To evaluate a non-contrast respiratory- and electrocardiogram-gated 3D cardiovascular magnetic resonance angiography (CMRA) based on magnetization-prepared Dixon method (relaxation-enhanced angiography without contrast and triggering, REACT) for the assessment of the thoracic vasculature in congenital heart disease (CHD) patients. 70 patients with CHD (mean 28 years, range: 10–65 years) were retrospectively identified in this single-center study. REACT-CMRA was applied with respiratory- and cardiac-gating. Image quality (IQ) of REACT-CMRA was compared to standard non-gated multi-phase first-pass-CMRA and respiratory- and electrocardiogram-gated steady-state-CMRA. IQ of different vessels of interest (ascending aorta, left pulmonary artery, left superior pulmonary vein, right coronary ostium, coronary sinus) was independently assessed by two readers on a five-point Likert scale. Measurements of vessel diameters were performed in predefined anatomic landmarks (ascending aorta, left pulmonary artery, left superior pulmonary vein). Both readers assessed artifacts and vascular abnormalities. Friedman test, chi-squared test, and Bland-Altman method were used for statistical analysis. Overall IQ score of REACT-CMRA was higher compared to first-pass-CMRA (3.5 ± 0.4 vs. 2.7 ± 0.4, P < 0.001) and did not differ from steady-state-CMRA (3.5 ± 0.4 vs. 3.5 ± 0.6, P = 0.99). Non-diagnostic IQ of the defined vessels of interest was observed less frequently on REACT-CMRA (1.7 %) compared to steady-state- (4.3 %, P = 0.046) or first-pass-CMRA (20.9 %, P < 0.001). Close agreements in vessel diameter measurements were observed between REACT-CMRA and steady-state-CMRA (e.g. ascending aorta, bias: 0.38 ± 1.0 mm, 95 % limits of agreement (LOA): − 1.62–2.38 mm). REACT-CMRA showed high intra- (bias: 0.04 ± 1.0 mm, 95 % LOA: − 1.9–2.0 mm) and interobserver (bias: 0.20 ± 1.1 mm, 95 % LOA: − 2.0–2.4 mm) agreements regarding vessel diameter measurements. Fat-water separation artifacts were observed in 11/70 (16 %) patients on REACT-CMRA but did not limit diagnostic utility. Six vascular abnormalities were detected on REACT-CMRA that were not seen on standard contrast-enhanced CMRA. Non-contrast-enhanced cardiac-gated REACT-CMRA offers a high diagnostic quality for assessment of the thoracic vasculature in CHD patients.

中文翻译：

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使用心脏门控、磁化准备的 3D Dixon 方法进行自由呼吸非对比血流独立心血管磁共振血管造影：评估先天性心脏病的胸部脉管系统


评估基于磁化准备 Dixon 方法（无造影剂和触发的松弛增强血管造影，REACT）的非造影呼吸和心电图门控 3D 心血管磁共振血管造影 (CMRA)，以评估先天性心脏病的胸部脉管系统（冠心病）患者。这项单中心研究回顾性鉴定了 70 名 CHD 患者（平均 28 岁，范围：10-65 岁）。 REACT-CMRA 与呼吸门控和心脏门控一起应用。将 REACT-CMRA 的图像质量 (IQ) 与标准非门控多相首过 CMRA 以及呼吸和心电图门控稳态 CMRA 进行比较。不同感兴趣血管（升主动脉、左肺动脉、左上肺静脉、右冠状动脉口、冠状窦）的智商由两名读者按照李克特五点量表独立评估。在预定的解剖标志（升主动脉、左肺动脉、左上肺静脉）中进行血管直径测量。两位读者都评估了伪影和血管异常。采用Friedman检验、卡方检验和Bland-Altman法进行统计分析。 REACT-CMRA 的总体 IQ 得分高于首次通过 CMRA（3.5 ± 0.4 与 2.7 ± 0.4，P < 0.001），并且与稳态 CMRA 没有差异（3.5 ± 0.4 与 3.5 ± 0.6， P = 0.99）。与稳态（4.3%，P = 0.046）或首过 CMRA（20.9%，P < 0.001）相比，REACT-CMRA 中观察到的指定感兴趣血管的非诊断 IQ 频率较低（1.7%）。 。 REACT-CMRA 和稳态-CMRA 之间观察到血管直径测量结果非常一致（例如升主动脉，偏差：0.38 ± 1.0 mm，95% 一致性限（LOA）：− 1.62–2.38 mm）。 REACT-CMRA 显示了关于血管直径测量的高度内部（偏差：0.04 ± 1.0 mm，95 % LOA：− 1.9–2.0 mm）和观察者间（偏差：0.20 ± 1.1 mm，95 % LOA：− 2.0–2.4 mm）一致性。 REACT-CMRA 中 11/70 (16%) 的患者观察到脂水分离伪影，但这并不限制诊断效用。 REACT-CMRA 检测到六种血管异常，而标准对比增强 CMRA 上未发现这些异常。非对比增强心脏门控 REACT-CMRA 为 CHD 患者的胸部血管系统评估提供了高诊断质量。