肝硬化是慢性肝病的常见终末期表现,门静脉高压症是肝硬化患者最常见、最致命的并发症,门静脉高压症及其并发症是肝硬化患者死亡的主要原因。肝硬化患者在门静脉高压症发展过程中,血流会发生剧烈变化。因此门静脉系统血流动力学的评价...肝硬化是慢性肝病的常见终末期表现,门静脉高压症是肝硬化患者最常见、最致命的并发症,门静脉高压症及其并发症是肝硬化患者死亡的主要原因。肝硬化患者在门静脉高压症发展过程中,血流会发生剧烈变化。因此门静脉系统血流动力学的评价在肝硬化病变的诊断与评估起着重要作用。4D Flow MRI是一种能无创性定量评估血流动力学的技术,本文将对目前4D Flow MRI在肝硬化门静脉高压中的应用进行综述。Cirrhosis is a common end-stage manifestation of chronic liver disease, and portal hypertension is the most common and fatal complication in patients with cirrhosis. Portal hypertension and its complications are the main cause of death in patients with cirrhosis. During the development of portal hypertension, patients with cirrhosis may experience significant changes in blood flow. Therefore, the evaluation of portal vein hemodynamics plays an important role in the diagnosis and assessment of liver cirrhosis lesions. 4D Flow MRI is a non-invasive quantitative assessment technique for hemodynamics. In this review, we will summarize the current research progress of 4D Flow MRI in portal hypertension in liver cirrhosis.展开更多
Background:Repaired Tetralogy of Fallot(rTOF)patients may have residual lesions such as main(MPA)and branch pulmonary artery stenosis(BPAS).While MPA stenosis is well studied,few data are available on BPAS in rTOF.We ...Background:Repaired Tetralogy of Fallot(rTOF)patients may have residual lesions such as main(MPA)and branch pulmonary artery stenosis(BPAS).While MPA stenosis is well studied,few data are available on BPAS in rTOF.We aimed to describe pulmonary perfusion in a large paediatric cohort of rTOF and its impact on right ventricular and outflow-tract hemodynamics using 4D flow CMR.Methods:130 consecutive patients(mean age at CMR 14.3±4.6 years)were retrospectively reviewed.96 patients had transannular patch without valve preservation while 34 patients had conserved annulus or valved conduit.A pulmonary blood flow ratio(right pulmonary artery(RPA)/left pulmonary artery(LPA))between 0.75 and 1.56 was considered normal.Results:Asymmetric pulmonary perfusion was present in 59/130 patients(45%),with 54/59(91%)having left lung hypoperfusion(blood flow ratio>1.56).RPA/LPA perfusion ratio in the whole cohort was independently associated with the LPA Z-score(−0.053,p=0.007),the RPA regurgitant fraction(RF)(0.013,p=0.011)and previous LPA stenting(0.648,p=0.004).Decreasing LPA%perfusion(and conversely increasing RPA%perfusion)was significantly associated with higher MPA diameter Z-score(−0.06,p=0.007).On multivariate analysis,MPA Z-score was independently associated with pulmonary RF(0.48,p<0.001)and with right ventricular indexed volumes(coefficient 3.6,p=0.023).In patients with transannular patch repair,asymmetric pulmonary flow was an independent predictor of right ventricular ejection fraction(RVEF)(−3.66,p=0.04).Conclusions:Pulmonary perfusion asymmetry is frequent in rTOF and is associated with abnormal right ventricular and outflow-tract hemodynamics,including MPA dilatation and decreased RVEF in patients after transannular patch.展开更多
The non-invasive method for estimating the pulmonary arterial pressure(PAP)plays an important role in the screening and diagnosis of pulmonary arterial hypertension(PAH).We aimed to establish a phase-contrast magnetic...The non-invasive method for estimating the pulmonary arterial pressure(PAP)plays an important role in the screening and diagnosis of pulmonary arterial hypertension(PAH).We aimed to establish a phase-contrast magnetic resonance imaging(PC-MRI)based method to estimate PAP.Through analyzing a patient's morphologic and hemodynamic features,this method could be used to identify PAH,and provide