三维平衡稳态自由进动磁共振成像序列在儿童冠状动脉异常起源于肺动脉诊断中的应用价值

doi:10.16150/j.1671-2870.2020.02.009

摘要/Abstract

摘要：

目的：评价磁共振成像（magnetic resonance imaging, MRI）三维平衡稳态自由进动（three-dimensional ba-lanced steady state free precession,3D b-SSFP）序列诊断儿童冠状动脉异常起源于肺动脉（anomalous origin of the coronary artery from the pulmonary artery, ACAPA）的应用价值。方法：回顾分析21例ACAPA患儿[平均年龄为（33.67±43.32）个月]的MRI 3D b-SSFP全心成像图像,评估其成像质量。观察者间的图像质量评估通过Kappa系数进行检测,对心率与图像质量之间的关系进行回归分析,同时以手术或数字减影血管造影（digital subtraction angiography,DSA）结果为金标准,评估3D b-SSFP诊断冠状动脉异常起源的准确性。结果：21例患儿的平均心率为（105.85±18.20）次/分;左心室平均舒张末期容积为（79.63±37.46）mL/m²,平均射血分数为（34.28±21.39）%。19例患儿ACAPA为孤立性异常,不伴其他心脏畸形。对比手术及DSA检查结果,21例患儿中有18例3D b-SSFP诊断正确,准确率达85.71%;3例被误诊,其中2例图像边缘模糊无法诊断,1例被误诊为冠状动脉正常起源。10例患者行对比剂延迟增强磁共振成像（late gadolinium-enhanced MRI,LGE-MRI）,8例显示左心室心肌延迟增强异常强化。2名观察者对3D b-SSFP图像质量评分的平均值分别为（2.84±0.82）分和（2.83±0.83）分,观察者间的一致率为81.8%（95%CI为57.0%%~86.6%）。线性回归分析结果显示,2名观察者对血管清晰度的评分与患儿心率间均无相关性,相关系数分别为-0.277和-0.263。结论：3D b-SSFP检查可以准确诊断ACAPA。心脏MRI一站式检查不仅可以显示心脏解剖结构（包括冠状动脉）,同时可以评价心脏功能和心肌组织学特征。

关键词: 磁共振血管成像, 先天性心脏病, 冠状动脉异常起源, 儿童

Abstract:

Objective: To evaluate the value of three-dimensional balanced steady state free precession sequence (3D b-SSFP) magnetic resonance imaging (MRI) sequence in diagnosis of anomalous origin of the coronary artery from the pulmonary artery（ACAPA）. Methods: The whole heart MRI3D b-SSFP performed on 21 children with an age of (33.67±43.32) months was retrospectively analyzed. All the subjects had DSA or surgical operation confirmed ACAPA, and 19 cases were isolated heart abnormality. The imaging quality of 3D b-SSFP was evaluated and inter-observer agreement was validated by the Kappa coefficient. Relationship between heart rate and imaging quality was assessed by regression analysis. The diagnostic accuracy of 3D b-SSFP for ACAPA was assessed by comparison with findings from DSA or surgical operation. Results: The subjective scores on the image quality from two observers were 2.84±0.82 and 2.83±0.83, and inter-observer agreement was 81.8% (95% CI 57.0%-86.6%). The heart rate (HR) of investigated subjects was(105.85±18.20) beat/min, and the left ventricular end diastolic volume and ejection fraction were (79.63±37.46) mL/m² and (34.28±21.39)% respectively. Left ventricular late gadolinium enhancement(LGE) was positive in 8 of 10. Regression analysis showed negative correlations between vessel sharpness and HR in both 2 observers, and correlation coefficients were -0.277 and -0.263, respectively. MRI3D b-SSFP identified ACAPA in 18 out of the 21 cases investigated, yielding a diagnostic accuracy of 85.71%. The MRI imaging of 2 cases was beyond recognition due to blurred edge and 1 case was misdiagnosed as normal. Conclusion: Cardiac MRI displays cardiac anatomy and coronary artery and facilitates evaluation of cardiac function. The 3D b-SSFP is a valuable MRI sequence for diagnosing ACAPA.

