磁共振对健康成年人肺动脉血流动力学及压力研究的价值

发布时间：2018-03-16 18:37

本文选题：磁共振成像　切入点：相位对比　出处：《宁夏医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的探讨MRI相位对比血流测量（PC-MRI）技术对健康成年人主肺动脉(MPA)结构及血流动力学测量的准确性及应用价值以及利用公式估测肺动脉平均压（MPAP）的可行性。方法采用3.0T PC-MRI测量20例健康志愿者MPA直径，面积，峰值流速及一个心动周期的平均血流量，利用公式计算MPA相对扩展度、返流分数及MPAP。48小时内对同一健康志愿者采用TTE测量MPA直径及正向峰值流速，利用公式计算MPA面积，一个心动周期的平均血流量、相对扩展度及MPAP。并将PC-MRI估测的MPAP及TTE估测的MPAP分别与右心导管荟萃报道的MPAP进行比较。结果 1.PC-MRI测量的20例健康成年人MPA最大直径为（26.70±2.11）mm，最小直径为（21.23±3.16）mm，最大面积为（5.14±0.99）cm2，最小面积为（3.55±1.01）cm2，正向峰值流速为（72.59±11.58）cm/s，反向峰值流速为（19.69±8.89）cm/s，，平均流量为（61.80±13.63）ml/beat，平均正向流量为（64.71±14.90）ml/beat，平均反向流量为（3.07±2.32）ml/beat，计算的相对扩展度为（49.08±20.55）%，反流分数为（4.54±2.98）%，MPAP为（14.08±2.95）mmHg；TTE测量的20例健康成年人主肺动脉最大直径为（22.34±1.71）mm，最小直径为（18.61±1.67）mm，正向峰值流速为（81.47±8.78）cm/s，计算的最大面积为（3.94±0.62）cm2，最小面积为（2.74±0.48）cm2，相对扩展度为（45.66±19.91）%，平均流量为（65.17±13.88）ml/beat，MPAP为（6.70±12.89）mmHg。 2.PC-MRI与TTE测量的MPA最大直径、最小直径、最大面积、最小面积、正向峰值流速及平均流量均存在明显差异（P均＜0.05）,但MPA相对扩展度在两种方法之间差异无统计学意义（P=0.609）。 3.PC-MRI估测MPAP与右心导管荟萃报道的平均、男性、女性、＜30岁、30～50岁及＞50岁健康成年人的MPAP差异无统计学意义（分别为P=0.8602，P=0.7611，P=0.7668，P=0.4460，P=0.5514，P=0.3839）。 4.以右心导管荟萃报道的平均MPAP为金标准,PC-MRI估测的20例健康志愿者MPAP100%位于右心导管测量95%可信区间内，无负值出现；而TTE估测的MPAP仅有45%位于右心导管测量95%可信区间内，且有6例（30%）出现负值。结论 1.PC-MRI可以准确测量健康成年人MPA血管大小、弹性及血流动力学参数，为心血管疾病提供正常参考。 2.利用公式PC-MRI可以准确估测健康成年人的MPAP，为MRI估测MPAP提供了新方法。 3.由于呼吸状态的不同，PC-MRI与TTE测量的血流动力学参数存在差异，可能不适用于对比研究。 4.PC-MRI公式估测的健康成年人MPAP准确性明显优于TTE，有望替代TTE成为筛查PH的新方法。
[Abstract]:Purpose. To investigate the accuracy and application value of MRI phase contrast flow measurement (PC-MRI) in measuring the structure and hemodynamics of MPAs in healthy adults, and the feasibility of using the formula to estimate the mean pulmonary artery pressure (MPAP). Method. The diameter, area, peak velocity and mean blood flow of MPA were measured by 3.0T PC-MRI in 20 healthy volunteers. The relative expansion of MPA was calculated by the formula. TTE was used to measure the diameter and forward peak velocity of MPA in the same healthy volunteers within MPAP.48 hour. The area of MPA and the mean blood flow in a cardiac cycle were calculated by the formula. The relative extensibility and MPAP. the MPAP and MPAP estimated by PC-MRI and TTE were compared with MPAP reported by right cardiac catheterization respectively. Results. 1. The maximum diameter of MPA measured by PC-MRI in 20 healthy adults was 26.70 卤2.11 mm, the minimum diameter was 21.23 卤3.16 mm, the maximum area was 5.14 卤0.99 cm ~ 2, the minimum area was 3.55 卤1.01 cm ~ (-2), the forward peak velocity was 72.59 卤11.58 cm / s, the reverse peak velocity was 19.69 卤8.89 cm / s, the average flow rate was 61.80 卤13.63 ml / L / s, the average positive flow rate was 64.71 卤14.90 ml / beat. The flow rate is 3.07 卤2.32 ml / L 路L 路beat, the calculated relative expansion is 49.08 卤20.55, the reflux fraction is 4.54 卤2.98 mm, the maximum diameter of pulmonary artery is 22.34 卤1.71 mm, the minimum diameter is 18.61 卤1.67 mm, the forward peak velocity is 81.47 卤8.78 cm / s, the maximum area is 3.94 卤0.62cm ~ (2), and the minimum area is 3.94 卤0.62 mm 路cm ~ (-2), the minimum diameter is 18.61 卤1.67 mm, the forward peak velocity is 81.47 卤8.78 cm / s, and the maximum calculated area is 3.94 卤0.62 mm 路cm ~ (-2), the minimum area is 1.71 mm, the minimum diameter is 18.61 卤1.67 mm, and the forward peak velocity is 81.47 卤8.78 cm / s, respectively. The average flow rate was 65.17 卤13.88ml / ml / m ~ (-1), and the mean MPAP was 6.70 卤12.89mm / h / g. The relative extensibility was 45.66 卤19.91 mm 路cm ~ (2), and the mean flow rate was 65.17 卤13.88 ml / m ~ (-1) 路min ~ (-1) 路m ~ (-2). 2. The maximum diameter, minimum diameter, maximum area, minimum area, forward peak velocity and average flow rate of MPA measured by PC-MRI and TTE were all significantly different (P < 0.05), but there was no significant difference in MPA relative expansion between the two methods. 3. PC-MRI estimated that there was no significant difference in MPAP between MPAP and right cardiac catheterization in average, male, female, < 30 years old, 30 years old and over 50 years old healthy adults (P = 0.8602, P 0.7611, P 0.7668, P = 0.4460, P = 0.5514, P 0.3839, respectively). 4. Using the average MPAP reported by right cardiac catheterization as the gold standard, MPAP100% of 20 healthy volunteers were located within the 95% confidence interval of right cardiac catheterization without negative value, while the MPAP estimated by TTE was only 45% in 95% confidence interval of right cardiac catheterization. There were negative values in 6 cases (30%). Conclusion. 1. PC-MRI can accurately measure the vascular size, elasticity and hemodynamic parameters of MPA in healthy adults, and provide a normal reference for cardiovascular diseases. 2. The formula PC-MRI can accurately estimate the MPAPs of healthy adults, which provides a new method for estimating MPAP by MRI. 3. The difference of hemodynamic parameters measured by PC-MRI and TTE may not be suitable for comparative study. 4. The accuracy of PC-MRI formula in estimating MPAP in healthy adults is better than that in healthy adults. It is expected that PC-MRI formula will replace TTE as a new method for screening PH.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R540.45;R445.2;R544.1

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