diagnostic and grading information for PAH.We selected 39 study participants,comprising 18 healthy volunteers and 21 patients with PAH.Morphologic and hemodynamic parameters of each participant's pulmonary arteries were obtained from 4D Flow images.Hemodynamic features were performed selected by principal component analysis(PCA).PAH identification model was built with binary logistic regression.Furthermore,A multiple linear regression(MLR)model was developed to estimate PAP,the accuracy of which was evaluated by comparing it with the value measured by right heart catheterization(RHC).PAH identification was achieved with high accuracy,using the features of pulmonary arterial morphology or blood flow velocity(BFV).Compared with RHC,MLR results showed that using pulmonary arterial morphology and BFV features in combination can greatly improve the accuracy of PAP estimation.Our results showed that the mean relative error of PAP estimation in PAH patients could reach<10%.A highly accurate PC-MRI based method for PAH identification and PAP estimation was successfully established.Using hemodynamic features of the pulmonary artery could improve PAP estimation accuracy,which highlights the importance of hemodynamic evaluation of pulmonary arteries in the screening and diagnosis of PAH.展开更多
Our study sought to investigate the blood flow pattern in the superior vena cava(SVC)of healthy adults and to describe the development and characteristics of the flow pattern using 4D flow magnetic resonance imaging(M...Our study sought to investigate the blood flow pattern in the superior vena cava(SVC)of healthy adults and to describe the development and characteristics of the flow pattern using 4D flow magnetic resonance imaging(MRI).4D flow MRI data with full coverage of SVC and brachiocephalic veins(BVs)were acquired with a 3-Testa MRI in thirty healthy adults(age:28.70±9.09).Hemodynamic parameters in the SVC,including velocity,velocity vector,flow visualization(pathlines,streamlines),flow waveform and energy loss,were obtained with specialized commercial post-processing software based on 4D flow MRI data.This study found that:(1)The SVC has a pulsating flow waveform with double peaks.(2)Based on BVs flow of the SVC pathline visualization,flow patterns could be divided into three development types:twining(n=14),untwining(n=)and no helical flow(n=7).(3)With the decreasing blood velocity,helical flow areas tended to gradually extend.(4)There were no significant differences in most hemodynamic parameters among the three types.The exploration of the blood flow characteristics of normal SVC may be the first step for capturing pathogenic features before the patients develop symptoms with a certain positive significance.The potential physiological significance of these phenomena deserves more exploration in future studies.展开更多
目的旨在应用4D血流MR成像研究正常志愿者及大脑中动脉(MCA)狭窄病人的颅内动脉血流动力学状态,并比较正常和狭窄颅内动脉的双侧血流动力学参数差异。方法纳入正常志愿者5名和MCA狭窄病人3例。应用3 T MR设备进行检查,采用3D时间飞跃法(...目的旨在应用4D血流MR成像研究正常志愿者及大脑中动脉(MCA)狭窄病人的颅内动脉血流动力学状态,并比较正常和狭窄颅内动脉的双侧血流动力学参数差异。方法纳入正常志愿者5名和MCA狭窄病人3例。应用3 T MR设备进行检查,采用3D时间飞跃法(TOF)MRA及高分辨3D-T1WI-SPACE序列显示及分析Willis环结构特点。应用4D血流MR成像获取血流数据,分析双侧颈内动脉(ICA)颅内段、MCA及大脑前动脉(ACA)的血流动力学状态,计算心动周期不同时相的平均血管面积、平均及最大血流速度、平均瞬时血流率,生成血流矢量图、流线图及粒子追踪图。分析颅内Willis环的结构特征及血流动力学状态。采用独立样本t检验比较正常志愿者及MCA狭窄病人双侧动脉血流动力学参数的差异。结果正常志愿者中,4名显示对称Willis环结构,1名右侧胚胎型大脑后动脉。双侧ICA、MCA和ACA的血流动力学参数包括平均血管面积、平均血流速度、最大血流速度和平均瞬时血流率之间差异均无统计学意义(均P>0.05)。血流矢量图、流线图及粒子追踪图显示,ICA可见高速血流,收缩晚期及舒张期显示血流速度下降,血流分布欠均匀。1名右侧胚胎型大脑后动脉志愿者双侧血流动力学参数明显不对称,除右侧ACA最大血流速度低于左侧,其余颅内血管段的平均血管面积、平均和最大血流速度以及平均瞬时血流率右侧均明显高于左侧。3例MCA狭窄病人的ICA、MCA及ACA双侧血流动力学参数之间的差异未见统计学意义(P>0.05)。3例狭窄侧平均瞬时血流率均低于对侧。2例局部平均血流速度及相对压力梯度较对侧降低;另1例则明显较对侧增大。血流矢量图、流线图及粒子追踪图显示狭窄局部血流矢量明显偏离血管主轴方向,血流分布明显不规则。结论应用4D血流MR成像可以提供对颅内动脉复杂血流动力学状态的综合评估,包括对血流参数进行定量评价。颅内Willis环的结构与其血流动力学状态及分布密切相关。展开更多