Key words: Magnetic resonance imaging, Congenital heart disease, Anomalous origin of the coronary artery, Pediatric

中图分类号:

R543

. 三维平衡稳态自由进动磁共振成像序列在儿童冠状动脉异常起源于肺动脉诊断中的应用价值[J]. 诊断学理论与实践, 2020, 19(02): 145-150.

GU Xiaohong, SUN Aimin, WANG Qian, ZHU Ming, ZHONG Yumin. The three-dimensional balanced steady state free precession magnetic resonance imaging sequence in diagnosis of anomalous origin of the coronary artery from the pulmonary artery in children[J]. Journal of Diagnostics Concepts & Practice, 2020, 19(02): 145-150.

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参考文献 23

[1]	Dodge-Khatami A, Mavroudis C, Backer CL. Anomalous origin of the left coronary artery from the pulmonary artery: collective review of surgical therapy[J]. Ann Thorac Surg, 2002, 74(3):946-955. pmid: 12238882
[2]	Sabaté-Rotés A, Betrián Blasco P, Giralt García G, et al. Casual diagnosis of anomalous origin of the left coronary artery from the pulmonary artery[J]. Int J Cardiol, 2016, 203:120-122. doi: 10.1016/j.ijcard.2015.10.138 pmid: 26512822
[3]	Tangcharoen T, Bell A, Hegde S, et al. Detection of coronary artery anomalies in infants and young children with congenital heart disease by using MR imaging[J]. Radiology, 2011, 259(1):240-247. doi: 10.1148/radiol.10100828 pmid: 21325034
[4]	Uribe S, Hussain T, Valverde I, et al. Congenital heart disease in children: coronary MR angiography during systole and diastole with dual cardiac phase whole-heart imaging[J]. Radiology, 2011, 260(1):232-240. doi: 10.1148/radiol.11101659 URL
[5]	Uribe S, Tangchaoren T, Parish V, et al. Volumetric cardiac quantification by using 3D dual-phase whole-heart MR imaging[J]. Radiology, 2008, 248(2):606-614. doi: 10.1148/radiol.2482071568 URL
[6]	Scheffler K, Lehnhardt S. Principles and applications of balanced SSFP techniques[J]. Eur Radiol, 2003, 13(11):2409-2418. pmid: 12928954
[7]	Jahnke C, Paetsch I, Schnackenburg B, et al. Coronary MR angiography with steady-state free precession: individually adapted breath-hold technique versus free-breathing technique[J]. Radiology, 2004, 232(3):669-676. doi: 10.1148/radiol.2323031225 URL
[8]	Delgado JA, Abad P, Rascovsky S, et al. Assessment of cardiac volumes using an isotropic whole-heart dual cardiac phase sequence in pediatric patients[J]. J Magn Reson Imaging, 2014, 39(3):708-716. doi: 10.1002/jmri.24203 pmid: 23723135
[9]	Younus Z, Iftikhar R, Ahmed I. Anomalous origin of left coronary artery from pulmonary artery(ALCAPA)[J]. J Coll Physicians Surg Pak, 2013, 23(10):743-744.
[10]	Angelini P. Normal and anomalous coronary arteries: definitions and classification[J]. Am Heart J, 1989, 117(2):418-434. pmid: 2644796
[11]	Angelini P, Velasco JA, Flamm S. Coronary anomalies: incidence, pathophysiology, and clinical relevance[J]. Circulation, 2002, 105(20):2449-2454. pmid: 12021235
[12]	Angelini P. Coronary artery anomalies: an entity in search of an identity[J]. Circulation, 2007, 115(10):1296-1305. pmid: 17353457
