發(fā)布時(shí)間：2018-04-28 12:20

  本文選題：雙源射頻發(fā)射 + 心臟磁共振��； 參考：《山東大學(xué)》2017年博士論文

【摘要】：第一部分3.0T雙源射頻發(fā)射技術(shù)在兒童心臟磁共振成像中的價(jià)值目的利用3.0 T雙源射頻發(fā)射技術(shù)對(duì)心臟行適形射頻勻場(chǎng),并與傳統(tǒng)的單源射頻系統(tǒng)比較,評(píng)估其在兒童心臟磁共振(cardiac magnetic resonance,CMR)成像B1射頻場(chǎng)均勻性及電影圖像質(zhì)量(圖像對(duì)比度及失諧共振偽影)中的價(jià)值。研究背景同成人相比,兒童CMR成像存在一系列技術(shù)難題:兒童心臟解剖結(jié)構(gòu)小,心率快,掃描過(guò)程中不能保持靜止以及不能配合屏氣掃描等。高場(chǎng)強(qiáng)心臟磁共振成像能夠滿(mǎn)足兒童CMR成像所需的高時(shí)間、空間分辨率,多信號(hào)采集技術(shù)可以減少兒童呼吸運(yùn)動(dòng)偽影及不自主運(yùn)動(dòng)偽影,但其應(yīng)用又會(huì)帶來(lái)磁場(chǎng)均勻性減低、圖像質(zhì)量下降等問(wèn)題。材料與方法本研究納入60位兒童,均在雙源及傳統(tǒng)單源兩種射頻適形發(fā)射技術(shù)進(jìn)行CMR成像,其中30位兒童在自由呼吸條件下進(jìn)行掃描,30位在屏氣條件下掃描。心臟B1射頻場(chǎng)均勻性采用水平長(zhǎng)軸位Bl-map圖所達(dá)到翻轉(zhuǎn)角的平均百分比及翻轉(zhuǎn)角變異系數(shù)(coefficient of variation,CV)進(jìn)行評(píng)估。由雙源射頻發(fā)射技術(shù)及傳統(tǒng)單源所得的B1射頻場(chǎng)均勻性以及心臟電影圖像的對(duì)比度采用T檢驗(yàn)進(jìn)行比較。兩位經(jīng)驗(yàn)豐富的放射科醫(yī)生分別對(duì)電影圖像中的偽影進(jìn)行1-4級(jí)評(píng)分,偽影評(píng)分的結(jié)果進(jìn)行Mann-Whitney U檢驗(yàn),觀察者間的一致性分析采用Kappa檢驗(yàn)。結(jié)果同傳統(tǒng)單源射頻技術(shù)相比,雙源射頻適形發(fā)射技術(shù)明顯提高了 B1射頻場(chǎng)實(shí)際平均翻轉(zhuǎn)角百分比(自由呼吸組:104.2±4.6 VS 95.5±6.3,P0.001;屏氣組:101.5±5.1 VS 92.5±6.3,P0.001),減小了反轉(zhuǎn)角的 CV(自由呼吸組:0.06±0.02 VS 0.09±0.03,P0.001;屏氣組:0.07±0.03 VS 0.10±0.04,P=0.005)。雙源射頻技術(shù)顯著提高了心臟電影左、右心室心腔血池-室間隔的對(duì)比度(P值均0.05)。心臟水平長(zhǎng)軸位電影圖像的失諧偽影明顯減少(P值均0.05),觀察者間的一致性較好(kappa:0.68-0.74)。結(jié)論同傳統(tǒng)單源射頻技術(shù)相比,雙源射頻適形發(fā)射技術(shù)能夠顯著改善3.0 T兒童CMR成像B1射頻場(chǎng)的均勻性,提高電影圖像質(zhì)量。這項(xiàng)技術(shù)有待于應(yīng)用到兒童CMR成像中。第二部分3.0 T心臟磁共振成像在兒童爆發(fā)性心肌炎診斷及短期預(yù)后中的價(jià)值目的本研究的目的為分析不同時(shí)期兒童爆發(fā)性心肌炎(Fulminant myocarditis,FM)的心臟磁共振(Cardiac magnetic resonance,CMR)表現(xiàn),評(píng)估兒童FM的短期預(yù)后并找出其預(yù)后因子。研究背景FM是一種起病急驟,可迅速導(dǎo)致心室收縮功能明顯異常及心衰的心肌炎性疾病。目前,CMR檢查已經(jīng)成為心肌炎診斷及評(píng)估的重要非侵入性檢查工具。但CMR在FM診斷及預(yù)后中的價(jià)值鮮有報(bào)道。材料與方法本研究納入8位進(jìn)行兩次CMR檢查的FM兒童。首次CMR檢查于FM發(fā)病10天(范圍,7-20天)時(shí)進(jìn)行,隨訪(fǎng)檢查于發(fā)病55天(范圍,33-75天)時(shí)進(jìn)行。采用配對(duì)T檢驗(yàn)及Mann-Whitney U檢驗(yàn)對(duì)FM兒童首次及隨訪(fǎng)CMR檢查時(shí)的心臟形態(tài)、功能及心肌組織特性進(jìn)行比較。從臨床表現(xiàn)、血清學(xué)及CMR表現(xiàn)三方面分析兒童FM的短期預(yù)后。對(duì)預(yù)后不同的FM兒童,比較其首次CMR檢查時(shí)的臨床信息及CMR表現(xiàn),找出FM兒童的短期預(yù)后因子。結(jié)果8位FM兒童的中位年齡為8.5歲(范圍,3-14歲)。在首次CMR檢查中,早期心肌強(qiáng)化(early gadolinium enhancement,EGE)是兒童FM最常見(jiàn)的CMR表現(xiàn)(100.0%);87.5%的兒童FM表現(xiàn)為心肌T2信號(hào)增加及心肌延遲強(qiáng)化(late gadolinium enhancement,LGE);心肌增厚見(jiàn)于75.0%兒童FM,左心室射血分?jǐn)?shù)(left ventricle ejection fraction,LVEF)增加見(jiàn)于 50.0%的兒童 FM。在隨訪(fǎng) CMR檢查中,僅有3位兒童FM表現(xiàn)為心肌LGE(37.5%),1位表現(xiàn)為心肌T2信號(hào)增加(12.5%),LVEF增加僅見(jiàn)于1位FM兒童(12.5%)。首次及隨訪(fǎng)CMR表現(xiàn)中的心肌厚度、左心室舒張末期橫徑、收縮末期容積、LVEF、左心室質(zhì)量、T2信號(hào)對(duì)比及LGE面積具有明顯統(tǒng)計(jì)學(xué)差異(P=0.011,P=0.042,P=0.016,P=0.001,P=0.003,P=0.011,P=0.020)。5位FM兒童的臨床表現(xiàn)、血清學(xué)及CMR表現(xiàn)完全恢復(fù)正常。短期預(yù)后好的FM兒童更常表現(xiàn)111°房室傳導(dǎo)阻滯(5例VS 0例)及小面積的 LGE(104.0±14.5 mm2 VS 138.0±25.2 mm2)。結(jié)論兒童FM的CMR表現(xiàn)具有特征性,CMR成像對(duì)FM早期診斷的敏感性高。FM兒童短期預(yù)后較好,Ⅲ°AVB的發(fā)生及LGE面積大小可能有助于FM兒童的短期預(yù)后評(píng)估。CMR成像在兒童FM的早期診斷及短期預(yù)后中均表現(xiàn)出巨大價(jià)值。