肥厚型心肌病LVOTO的4D Flow半自动峰值流速测量
由两名观察者分别用传统法与半自动法测量左心室流出道峰值流速并记录后处理时间。结果显示半自动法观察者内及观察者间一致性均为优秀，且分析时间显著短于传统法。
要点
- 半自动法测量LVOT峰值流速观察者间一致性优秀（ICC=0.999），优于传统法（ICC=0.859）。
- 半自动法后处理时间显著缩短（p<10⁻³），适合临床繁忙工作流。
- 该法基于1.5T下kat-ARC加速4D flow序列，适用于肥厚型心肌病伴LVOTO患者初诊或随访。
核心结论
- 半自动法在kat-ARC加速4D flow序列上测量LVOT峰值流速快速且可重复。
- 该法可替代耗时且依赖操作者的传统定量方法，用于肥厚型心肌病伴左心室流出道梗阻患者。
研究设计与样本
- 所有患者在1.5T心脏MRI常规方案中加做自由呼吸kat-ARC加速4D flow序列，用于初诊或随访评估。
- MRI图像匿名化后由两名观察者分别采用传统法与半自动法测量LVOT峰值流速，并记录每种方法后处理时长。
关键影像表现/征象
- 观察者内一致性方面，半自动法ICC=0.998，传统法ICC=0.905，半自动法略高于传统法。
- 观察者间一致性方面，传统法ICC=0.859为良好，半自动法ICC=0.999为优秀。
- 半自动法分析时间显著短于传统法（p<10⁻³）。
诊断标准与关键数值
- 观察者内一致性：半自动法ICC=0.998，传统法ICC=0.905。
- 观察者间一致性：半自动法ICC=0.999，传统法ICC=0.859。
- 分析时间差异有统计学意义，半自动法显著更短（p<10⁻³）。
临床应用与阅片要点
- 对肥厚型心肌病伴左心室流出道梗阻患者，可考虑采用半自动法在4D flow序列上测量LVOT峰值流速以节省报告时间。
- 半自动法的观察者间一致性优秀，有助于减少不同报告医师之间的测量差异。
- 该半自动法需在kat-ARC加速4D flow序列条件下使用，推广至其他序列前需验证。
局限性
- 本研究为单中心设计。
- 研究设备固定为1.5T MRI及kat-ARC加速4D flow序列，结果向其他场强或序列推广需进一步验证。
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: The presence of left ventricular outflow tract obstruction (LVOTO) is an important factor in the management of hypertrophic cardiomyopathy. Measurement of left ventricular outflow tract (LVOT) peak velocity on 4D flow cardiac magnetic resonance imaging using current postprocessing methods can be laborious and time-consuming. The purpose of this study was to assess the reliability and reproducibility of a new semiautomatic measurement method.
MATERIALS AND METHODS: This single-center prospective study included patients who underwent cardiac MRI at 1.5 T for the assessment of hypertrophic cardiomyopathy with left ventricular ejection obstruction as part of their initial assessment or follow-up. A free-breathing kat-ARC accelerated 4D flow sequence was added to the usual protocol. MRI scans were anonymized and analyzed by two observers to quantify LVOT peak velocity using conventional and semiautomatic methods. The duration of postprocessing was recorded for each method.
RESULTS: Twenty-six patients (60.9 ± 11 years, 11 men) were included. Intraobserver agreement was excellent for both methods but was slightly higher for the semiautomatic method than for the conventional method (Intraclass Correlation Coefficient ICC = 0.998 vs 0.905). Interobserver agreement was good for the conventional method (ICC = 0.859) and excellent for the semiautomatic method (ICC = 0.999). In addition, analysis times were significantly shorter with the semiautomatic method (p < 10-3).
CONCLUSION: The semiautomatic method for measuring LVOT peak velocity on a kat-ARC accelerated 4D flow sequence in hypertrophic cardiomyopathy with left ventricular outflow tract obstruction is fast and reproducible. It is an alternative to the conventional quantification method, which is time-consuming and operator dependent.
引用
- Desdoit, Bouzerar, Dantoing, et al. Semiautomatic method for peak velocity quantification using 4D flow imaging in hypertrophic cardiomyopathy with left ventricular outflow tract obstruction. Eur J Radiol. 2026. PMID: 42250485. doi:10.1016/j.ejrad.2026.112975
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。