高分辨弥散加权成像在心房颤动导管消融围术期无症状脑栓塞发生的评估价值

The value of high-resolution diffusion-weighted MRI in the diagnosis of asymptomatic cerebral emboli after atrial fibrillation ablation

目的比较高分辨弥散加权成像(hDWI)和常规DWI(cDWI)检测心房颤动(房颤)导管消融相关无症状性脑栓塞(ACE)的发生率及其特征。方法连续入组2018年11月至2018年12月南京医科大学第一附属医院的32例房颤消融患者,以及上海市东方医院2019年1月至2019年2月的18例房颤消融患者。消融前24 h进行头颅高分辨率DWI检查以除外近期脑栓塞事件,消融后48 h内重复hDWI和cDWI检查。比较同一患者消融术后hDWI与cDWI中ACE的发生率、数量、大小和位置。结果与cDWI相比,hDWI显示急性ACE的发生率更高(70%对42%,P<0.001),ACE病灶数量明显更多(102对42,P<0.001),且hDWI测量的病灶尺寸较大(5.42 mm对4.21 mm,P<0.001)。多因素回归分析显示,左心室射血分数受损(P=0.047)和术中激活凝血时间较低(P=0.003)与ACE发生相关。结论hDWI能够更好地显示房颤消融相关ACE的发病情况及病灶特点。在评估ACE的研究中应考虑磁共振设置。

Objective To compare the incidence and characteristics of atrial fibrillation(AF)ablation-related asymptomatic cerebral emboli(ACE)between high-resolution diffusion-weighted imaging(hDWI)and conventional DWI(cDWI).Methods Thirty eight consecutive AF patients in Jiangsu Province Hospital from November 2018 to December 2018,and 18 consecutive AF patients in Shanghai East Hospital from January 2019 to February 2019 who underwent ablation were recruited.All the patients received hDWI,in order to exclude recent events of cerebral embolism.High-resolution DWI and conventional DWI were performed after ablation within 48 h,and the incidence,number,size,and location of ACE in the same patient were compared.Results High-resolution DWI showed a higher incidence of acute ACE(70%vs.42%,P<0.001),a significantly higher number of ACE lesions(102 vs.42,P<0.001),and a larger ACE size(5.42 mm vs.4.21 mm,P<0.001)compared to cDWI.Multivariate regression analysis revealed that impaired left ventricular ejection fraction(P=0.012)and low intraoperative active clotting time(P=0.009)were associated with the incidence of ACE.Conclusion High-resolution DWI showed higher incidence and greater features of ACE after AF ablation,and MRI settings should be considered in studies evaluating ACE.