磁共振成像在法洛四联症术后随访中的应用价值

Application of magnetic resonance imaging in follow-up after surgery for tetralogy of Fallot

目的评价磁共振成像(MRI)在法洛四联症(TOF)术后随访中的应用价值。方法在71例TOF根治术后患者的随访中应用MRI进行检查,扫描序列包括真稳态进动快速成像序列(FIESTA)、相位对比技术(PCMR)和血管增强(CE-MRA)。结果 71例患者中,CE-MRA诊断肺动脉分支狭窄44例(62.0%),其中左肺动脉狭窄29例(40.8%),右肺动脉狭窄4例(5.6%),同时伴有左肺动脉和右肺动脉狭窄11例(15.5%)。FIESTA序列测得右心室舒张末期容积为(115.28±15.18)mL/m2。38例应用PCMR法测量肺动脉血流的患者均存在肺动脉瓣反流,反流分数为(42.12±16.30)%,其中14例(36.8%)肺动脉重度反流(反流分数>40%);在无肺动脉分支狭窄患者中,左肺动脉的反流分数明显高于右肺动脉[(57.70±21.99)%vs(30.32±13.44)%](P<0.01)。33例患者的二尖瓣和三尖瓣血流测量应用PCMR法,结果有18例(54.5%)存在三尖瓣开放延迟于二尖瓣;但三尖瓣开放延迟和无三尖瓣开放延迟患者中,在肺动脉瓣反流分数、右心室舒张末期容积和射血分数上差异均无统计学意义(P>0.05)。结论左肺动脉狭窄、肺动脉瓣反流和右心室扩大是TOF术后常见的并发症。MRI不仅可准确诊断TOF术后残余解剖畸形,还能提供全面的心功能及血流动力学信息,重复性好,是TOF术后随访中理想的影像学诊断方法。

In recent years,with the rapid development of medical imaging in techniques and equipment,more imaging diagnostic methods have been available to the diagnosis of congenital heart disease,especially complicated congenital heart disease.The commonly used imaging diagnostic methods in clinics are digital subtraction angiography(DSA),echocardiography(Echo),multi-slice spiral CT(MSCT) and magnetic resonance imaging(MRI).MRI can evaluate both anatomy and function of congenital heart disease,and has been extensively applied in clinics.This review introduces the application of MRI in the diagnosis of congenital heart disease.