Chronic Thromboembolic Pulmonary Hypertension Perioperative Monitoring Using Phase-Resolved Functional Lung (PREFUL)-MRI.

Autor: Pöhler GH; Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.; German Centre for Lung Research, BREATH, Hannover, Germany., Klimes F; Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.; German Centre for Lung Research, BREATH, Hannover, Germany., Voskrebenzev A; Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.; German Centre for Lung Research, BREATH, Hannover, Germany., Behrendt L; Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.; German Centre for Lung Research, BREATH, Hannover, Germany., Czerner C; Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.; German Centre for Lung Research, BREATH, Hannover, Germany., Gutberlet M; Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.; German Centre for Lung Research, BREATH, Hannover, Germany., Cebotari S; Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany., Ius F; Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany., Fegbeutel C; Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany., Schoenfeld C; Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.; German Centre for Lung Research, BREATH, Hannover, Germany., Kaireit TF; Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.; German Centre for Lung Research, BREATH, Hannover, Germany., Hauck EF; Department of Neurosurgery, Duke Hospital, Durham, North Carolina, USA., Olsson KM; Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.; German Centre for Lung Research, BREATH, Hannover, Germany., Hoeper MM; Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.; German Centre for Lung Research, BREATH, Hannover, Germany., Wacker F; Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.; German Centre for Lung Research, BREATH, Hannover, Germany., Vogel-Claussen J; Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.; German Centre for Lung Research, BREATH, Hannover, Germany.
Jazyk: angličtina
Zdroj: Journal of magnetic resonance imaging : JMRI [J Magn Reson Imaging] 2020 Aug; Vol. 52 (2), pp. 610-619. Date of Electronic Publication: 2020 Feb 24.
DOI: 10.1002/jmri.27097
Abstrakt: Background: The translation of phase-resolved functional lung (PREFUL)-MRI to routine practice in monitoring chronic thromboembolic pulmonary hypertension (CTEPH) still requires clinical corresponding imaging biomarkers of pulmonary vascular disease.
Purpose: To evaluate successful pulmonary endarterectomy (PEA) via PREFUL-MRI with pulmonary pulse wave transit time (pPTT).
Study Type: Retrospective.
Population: Thirty CTEPH patients and 12 healthy controls were included.
Field Strength/sequence: For PREFUL-MRI a 2D spoiled gradient echo sequence and for DCE-MRI a 3D time-resolved angiography with stochastic trajectories (TWIST) sequence were performed on 1.5T.
Assessment: Eight coronal slices of PREFUL-MRI were obtained on consecutive 13 days before and 14 days after PEA. PREFUL quantitative lung perfusion (PREFUL Q ) phases over the whole cardiac cycle were calculated to quantify pPTT, the time the pulmonary pulse wave travels from the central pulmonary arteries to the pulmonary capillaries. Also, perfusion defect percentage based on pPTT (QDP pPTT ), PREFUL Q (QDP PREFUL ), and V/Q match were calculated. For DCE-MRI, pulmonary blood flow (PBF) and QDP PBF were computed as reference. For clinical correlation, mean pulmonary arterial pressure (mPAP) and 6-minute walking distance were evaluated preoperatively and after PEA.
Statistical Tests: The Shapiro-Wilk test, paired two-sided Wilcoxon rank sum test, Dice coefficient, and Spearman's correlation coefficient (ρ) were applied.
Results: Median pPTT was significantly lower post PEA (139 msec) compared to pre PEA (193 msec), P = 0.0002. Median pPTT correlated significantly with the mPAP post PEA (r = 0.52, P < 0.008). Median pPTT was distributed more homogeneously after PEA: IQR pPTT decreased from 336 to 281 msec (P < 0.004). Median PREFUL Q (P < 0.0002), QDP pPTT (P < 0.0478), QDP PREFUL (P < 0.0001) and V/Q match (P < 0.0001) improved significantly after PEA. Percentage change of PREFUL Q correlated significantly with percentage change of 6-minute walking distance (ρ = 0.61; P = 0.0031) 5 months post PEA.
Data Conclusion: Perioperative perfusion changes in CTEPH can be detected and quantified by PREFUL-MRI. Normalization of pPTT reflects surgical success and improvement of PREFUL Q predicts 6-minute walking distance changes.
Level of Evidence: 3 TECHNICAL EFFICACY STAGE: 2 J. Magn. Reson. Imaging 2020;52:610-619.
(© 2020 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine.)
Databáze: MEDLINE
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