心脏MR双时相三维全心成像在儿童冠状动脉评估中的研究

The value of cardiac MR dual-phase 3D whole heart imaging in evaluation of coronary artery in children

目的探讨心脏MR双时相三维平衡稳态自由进动序列全心成像(3D bSSFP)在儿童冠状动脉评估中的价值。方法回顾性收集上海交通大学医学院附属上海儿童医学中心2014年1月至2015年12月间进行心脏MR检查的先心病及川崎病患儿,按照纳入和排除标准共197例患儿纳入研究,其中先心病患儿189例,川崎病患儿8例,冠状动脉异常17例。分析心脏MR 3D bSSFP在显示先心病或川崎病中冠状动脉的图像质量,评估该序列显示冠状动脉的起源、走行及形态,卡方检验分析双时相冠状动脉显示的准确度及差异,配对t检验分析左右冠状动脉主干直径在收缩末期与舒张中晚期的差异。结果图像质量评分整体上收缩期较舒张期高,评分分别为(3.9±0.5)、(3.5±0.7)分,差异具有统计学意义(t=12.49,P<0.001)。该序列结合收缩期及舒张期评估先天性心脏病和川崎病中冠状动脉正常或异常的准确度为100%,但不同时相显示冠状动脉的清晰度不一致,左前降支、回旋支在收缩末期与舒张中晚期的清晰显示率差异有统计学意义(P<0.001)。整体上左右冠状动脉平均直径在收缩期较舒张期大,收缩期和舒张期左冠状动脉主干直径分别为(3.1±1.3)、(2.8±1.3)mm,右冠状动脉主干分别为(2.5±0.9)、(2.3±0.7)mm,差异均有统计学意义(t=4.93、4.02,P<0.001)。结论心脏MR 3D bSSFP可回顾性选择冠状动脉静息期以获得最佳图像,为儿童冠状动脉的评估提供了一种更为可靠的影像学检查方式,以便更好地临床决策。

Objective To investigate the value of whole-heart and volume-targeted balanced steady-state free precession(bSSFP)in the evaluation of coronary artery in children.Methods Children with congenital heart disease and Kawasaki disease who underwent cardiac magnetic resonance imaging were retrospectively collected from January 2014 to December 2015,197 cases(male:female 124∶73)were included according to the inclusion and exclusion criteria in this study.There were 189 cases of congenital heart disease and 8 Kawasaki disease,in which 23 cases had abnormal coronal arteries.Image quality of the coronary artery segments,the coronary artery origin and course,and coronary artery dimension in dual phase 3D bSSFP were analyzed.Chi-square test was used to evaluation the degree of accuracy and difference of coronal artery segments.T test was used to compare the diameter of left with right coronal artery in end systolic phase and mid to end diastolic phase.Results Image quality was better in systolic phase than diastolic phase(3.9±0.5 and 3.5±0.7 respectively,P<0.001)for all cases.Combining the dual phases,the sensitivity,specificity and accuracy of dual phase 3D whole heart imaging in evaluating the coronal artery origin,course and shape was 100%.However,there was a little difference in revealing left anterior descending coronary artery,left circumflex artery and right coronary artery.There was significant difference in the clearly revealing the left anterior descending coronary artery and left circumflex artery(P<0.001).The left and right coronary artery dimension was larger in systolic phase than in mid-diastolic phase(left coronary artery 3.1±1.3 mm and 2.8±1.3 mm,respectively,right coronary artery(2.5±0.9)and(2.3±0.7)mm,respectively,P<0.001).Conclusion Cardiac MR 3D bSSFP can retrospectively select coronary resting periods for optimal images,providing a more reliable imaging modality for the assessment of coronary arteries in children to make better clinical decision.