第三部分采用定量T1及T2 mapping技術(shù)評(píng)估心肌炎兒童"正常,"心肌的潛在心肌損害目的探究T1及T2 mapping技術(shù)是否能夠識(shí)別出心肌炎兒童"正常"心肌中的潛在心肌損害,并評(píng)估T1及T2值同左心室心功能間的關(guān)系。研究背景傳統(tǒng)的心臟磁共振(cardiac magnetic resonance,CMR)成像對(duì)心肌炎局限性心肌損害的診斷準(zhǔn)確性較高,而對(duì)于彌漫性心肌損害的敏感性可能略有下降。新的CMR成像技術(shù)-T1,T2 mapping技術(shù)能夠?qū)π募⌒盘?hào)進(jìn)行量化評(píng)估,并可以發(fā)現(xiàn)傳統(tǒng)CMR表現(xiàn)正常的心肌中所存在的彌漫性心肌損害。材料與方法本研究納入46位受試者-20位急性心肌炎(acutemyocarditis,AM)兒童,11位慢性心肌炎(chronic myocarditis,CM)兒童及15位健康兒童(normal controls,NC)。采用線(xiàn)性回歸分析比較AM,CM及NC三組受試者水平長(zhǎng)軸(Horizontal long axis,HLA)位和短軸(Short axis,SA)位"正常"心肌的T2值,初始T1值,強(qiáng)化后T1值和細(xì)胞外容積(extracellular volume,ECV)。強(qiáng)化后T1值、ECV同左心室心功能之間的關(guān)系采用多元線(xiàn)性回歸分析進(jìn)行評(píng)估。結(jié)果同NC組比較,AM組病人"正常"心肌的強(qiáng)化后T1值明顯低于NC組(HLA:718.3±65.3 ms VS 776.5±62.4 ms,P=0.005;SA:723.9±61.2 ms VS 787.7±62.3 ms,P=0.002)。CM組病人"正常"心肌的強(qiáng)化后T1值明顯低于NC組(HLA:693.0±77.7 ms VS 776.5±62.4 ms,P=0.001;SA:710.9±75.9 ms VS 787.7±62.3 ms,P=0.001),而ECV 值明顯增高(SA:30.1 ±2.8 VS 27.0±2.4,P=0.004)。在 CM 組,強(qiáng)化后 T1 值及ECV同左心室射血分?jǐn)?shù)(left ventricle ejection fraction,LVEF)及每搏輸出量(stroke volume,SV)間具有顯著關(guān)聯(lián)(P0.05)。結(jié)論強(qiáng)化后T1值和ECV能夠識(shí)別出心肌炎兒童"正常"心肌中的潛在心肌損害,并在CM病人中同LVEF及SV具有顯著關(guān)聯(lián)。Mapping技術(shù)能夠增加心肌炎CMR診斷的敏感性,可以作為心肌炎病情進(jìn)展評(píng)估及療效評(píng)估的一種有效手段。
[Abstract]:The value of 3.0T dual source radiofrequency (RFID) technique in children's cardiac magnetic resonance imaging (fMRI) in the first part is to use 3 T dual source radiofrequency emission (RFID) technique to homogenate the conformal radiofrequency of the heart. Compared with the traditional single source radio frequency system, the uniformity of the radio frequency field of the cardiac magnetic resonance (CMR) imaging in children and the film map of the radio frequency field are evaluated. Compared with adults, there are a series of technical problems in children's CMR imaging: the children's heart structure is small, the heart rate is fast, the scanning process can not keep still, and the breath holding scan can not be matched. High field cardiac magnetic resonance imaging can meet the needs of children's CMR imaging. The high time, spatial resolution, multi signal acquisition technology can reduce the artifact of children's breathing motion and the immobile artifact, but its application will bring about the reduction of magnetic field uniformity and the decline of image quality. Materials and methods are included in the study of 60 children with two radio-frequency adaptive emission techniques of dual source and single source in CMR imaging. 30 children were scanned under free breathing conditions, and 30 were scanned under breath holding conditions. The average percentage of the B1 radiofrequency field uniformity by the horizontal long axis Bl-map map and the variable coefficient of variation (coefficient of variation, CV) were evaluated by the horizontal long axis position. The dual source radiofrequency emission technology and the traditional single source B1 shot were used. The frequency field uniformity and the contrast of the heart film images were compared by T test. Two experienced radiologists