青少年三维超快心脏磁共振协议验证：与二维金标准对照的非劣效性研究
研究纳入39名青少年（平均12.2±2.6岁），在3T设备上对比三维超快CMR协议与常规二维金标准。三维协议总扫描时间显著缩短（75.8±10.0秒 vs. 734.4±19.6秒，P<0.05），图像质量评分相当（中位评分4.0，P=0.74），所有功能与应变指标均达到非劣效性，Bland-Altman偏倚小、ICC良好至优秀。结论认为三维超快协议在青少年心功能与应变定量评估中非劣于二维金标准，且扫描时间大幅缩短。
要点
- 所有心功能与应变指标均达到预设非劣效性，Bland-Altman偏倚小、ICC良好至优秀。
- 该协议含ESSOS电影序列与三维延迟强化，适用于需多次屏气的青少年人群。
核心结论
- 三维超快CMR协议在青少年心功能与应变定量评估中非劣于二维金标准，图像质量相当且扫描时间显著缩短。
研究设计与样本
- 单中心非劣效性研究，纳入39名青少年（平均年龄12.2±2.6岁），在3T设备上先后行常规二维协议与三维超快协议。
- 三维协议包含ESSOS电影序列与三维延迟强化，以预设非劣效性界值评估功能与应变参数，采用Bland-Altman分析和组内相关系数评价一致性。
关键影像表现/征象
- 三维协议图像质量评分中位数为4.0，与二维协议相当（P=0.74）。
- 三维协议在全部功能与应变指标上均达到统计非劣效性，Bland-Altman分析显示关键参数偏倚小。
诊断标准与关键数值
- 预设非劣效性界值用于评估功能与应变参数，各参数差值95%CI均落在非劣效性界值内。
- 组内相关系数显示所有参数一致性良好至优秀（n=39）。
临床应用与阅片要点
- 三维超快协议可显著缩短青少年CMR检查时间，减少屏气次数，提升临床可行性。
- 报告心功能与应变时，三维ESSOS电影与三维延迟强化序列的定量结果可与二维金标准同等参考。
局限性
- 单中心研究，样本量较小（39例），仅纳入青少年人群，结论外推需谨慎。
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
BACKGROUND: Cardiac magnetic resonance (CMR) is the gold standard for assessing cardiac anatomy and function. However, long acquisition times and multiple breath-holds pose significant challenges in pediatric imaging.
OBJECTIVE: To perform a non-inferiority analysis comparing a novel 3-dimensional (D) ultrafast CMR protocol against the conventional 2-dimensional (D) gold standard for evaluating cardiac function, strain, and tissue characterization in adolescents.
MATERIALS AND METHODS: Thirty-nine adolescents (mean age 12.2±2.6 years) underwent both a standard 2-D protocol and a 3-D ultrafast protocol at 3-T. The 3-D protocol comprised enhanced sensitivity encoding by static outer volume subtraction (ESSOS) cine and 3-D late gadolinium enhancement. Image quality and diagnostic confidence were compared. A pre-specified non-inferiority margin (Δ) was used to assess functional and strain parameters. Agreement was evaluated using Bland-Altman analysis and intraclass correlation coefficients (ICCs).
RESULTS: The total scan time was significantly shorter for the 3-D protocol compared to the 2-D protocol (75.8±10.0 s vs. 734.4±19.6 s, P<0.05). Image quality scores were comparable between protocols (median score 4.0, P=0.74). The 3-D protocol demonstrated statistical non-inferiority for all functional and strain metrics. Bland-Altman analysis showed minimal bias for key parameters, and the 95% confidence intervals for differences met the pre-specified non-inferiority margins. Intraclass correlation coefficients (ICCs) indicated good to excellent agreement for all parameters (n=39).
CONCLUSION: The novel 3-D ultrafast CMR protocol is non-inferior to the conventional 2-D gold standard for quantitative assessment of cardiac function and strain in adolescents. It offers comparable image quality with significantly reduced acquisition times, potentially improving clinical feasibility in pediatric populations.
引用
- Chen W, Liu S, Li W, et al. Validation of a novel three-dimensional ultrafast cardiac magnetic resonance imaging protocol in adolescents: a non-inferiority study compared with the two-dimensional gold standard. Pediatr Radiol. 2026. PMID: 42165860. doi:10.1007/s00247-026-06651-w
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。