[13]	Pérez-Pomares JM, de la Pompa JL, Franco D, et al. Congenital coronary artery anomalies: a bridge from embryology to anatomy and pathophysiology--a position statement of the development, anatomy, and pathology ESC Working Group[J]. Cardiovasc Res, 2016, 109(2):204-216. doi: 10.1093/cvr/cvv251 pmid: 26811390
[14]	Mazurak M1, Kusa J. The radiologist's tragedy, or Bland-White-Garland syndrome (BWGS). On the 80(th) anniversary of the first clinical description of ALCAPA (anomalous left coronary artery from the pulmonary artery)[J]. Kardiochir Torakochirurgia Pol, 2014, 11(2):225-229.
[15]	Shriki JE, Shinbane JS, Rashid MA, et al. Identifying, characterizing, and classifying congenital anomalies of the coronary arteries[J]. Radiographics, 2012, 32(2):453-468. doi: 10.1148/rg.322115097 pmid: 22411942
[16]	Peña E, Nguyen ET, Merchant N, et al. ALCAPA syndrome: not just a pediatric disease[J]. Radiographics, 2009, 29(2):553-565. doi: 10.1148/rg.292085059 URL
[17]	Sørensen TS, Körperich H, Greil GF, et al. Operator-independent isotropic three-dimensional magnetic resonance imaging for morphology in congenital heart disea-se: a validation study[J]. Circulation, 2004, 110(2):163-169. pmid: 15210590
[18]	Fenchel M, Greil GF, Martirosian P, et al. Three-dimensional morphological magnetic resonance imaging in infants and children with congenital heart disease[J]. Pedia-tr Radiol. 2006 Dec; 36(12):1265-1272.
[19]	Hussain T, Lossnitzer D, Bellsham-Revell H, et al. Three-dimensional dual-phase whole-heart MR imaging: clinical implications for congenital heart disease[J]. Radiology. 2012 May; 263(2):547-554. doi: 10.1148/radiol.12111700 URL
[20]	Goo HW. Coronary artery imaging in children[J]. Korean J Radiol, 2015, 16(2):239-250. doi: 10.3348/kjr.2015.16.2.239 URL
[21]	Fratz S, Chung T, Greil GF, et al. Guidelines and protocols for cardiovascular magnetic resonance in children and adults with congenital heart disease: SCMR expert consensus group on congenital heart disease[J]. J Cardiovasc Magn Reson, 2013, 15:51. doi: 10.1186/1532-429X-15-51 URL
[22]	Browne LP, Kearney D, Taylor MD, et al. ALCAPA: the role of myocardial viability studies in determining prognosis[J]. Pediatr Radiol, 2010, 40(2):163-167. doi: 10.1007/s00247-009-1412-5 pmid: 19795113
[23]	Secinaro A, Ntsinjana H, Tann O, et al. Cardiovascular magnetic resonance findings in repaired anomalous left coronary artery to pulmonary artery connection(ALCAPA)[J]. J Cardiovasc Magn Reson, 2011, 13:27. doi: 10.1186/1532-429X-13-27 URL

参数	2D cine b-SSFP	3D b-SSFP	CE-MRA	LGE-MRI
TR/TE（ms）	3.5/1.7	4.7/2.4	2.0/1.1	6.1/3.0
翻转角（°）	60	90	35	25
扫描视野（mm）	220~300	260~400	260~400	220~300
层数	12~16	70~90	70~90	10~12
采集像素（mm³）	1.3×1.6×（6~8）	0.5~0.6	1.3×1.3×1.8	1.5×1.5×（6~8）
重建像素（mm³）	1.0×0.9×（6~8）	（0.5~0.6）×（0.5~0.6）×（0.5~0.6）	0.76×0.76×0.9	0.63×0.63×（6~8）
加速因子	2.0	2.0	1.8	无
激励次数	3~4	1	1	1
膈肌导航	无	无	无	无
心电门控	是	是	是	是