scored 1-4 grades on the artifact in the film images, the results of the artifact score were tested by Mann-Whitney U test, and the consistency analysis between the observers was tested by the Kappa test. The actual average turning angle percentage of B1 radio frequency field (free breathing group: 104.2 + 4.6 VS 95.5 + 6.3, P0.001, 101.5 + 5.1 VS 92.5 + 6.3, P0.001), decreased the CV (free breathing group: 0.06 + 0.02 VS 0.09 + 0.03, P0.001, and breath holding group: 0.07 + 95.5 + VS + + P=0.005). Dual source radiofrequency technology significantly enhanced the contrast of left and right ventricular septum interventricular septum (P value of 0.05). The detuning artifacts of the long axis image of the heart were significantly reduced (P value was 0.05) and the consistency between the observers was better (kappa:0.68-0.74). Conclusion compared with the traditional single source radio frequency technology, the dual source radio frequency adaptive emission technique was compared. It can significantly improve the uniformity of the B1 radiofrequency field of 3 T children's CMR imaging and improve the quality of the film image. This technique needs to be applied to children's CMR imaging. The purpose of the second part 3 T cardiac magnetic resonance imaging in the diagnosis and short-term prognosis of children with explosive myocarditis Cardiac magnetic resonance (Cardiac magnetic resonance, CMR) manifestations of Fulminant myocarditis (FM), to assess the short-term prognosis of children's FM and to identify its prognostic factors. Background FM is an acute onset, which can rapidly cause obvious ventricular systolic dysfunction and heart failure of cardiac myositis. Currently, CMR examination has become a diagnosis of myocarditis. An important noninvasive examination tool for the assessment. But the value of CMR in the diagnosis and prognosis of FM was rarely reported. Materials and methods were included in 8 FM children with two CMR examinations. The first CMR examination was performed at 10 days (range, 7-20 days) of FM, followed up for 55 days (range, 33-75 days). Paired T test and Mann-W were used. Hitney U test compared the heart shape, function and myocardial tissue characteristics of FM children at the first and follow up CMR examination. The short-term prognosis of children's FM was analyzed from three aspects of clinical manifestation, serology and CMR performance. The clinical information and CMR manifestations of the first CMR examination were compared to the FM children with different prognosis, and the short-term prognosis of FM children was found out. Results the median age of 8 FM children was 8.5 years (range, 3-14 years). In the first CMR examination, early myocardial enhancement (early gadolinium enhancement, EGE) was the most common CMR performance of children FM (100%); 87.5% of children FM showed increased myocardium T2 signal and myocardial extension Chi Qianghua (late gadolinium); myocardial thickening was found in 75. 