管顺应性下降的重要因素之一。
Purpose To study the changes of hemodynamic parameters in children who received coarctation of aorta(CoA) and normal children volunteers by four-dimensional flow(4D Flow) analysis, and to explore the evaluation value of 4D Flow after aortic coarctation. Materials and Methods Three cases of patients after CoA(study group) in Shanghai Jiaotong University School of Medicine Affiliated Shanghai Children's Medical Center, including 2 males and 1 female, aged 12±4, with postoperative follow-up for 1-11 years were retrospectively analyzed; meanwhile, 3 age-matched normal children volunteers were included in the study as a control group, including 3 males, aged 13±3. Quantitative evaluation was performed by calculating hemodynamic parameters of pulse wave velocity(PWV), energy loss(EL) and wall shear stress(WSS) using 4D Flow technique. The Bland-Altman method was used to compare the deviation of quantitative analysis data of image and 95% confidence interval(95% CI). Results Compared with the control group, the shear stress at the distal end of stenosis of the study group was significantly increased, reaching(0.78±0.12) Pa and(0.44±0.11) Pa, respectively. The PWV of the study group was higher than that of the control group, which were(13.39±6.31) Pa and(5.86±0.62) Pa, respectively. In the repeatability evaluation, PWV, EL, WSS deviation and 95% CI displayed relatively good performance, with the deviations being 1.07,-1.00 and-0.04, respectively, and 95% CI-1.99-4.13,-6.54-4.54 and-0.18-0.09, respectively. Conclusion 4D Flow can be used to quantitatively evaluate hemodynamic changes after CoA. The aortic EL is related to the size of vortex at the proximal end of stenosis. The location of stenosis, the size of vortex and the increase of WSS serve as one of the key factors that affect the decline of vascular compliance after CoA in the early stage.
Purpose To study the changes of hemodynamic parameters in children who received coarctation of aorta(CoA) and normal children volunteers by four-dimensional flow(4D Flow) analysis, and to explore the evaluation value of 4D Flow after aortic coarctation. Materials and Methods Three cases of patients after CoA(study group) in Shanghai Jiaotong University School of Medicine Affiliated Shanghai Children's Medical Center, including 2 males and 1 female, aged 12±4, with postoperative follow-up for 1-11 years were retrospectively analyzed; meanwhile, 3 age-matched normal children volunteers were included in the study as a control group, including 3 males, aged 13±3. Quantitative evaluation was performed by calculating hemodynamic parameters of pulse wave velocity(PWV), energy loss(EL) and wall shear stress(WSS) using 4D Flow technique. The Bland-Altman method was used to compare the deviation of quantitative analysis data of image and 95% confidence interval(95% CI). Results Compared with the control group, the shear stress at the distal end of stenosis of the study group was significantly increased, reaching(0.78±0.12) Pa and(0.44±0.11) Pa, respectively. The PWV of the study group was higher than that of the control group, which were(13.39±6.31) Pa and(5.86±0.62) Pa, respectively. In the repeatability evaluation, PWV, EL, WSS deviation and 95% CI displayed relatively good performance, with the deviations being 1.07,-1.00 and-0.04, respectively, and 95% CI-1.99-4.13,-6.54-4.54 and-0.18-0.09, respectively. Conclusion 4D Flow can be used to quantitatively evaluate hemodynamic changes after CoA. The aortic EL is related to the size of vortex at the proximal end of stenosis. The location of stenosis, the size of vortex and the increase of WSS serve as one of the key factors that affect the decline of vascular compliance after CoA in the early stage.
引文
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[14]马珂,岳云龙,周赜辰,等.利用4D-Flow技术定量分析肺动脉血流和相对压力的可重复性研究.中国医学影像学杂志,2016,24(3):215-217,222.
[15]Rerkpattanapipat P,Hundley WG,Link KM,et al.Relation of aortic distensibility determined by magnetic resonance imaging in patients>or=60 years of age to systolic heart failure and exercise capacity.Am J Cardiol,2002,90(11):1221-1225.
[2]Roifman I,Therrien J,Ionescu-Ittu R,et al.Coarctation of the aorta and coronary artery disease:fact or fiction?Circulation,2011,57(14):16-21.
[3]Marshall AC,Perry SB,Keane JF,et al.Early results and medium-term follow-up of stent implantation for mild residual or recurrent aortic coarctation.Am Heart J,2000,139(6):1054-1060.
[4]Hager A,Kanz S,Kaemmerer H,et al.Coarctation long-term assessment(COALA):significance of arterial hypertension in a cohort of 404 patients up to 27 years after surgical repair of isolated coarctation of the aorta,even in the absence of restenosis and prosthetic material.J Thorac Cardiovasc Surg,2007,134(3):738-745.
[5]姚琼,胡喜红,沈全力,等.主动脉缩窄术后磁共振脉搏波传导速度法评估主动脉顺应性.实用放射学杂志,2017,33(10):1584-1587.
[6]Stankovic Z,Allen BD,Garcia J,et al.4D flow imaging with MRI.Cardiovasc Diagn Ther,2014,4(2):173-192.
[7]胡立伟,钟玉敏.4D Flow在儿童先天性心脏病诊断中的应用.中国医学影像技术,2018,34(3):460-463.
[8]Dyverfeldt P,Ebbers T,Lanne T.Pulse wave velocity with4D flow MRI:systematic differences and age-related regional vascular stiffness.Magn Reson Imaging,2014,32(10):1266-1271.
[9]Brown ML,Burkhart HM,Connolly HM,et al.Coarctation of the aorta lifelong surveillance is mandatory following surgical repair.J Am Coll Cardiol,2013,62(11):1020-1025.
[10]Dyverfeldt P,Bissell M,Barker AJ,et al.4D flow cardiovascular magnetic resonance consensus statement.JCardiovasc Magn Reson,2015,17(1):72.
[11]Wentland AL,Wieben O,Fran?ois CJ,et al.Aortic pulse wave velocity measurements with under sampled 4D Flowsensitive MRI:comparison with 2D and algorithm determination.J Magn Reson Imaging,2013,37(4):853-859.
[12]Boese JM,Bock M,Schoenberg SO,et al.Estimation of aortic compliance using magnetic resonance pulse wave velocity measurement.Phys Med Biol,2000,45(6):1703-1713.
[13]陈宇,张宇,周赜辰,等.颅内动脉瘤4D Flow MRI与CFD血流动力学参数测量的对比研究.磁共振成像,2016,7(8):613-617.
[14]马珂,岳云龙,周赜辰,等.利用4D-Flow技术定量分析肺动脉血流和相对压力的可重复性研究.中国医学影像学杂志,2016,24(3):215-217,222.
[15]Rerkpattanapipat P,Hundley WG,Link KM,et al.Relation of aortic distensibility determined by magnetic resonance imaging in patients>or=60 years of age to systolic heart failure and exercise capacity.Am J Cardiol,2002,90(11):1221-1225.