文摘目的基于4D Flow MRI技术探究急性心肌梗死患者左心室(left ventricular,LV)腔内局部血流动能(kinetic energy,KE)改变。方法纳入30名急性心肌梗死(acute myocardial infarction,AMI)患者和20名对照者。应用4D Flow MRI技术定量评价左心室腔内血流动能,包括左心室平均动能、最小动能、收缩期动能、舒张期动能以及平面内动能(in-plane kinetic energy,In-plane KE)百分比。比较心肌梗死组和对照组之间以及梗死节段与非梗死节段之间血流动能参数的差异。结果与对照组相比,急性心肌梗死组左心室整体平均动能(10.7μJ/mL±3.3 vs 14.7μJ/mL±3.6,P<0.001)、收缩期动能(14.6μJ/mL±5.1 vs 18.9μJ/mL±3.9,P=0.003)及舒张期动能(7.9μJ/mL±2.5 vs 10.6μJ/mL±3.8,P=0.018)均显著降低,其中梗死节段较非梗死节段邻近心腔血流的平均动能降低而收缩期平面内动能百分比增加(49.5μJ/mL±18.7 vs 126.3μJ/mL±50.7,P<0.001;61.8%±11.5 vs 42.9%±14.4,P=0.001)。结论4D Flow MRI技术可定量评价左心室腔内局部血流动能参数。急性心肌梗死后整体心腔血流动能减低,而梗死节段邻近心腔局部血流平面内动能百分比增加。
文摘肝硬化是慢性肝病的常见终末期表现,门静脉高压症是肝硬化患者最常见、最致命的并发症,门静脉高压症及其并发症是肝硬化患者死亡的主要原因。肝硬化患者在门静脉高压症发展过程中,血流会发生剧烈变化。因此门静脉系统血流动力学的评价在肝硬化病变的诊断与评估起着重要作用。4D Flow MRI是一种能无创性定量评估血流动力学的技术,本文将对目前4D Flow MRI在肝硬化门静脉高压中的应用进行综述。Cirrhosis is a common end-stage manifestation of chronic liver disease, and portal hypertension is the most common and fatal complication in patients with cirrhosis. Portal hypertension and its complications are the main cause of death in patients with cirrhosis. During the development of portal hypertension, patients with cirrhosis may experience significant changes in blood flow. Therefore, the evaluation of portal vein hemodynamics plays an important role in the diagnosis and assessment of liver cirrhosis lesions. 4D Flow MRI is a non-invasive quantitative assessment technique for hemodynamics. In this review, we will summarize the current research progress of 4D Flow MRI in portal hypertension in liver cirrhosis.
文摘Background:Repaired Tetralogy of Fallot(rTOF)patients may have residual lesions such as main(MPA)and branch pulmonary artery stenosis(BPAS).While MPA stenosis is well studied,few data are available on BPAS in rTOF.We aimed to describe pulmonary perfusion in a large paediatric cohort of rTOF and its impact on right ventricular and outflow-tract hemodynamics using 4D flow CMR.Methods:130 consecutive patients(mean age at CMR 14.3±4.6 years)were retrospectively reviewed.96 patients had transannular patch without valve preservation while 34 patients had conserved annulus or valved conduit.A pulmonary blood flow ratio(right pulmonary artery(RPA)/left pulmonary artery(LPA))between 0.75 and 1.56 was considered normal.Results:Asymmetric pulmonary perfusion was present in 59/130 patients(45%),with 54/59(91%)having left lung hypoperfusion(blood flow ratio>1.56).RPA/LPA perfusion ratio in the whole cohort was independently associated with the LPA Z-score(−0.053,p=0.007),the RPA regurgitant fraction(RF)(0.013,p=0.011)and previous LPA stenting(0.648,p=0.004).Decreasing LPA%perfusion(and conversely increasing RPA%perfusion)was significantly associated with higher MPA diameter Z-score(−0.06,p=0.007).On multivariate analysis,MPA Z-score was independently associated with pulmonary RF(0.48,p<0.001)and with right ventricular indexed volumes(coefficient 3.6,p=0.023).In patients with transannular patch repair,asymmetric pulmonary flow was an independent predictor of right ventricular ejection fraction(RVEF)(−3.66,p=0.04).Conclusions:Pulmonary perfusion asymmetry is frequent in rTOF and is associated with abnormal right ventricular and outflow-tract hemodynamics,including MPA dilatation and decreased RVEF in patients after transannular patch.
基金supported by Nature Science Foundation of Hubei Province(2024AFD183)State Key Laboratory of Virtual Reality Technology and Systems.
