CAJ | 학술논문

目的：评价高时间分辨率对比增强MR血管成像(TR-MRA)在儿童先天性心脏病术后随访中的应用价值。方法回顾性分析先天性心脏病术后行心脏TR-MRA扫描患儿73例。73例中29例行常规对比增强MR血管成像（CE-MRA），44例行相位对比法（PC）测量左右肺血流量。TR-MRA和CE-MRA图像选取上腔静脉、下腔静脉、肺静脉、肺动脉和升主动脉，采用5分法进行图像质量评判。通过TR-MRA自动重建图像定性观察左右肺血流灌注情况，并与相位对比法进行比较。图像评分比较采用配对t检验，TR-MRA和相位对比法两种方法评价左右肺血流分布的一致性评判采用Kappa一致性分析。结果73例患儿术后TR-MRA图像评分均在3分以上，无一例影响诊断。29例患儿中下腔静脉CE-MRA评分[（3.77±0.39）分]高于TR-MRA评分[（3.44±0.55）分]，差异具有统计学意义（t=3.68，P=0.01），其余大血管两种成像方法间评分差异均无统计学意义（P值均>0.05)。44例采用相位对比法进行左右肺动脉血流量测定，结果显示左右肺血流分布对称8例、不对称分布36例，而TR-MRA显示两肺血流对称分布6例、非对称分布38例，两种方法对肺血流分布的判断一致性好（Kappa=0.83，P=0.01）。结论 TR-MRA对先天性心脏病术后血管解剖结构特征显示清晰，具有较高的空间分辨率，还能观察到术后残余肺动脉狭窄导致的两肺血流灌注不均衡的功能信息，是先天性心脏病术后心脏MR随访中重要的扫描序列。
목적：평개고시간분변솔대비증강MR혈관성상(TR-MRA)재인동선천성심장병술후수방중적응용개치。방법회고성분석선천성심장병술후행심장TR-MRA소묘환인73례。73례중29례행상규대비증강MR혈관성상（CE-MRA），44례행상위대비법（PC）측량좌우폐혈류량。TR-MRA화CE-MRA도상선취상강정맥、하강정맥、폐정맥、폐동맥화승주동맥，채용5분법진행도상질량평판。통과TR-MRA자동중건도상정성관찰좌우폐혈류관주정황，병여상위대비법진행비교。도상평분비교채용배대t검험，TR-MRA화상위대비법량충방법평개좌우폐혈류분포적일치성평판채용Kappa일치성분석。결과73례환인술후TR-MRA도상평분균재3분이상，무일례영향진단。29례환인중하강정맥CE-MRA평분[（3.77±0.39）분]고우TR-MRA평분[（3.44±0.55）분]，차이구유통계학의의（t=3.68，P=0.01），기여대혈관량충성상방법간평분차이균무통계학의의（P치균>0.05)。44례채용상위대비법진행좌우폐동맥혈류량측정，결과현시좌우폐혈류분포대칭8례、불대칭분포36례，이TR-MRA현시량폐혈류대칭분포6례、비대칭분포38례，량충방법대폐혈류분포적판단일치성호（Kappa=0.83，P=0.01）。결론 TR-MRA대선천성심장병술후혈관해부결구특정현시청석，구유교고적공간분변솔，환능관찰도술후잔여폐동맥협착도치적량폐혈류관주불균형적공능신식，시선천성심장병술후심장MR수방중중요적소묘서렬。
Objective To assess the application value of high time-resolved MR angiography (TR-MRA) in postoperative follow-up study of children with congenital heart diseases. Methods Seventy-three patients (median age 6 years, range 1-20 years) with congenital heart diseases who underwent TR-MRA scan after operation were retrospectively analyzed. Twenty-nine cases also were performed conventional contrast-enhanced MRA and forty-four cases were performed phase-contrast MRA. A 3D T1-weighted fast gradient-echo sequence was used for time-resolved three-dimensional MRA (10-20 dynamic data sets, less than three seconds per dynamic data set). The flow dynamics and morphology of pulmonary circulations, lung perfusion and collaterals flow direction were noted. All imaging quality was evaluated by using 5 scales. Left and right pulmonary artery flow volumes were measured and left and right pulmonary artery ratio was noted. SPSS22.0 was used in statistic analysis. The statistical analysis of comparing imaging quality was performed by using paired t-test. The intermodality agreement between TR-MRA and phase contrast in assessing left and right pulmonary perfusion was tested by Kappa coefficient. Results In 73 cases, imaging scores were over 3 and imaging quality was good enough for diagnosis. In 29 cases, there was no statistic difference between TR-MRA and conventional CE-MRA in demonstrating great vessels (P>0.05) except that CE-MRA scores(3.77 ± 0.39)was higher than TR-MRA scores(3.44 ± 0.55)of <br> inferior vena cava (IVC). There was statistic difference(t=3.68,P=0.01)between two sequences. TR-MRA could qualitatively demonstrate the pulmonary perfusion comparing to the results of PC. In PC sequence, there were 8 cases with symmetric and 36 cases with asymmetric left and right pulmonary perfusion. In TR-MRA sequence, there were 6 cases with symmetric and 38 cases with asymmetric left and right pulmonary perfusion. There was an excellent agreement between PC and TR-MRA (Kappa=0.83,P=0.01). Conclusions TR-MRA not only supplies with high spatial resolution imaging which demonstrates postoperative great arteries anatomy and also with high temporal resolution imaging which can demonstrate the preferential or balanced pulmonary blood flow and collaterals flow direction. TR-MRA is a very important sequence in follow-up study of congenital heart disease.