0% children FM, left ventricular ejection fraction (left ventricle ejection fraction, LVEF) increased in 50% of children FM. in the follow-up CMR examination. Only 3 children showed FM in LGE (37.5%), 1 showed increased myocardial T2 signal (12.5%), LVEF increased only in 1 children (12.5%). Shi Shuzhang terminal transverse diameter, end systolic volume, LVEF, left ventricular mass, T2 signal contrast and LGE area had significant statistical differences (P=0.011, P=0.042, P=0.016, P=0.001, P=0.003, P=0.011, P=0.020).5 bit FM children. The serology and manifestations were completely restored to normal. The children with good short-term prognosis were more often characterized by 111 degrees of atrioventricular conduction resistance. Stagnation (5 cases of VS 0 cases) and small area LGE (104 + 14.5 mm2 VS 138 + 25.2 mm2). Conclusion the CMR expression of FM in children is characteristic. CMR imaging for early diagnosis of FM.FM children has better short-term prognosis. The occurrence of III degree AVB and the size of LGE area may help the short-term prognosis evaluation of children. The third part uses quantitative T1 and T2 mapping techniques to evaluate the potential myocardial damage of myocarditis in children with myocarditis by using quantitative T1 and T2 techniques to explore whether T1 and T2 mapping technology can identify potential cardiac damage in the "normal" myocardium of children with myocarditis, and evaluate the value of T1 and T2 value to the left ventricular cardiac function. The diagnostic accuracy of traditional cardiac magnetic resonance (CMR) imaging for myocarditis localized myocardial damage is higher, and the sensitivity to diffuse myocardial damage may be slightly decreased. The new CMR imaging technique -T1, T2 mapping technology can quantify the myocardial signal and can find the transmission of myocardium. CMR showed diffuse myocardial damage in normal myocardium. Materials and methods were included in 46 subjects with acutemyocarditis (AM), 11 chronic myocarditis (chronic myocarditis, CM) and 15 healthy children (normal controls, NC). Linear regression analysis was used to compare AM, CM, and three groups. The Horizontal long axis, HLA position and the short axis (Short axis, SA) position of the "normal" cardiac muscle T2 value, initial T1 value, enhanced T1 value and extracellular volume (extracellular volume). The T1 value of normal myocardium was significantly lower than that in group NC (HLA:718.3 + 65.3 MS VS 776.5 + 62.4 MS, P=0.005; SA:723.9 + 61.2 MS VS 787.7 + 62.3 MS, P=0.002) There was a significant increase (SA:30.1 + 2.8 VS 27 + 2.4, P=0.004). In group CM, there was a significant correlation between T1 value and ECV with left ventricular ejection fraction (left ventricle ejection fraction, LVEF) and stroke output (stroke). Damage, and a significant association with LVEF and SV in CM patients,.Mapping technique can increase the sensitivity of CMR diagnosis of myocarditis, which can be used as an effective means for evaluating the progression of myocarditis and evaluating the efficacy of the myocarditis.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R445.2;R725.4

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