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DOI: 10.1055/s-2001-16976
© Georg Thieme Verlag Stuttgart · New York
2D-Phasenkontrast-Flussquantifizierung und kontrastangehobene
3D-MR-Angiographie zur perioperativen Untersuchung des Arteria-mammaria-interna-Bypasses
2D-Phase contrast flow evaluation and contrast-enhanced MR angiography for perioperative assessment of internal mammary artery grafts
Publication History
Publication Date:
10 September 2001 (online)
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Zusammenfassung.
Ziel: Evaluation eines MR-Protokolls zur perioperativen Untersuchung des A.-mammaria-interna(IMA)- Bypasses mit Kombination der 2D-Phasenkontrasttechnik und kontrastangehobener 3D-MR-Angiographie mit gleichzeitiger Bestimmung linksventrikulärer (LV) Funktionsparameter. Material und Methoden: 27 Patienten mit 27/41 linksseitigen IMA (LIMA)/venösen Bypasses wurden prä- und 6 Monate postoperativ untersucht. Nach morphologischer Darstellung des Mediastinums (T1w-TSE, Schichtdicke 5 mm) wurden LV Funktionsparameter mittels cine-Bildgebung (segmentierte FLASH 2D, TReff 11 ms, TE 4,8 ms, Flipwinkel 25 °) bestimmt. Phasenkontrast-Flussmessungen (TR 24 ms, TE 5 ms, Flipwinkel 20 °) in der Aorta ascendens (venc 250 cm/s) und in den IMA (venc 75 cm/s) folgten. Die Bypassdarstellung erfolgte mittels einer FLASH-3D-MR-Angiographie (TR 3,8 ms, TE 1,4 ms, Flipwinkel 30 °) unter Gabe von 25 ml Gd-DTPA.Ergebnisse: Patienten mit eingeschränkter LV Funktion (EF < 50 %) zeigten postoperativ eine Besserung der EF von 38,4 ± 10,3 % auf 49,8 ± 15,3 % (p < 0,05). Von den LIMA-grafts waren 1/27 (koronarangiographisch bestätigt), von den venösen 6/41 verschlossen. Die Beurteilung der distalen Anastomose des LIMA-Bypasses gelang in 33 %. Im LIMA-Bypass fand sich eine Abnahme der Flusswerte von präoperativ 21,2 ± 11 ml/min/m2 auf 14,4 ± 9,6 ml/min/m2 (p < 0,01). Schlussfolgerungen: Die Kombination aus Flussmessung, 3D-MR-Angiographie und LV-Funktionsdiagnostik erhöht die Aussagekraft und diagnostische Sicherheit in der perioperativen Verlaufskontrolle von Patienten nach Myokardrevaskularisation.
2D-Phase contrast flow evaluation and contrast-enhanced MR angiography for perioperative assessment of internal mammary artery grafts.
Purpose: To evaluate LV functional parameters, graft flow and patency in patients with IMA grafts using a combined MR protocol with phase-contrast technique and contrast enhanced MR angiography. Material and Methods: Using a 1.5 T MR system 27 patients with 27 left internal mammary artery (LIMA) and 41 venous grafts were examined before and 6 months after CABG surgery. A T1w-TSE sequence (slice thickness 5 mm) was applied for morphological imaging. LV function (EF, CO) was evaluated on cine images (segmented FLASH 2D, TReff 11 ms, TE 4.8 ms, flip angle 25 °). A phase-contrast FLASH 2D (TR 24 ms, TE 5 ms, flip angle 20 °) sequence was applied for aortic and IMA flow measurements. Postoperatively, a contrast enhanced FLASH 3D MR angiography (TR 3.8 ms, TE 1.4 ms, flip angle 30 °) with 25 ml Gd-DTPA was performed to assess bypass patency. Results: In patients with reduced LV function (ejection fraction < 50 %) an improvement of the ejection fraction from 38.4 ± 10.3 % to 49.8 ± 15.3 % (p < 0.05) was found postoperatively. LIMA grafts were occluded in 1/27 patients, while 6/41 venous grafts were occluded. Distal LIMA anastomoses were demonstrated in 33 % by MRA. Flow of LIMA decreased from 21.2 ± 11 ml/min/m2 preoperatively to 14.4 ± 9.6 ml/min/m2 postoperatively (p < 0.01). Conclusion: MR imaging allows accurate combined assessment of LV function, bypass patency and flow. The protocol of this study may be applicable for perioperative follow-up studies in patients after CABG surgery.
Schlüsselwörter:
Magnetresonanztomographie - IMA Bypassgefäße - MR-Angiographie - MR-Flussquantifizierung - Myokardfunktion
Key words:
Magnetic Resonance Imaging - IMA Grafts - MR Angiography - MR Flow Quantification - Myocardial Function
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Dr. med. Norbert I. Stauder
Abteilung Radiologische Diagnostik
Universitätsklinik Tübingen
Hoppe-Seyler-Str. 3
72076 Tübingen
Phone: + 49-7071-2985837
Fax: + 49-7071-295392
Email: norbert.stauder@med.uni-tuebingen.de