文摘The non-invasive method for estimating the pulmonary arterial pressure(PAP)plays an important role in the screening and diagnosis of pulmonary arterial hypertension(PAH).We aimed to establish a phase-contrast magnetic resonance imaging(PC-MRI)based method to estimate PAP.Through analyzing a patient's morphologic and hemodynamic features,this method could be used to identify PAH,and provide diagnostic and grading information for PAH.We selected 39 study participants,comprising 18 healthy volunteers and 21 patients with PAH.Morphologic and hemodynamic parameters of each participant's pulmonary arteries were obtained from 4D Flow images.Hemodynamic features were performed selected by principal component analysis(PCA).PAH identification model was built with binary logistic regression.Furthermore,A multiple linear regression(MLR)model was developed to estimate PAP,the accuracy of which was evaluated by comparing it with the value measured by right heart catheterization(RHC).PAH identification was achieved with high accuracy,using the features of pulmonary arterial morphology or blood flow velocity(BFV).Compared with RHC,MLR results showed that using pulmonary arterial morphology and BFV features in combination can greatly improve the accuracy of PAP estimation.Our results showed that the mean relative error of PAP estimation in PAH patients could reach<10%.A highly accurate PC-MRI based method for PAH identification and PAP estimation was successfully established.Using hemodynamic features of the pulmonary artery could improve PAP estimation accuracy,which highlights the importance of hemodynamic evaluation of pulmonary arteries in the screening and diagnosis of PAH.
基金This work was supported by the Key Research&Development Project of Science and Technology of Sichuan Province(2021YFS0142)the National Natural Science Foundation of China(81601462)+1 种基金the National Natural Science Foundation of China(12072214)the 1⋅3⋅5 Project for Disciplines of Excellence,West China Hospital,Sichuan University(ZYGD18013).
文摘Our study sought to investigate the blood flow pattern in the superior vena cava(SVC)of healthy adults and to describe the development and characteristics of the flow pattern using 4D flow magnetic resonance imaging(MRI).4D flow MRI data with full coverage of SVC and brachiocephalic veins(BVs)were acquired with a 3-Testa MRI in thirty healthy adults(age:28.70±9.09).Hemodynamic parameters in the SVC,including velocity,velocity vector,flow visualization(pathlines,streamlines),flow waveform and energy loss,were obtained with specialized commercial post-processing software based on 4D flow MRI data.This study found that:(1)The SVC has a pulsating flow waveform with double peaks.(2)Based on BVs flow of the SVC pathline visualization,flow patterns could be divided into three development types:twining(n=14),untwining(n=)and no helical flow(n=7).(3)With the decreasing blood velocity,helical flow areas tended to gradually extend.(4)There were no significant differences in most hemodynamic parameters among the three types.The exploration of the blood flow characteristics of normal SVC may be the first step for capturing pathogenic features before the patients develop symptoms with a certain positive significance.The potential physiological significance of these phenomena deserves more exploration in future studies.
文摘目的旨在应用4D血流MR成像研究正常志愿者及大脑中动脉(MCA)狭窄病人的颅内动脉血流动力学状态,并比较正常和狭窄颅内动脉的双侧血流动力学参数差异。方法纳入正常志愿者5名和MCA狭窄病人3例。应用3 T MR设备进行检查,采用3D时间飞跃法(TOF)MRA及高分辨3D-T1WI-SPACE序列显示及分析Willis环结构特点。应用4D血流MR成像获取血流数据,分析双侧颈内动脉(ICA)颅内段、MCA及大脑前动脉(ACA)的血流动力学状态,计算心动周期不同时相的平均血管面积、平均及最大血流速度、平均瞬时血流率,生成血流矢量图、流线图及粒子追踪图。分析颅内Willis环的结构特征及血流动力学状态。采用独立样本t检验比较正常志愿者及MCA狭窄病人双侧动脉血流动力学参数的差异。结果正常志愿者中,4名显示对称Willis环结构,1名右侧胚胎型大脑后动脉。双侧ICA、MCA和ACA的血流动力学参数包括平均血管面积、平均血流速度、最大血流速度和平均瞬时血流率之间差异均无统计学意义(均P>0.05)。血流矢量图、流线图及粒子追踪图显示,ICA可见高速血流,收缩晚期及舒张期显示血流速度下降,血流分布欠均匀。1名右侧胚胎型大脑后动脉志愿者双侧血流动力学参数明显不对称,除右侧ACA最大血流速度低于左侧,其余颅内血管段的平均血管面积、平均和最大血流速度以及平均瞬时血流率右侧均明显高于左侧。3例MCA狭窄病人的ICA、MCA及ACA双侧血流动力学参数之间的差异未见统计学意义(P>0.05)。3例狭窄侧平均瞬时血流率均低于对侧。2例局部平均血流速度及相对压力梯度较对侧降低;另1例则明显较对侧增大。血流矢量图、流线图及粒子追踪图显示狭窄局部血流矢量明显偏离血管主轴方向,血流分布明显不规则。结论应用4D血流MR成像可以提供对颅内动脉复杂血流动力学状态的综合评估,包括对血流参数进行定量评价。颅内Willis环的结构与其血流动力学状态及分布密切相关。
