心脏MRI的儿童心血管疾病评价及临床应用现状

doi:10.3877/cma.j.issn.1673-5250.2022.04.001

心血管疾病(CVD)可导致包括儿童心脏解剖结构、血流动力学、心功能和心肌组织在内的一系列病理生理改变，治疗前、后准确评估这些改变，对CVD治疗方案制定、疗效评估及远期随访至关重要。心脏MRI(CMR)凭借对软组织的高分辨率、无电离辐射，以及对心脏解剖结构、心功能和心肌组织一站式成像等优势，成为儿童CVD重要检查手段。CMR的自旋回波脉冲序列、脂肪抑制3D真实稳态自由进动快速成像序列及对比剂增强MRI血管造影(MRA)，可清晰显示心房、心室、大血管等解剖结构的形态、大小及相互连接关系。相位对比(PC) CMR和4D-flow CMR技术，可准确定量测定血流流速和流量，分析心搏量、肺/体循环比、瓣膜口反流量和房室压力梯度差等血流动力学参数改变。电影序列CMR可精确测定心室整体收缩和舒张功能，结合组织追踪技术评价心肌形变，还可用于心功能亚临床障碍的早期评估。首过灌注、钆(Gd)对比剂延迟强化(LGE)、T1及T2-mapping技术等CMR，可无创定量评估冠状动脉微循环、心肌纤维化和心肌水肿改变，为儿童CVD病因探索、病理生理监测和预后评估提供关键信息，为儿童CVD的临床管理提供科学依据。笔者拟就CMR在儿童CVD诊疗过程中的价值及其最新研究现状进行阐述。

关键词: 磁共振成像，心脏, 心血管疾病, 磁共振血管造影术, 心功能, 心肌应力, 首过灌注, 钆对比剂延迟强化, 纵向弛豫时间定量成像, 横向弛豫时间定量成像, 儿童

Cardiovascular diseases (CVD) in children would cause pathophysiological disorders in cardiac structure, hemodynamics, function and myocardial tissue. Accurate assessment of these disorders is of great importance for treatment decision making, therapeutic efficacy evaluation and long-term follow-up for CVD. Based on cardiac magnetic resonance (CMR)′s advantages of high soft tissue resolution, without ionizing radiation and one-stop imaging of anatomical structure, function and myocardial tissue, CMR has become an important examination modality for children with CVD. The spin-echo pulse sequence, fast-suppressed-3D-true fast imaging with steady-state precession sequence of CMR and contrast-enhanced magnetic resonance angiography (MRA) showed good visualization of the morphology, size, interconnections of atrium, ventricles and large vessels. Phase contrast (PC) and 4D-flow of CMR can measure blood flow velocity and volume quantitatively, evaluate hemodynamic accurately, including analyze cardiac stroke volume, pulmonary blood flow/systemic blood flow, valvular reverse flow, and pressure gradient. Cine sequence of CMR can assess cardiac systolic and diastolic functions accurately. Combined with feature tissue tracking, cine sequence of CMR can also be used to early assess subclinical cardiac dysfunction by evaluating myocardial deformation. Furthermore, coronary microcirculation, myocardial fibrosis and edema can be detected quantitatively with first-pass perfusion imaging, late gadolinium enhancement (LGE), T1-mapping and T2-mapping of CMR , which could provide clinical information related to etiology, pathophysiology and prognosis for improving clinical management of children with CVD. Herein, the author intends to expound the value of CMR in diagnosis and treatment of children with CVD.

Key words: Magnetic resonance imaging, cardiac, Cardiovascular diseases, Magnetic resonance angiography, Cardiac function, Myocardial stress, First-pass perfusion, Delayed enhancement, T1-mapping, T2-mapping, Child

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Assessment of cardiovascular diseases in children by cardiac magnetic resonance

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