高对比度呼吸运动校正与心电门控3D T2准备GRE MRI结合Dixon水脂分离在3T下评估主动脉和冠状动脉：有无主动脉根部手术患者的对比研究
本研究纳入55例心血管MRI患者（26例有主动脉手术史，29例无），比较新型心电门控非增强T2准备GRE联合Dixon水脂分离序列（T2p GD）与标准对比增强MR血管成像（CE-MRA）的诊断性能。结果显示T2p GD序列在主动脉信噪比与CE-MRA相当，但在室间隔和心包脂肪信噪比更高，主动脉-脂肪对比噪声比显著增加，且图像质量评分更高，能更准确测量主动脉窦和冠状动脉近段。
要点
- T2p GD序列可提供与CE-MRA相当的主动脉信噪比，且主动脉-脂肪对比噪声比更高。
- T2p GD序列测量的血管直径一致大于CE-MRA，因其包含血管壁解剖轮廓而非仅管腔内边界。
- 新序列图像整体质量评分更高，对主动脉窦和冠状动脉近段的主观 delineation 更优，便于准确测量。
关键影像表现/征象
- T2p GD序列在室间隔和心包脂肪的信噪比高于CE-MRA，主动脉-脂肪对比噪声比显著增加。
- 有主动脉手术史不影响整体信噪比或对比噪声比，但在T2p GD的水-only图像中，主动脉-脂肪对比噪声比在有手术史患者中显著降低。
- T2p GD序列测量的血管直径一致大于CE-MRA，因CE-MRA仅评估管腔内边界，而T2p GD序列包含血管壁解剖 delineation。
- 定性图像评估显示新序列整体质量评分更高，主观 delineation 更优，使所有读者能更准确测量主动脉窦和冠状动脉近段。
诊断标准与关键数值
- 图像质量采用五点Likert量表评估，新序列整体质量评分高于CE-MRA。
- 信噪比在主动脉、心包脂肪和心肌室间隔测量，对比噪声比计算主动脉-室间隔和主动脉-脂肪。
临床应用与阅片要点
- 在需要评估主动脉壁解剖（如主动脉根部手术前后）时，T2p GD序列可提供管壁信息，弥补CE-MRA仅显示管腔的不足。
- 测量主动脉直径时需注意T2p GD序列因包含血管壁而测值大于CE-MRA，报告时应注明测量方法。
- 对于有主动脉手术史的患者，T2p GD水-only图像中主动脉-脂肪对比噪声比可能降低，阅片时需关注图像质量并必要时调整窗宽窗位。
局限性
- 单中心研究，样本量55例，结果需多中心验证。
- 有主动脉手术史患者亚组样本量较小（26例），可能影响亚组分析效能。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
OBJECTIVES: Magnetic resonance imaging (MRI) is a widely utilized, non-invasive imaging modality for evaluating aortic diseases. In this study, we sought to validate a novel, ECG-gated, non-contrast enhanced cardiovascular magnetic resonance sequence (T2-Prepared GRE and Dixon Water-Fat Separation, T2p GD) in patients with aortic disease - both with and without prior aortic surgery - and to compare its diagnostic performance with that of standard contrast-enhanced MR angiography (CE-MRA).
MATERIALS AND METHODS: A total of 55 patients undergoing cardiovascular MRI were recruited, including 26 with and 29 without a history of aortic surgery. The signal-to-noise ratio (SNR) was measured in the aorta, pericardial fat, and myocardial septum, while the contrast-to-noise ratios (CNR) between the aorta and septum, and the aorta and fat, were calculated for both imaging methods, stratified by surgical history. Additionally, diameters of the aorta and coronary arteries were assessed. The diagnostic quality of the images was evaluated using a five-point Likert scale.
RESULTS: While the SNR in the aorta was comparable between sequences, the new sequence provided higher SNR in both the septum and pericardial fat, as well as a significant increase in the aorta-to-fat CNR. Prior aortic surgery did not affect SNR or CNR values overall; however, in the water-only images of the new sequence, CNR between the aorta and fat was significantly lower in patients with prior surgery. Vascular diameters measured with the T2p GD sequence were consistently larger, as CE-MRA only assesses the endoluminal borders, while the T2p GD sequence includes anatomic delineation of the vessel wall. Qualitative image assessment revealed that the new sequence achieved higher overall quality ratings and superior subjective delineation, enabling more accurate measurement of the aortic sinus and the proximal third of the coronary arteries across all readers.
CONCLUSIONS: The novel T2p GD sequence enables detailed anatomic characterization of the aorta and coronary arteries and a higher CNR than conventional CE-MRA, even in patients with a history of aortic surgery.
引用
- Cereghetti GM, Huber LP, Todorski I, et al. Aorta and coronary artery assessment using high-contrast respiratory motion corrected and ECG-gated 3D T2-prepared GRE MRI with Dixon fat-water separation in patients with and without prior aortic root surgery at 3 T. Eur J Radiol. 2026. PMID: 42114380. doi:10.1016/j.ejrad.2026.112919
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。