학술논문
MRI Phase-Contrast Blood Flow in Fasting Pediatric Patients with Fontan Circulation Correlates with Exercise Capacity.
Document Type
Academic Journal
Author
Lam CZ; Department of Diagnostic Imaging (C.Z.L., D.D., L.A.I., P.P., G.B.C., M.S., S.J.Y.), Division of Cardiology, Department of Paediatrics (A.I.D., E.J.S.M., R.R.C., R.M.W., M.S., S.J.Y.), and Division of Gastroenterology, Department of Paediatrics (S.C.L.), Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; Department of Medical Imaging, University of Toronto, Toronto, Canada (C.Z.L., L.A.I., G.B.C., S.J.Y.); Joint Department of Medical Imaging, University Health Network, Toronto, Canada (R.M.W.); and Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, Toronto, Canada (R.M.W.).; David D; Department of Diagnostic Imaging (C.Z.L., D.D., L.A.I., P.P., G.B.C., M.S., S.J.Y.), Division of Cardiology, Department of Paediatrics (A.I.D., E.J.S.M., R.R.C., R.M.W., M.S., S.J.Y.), and Division of Gastroenterology, Department of Paediatrics (S.C.L.), Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; Department of Medical Imaging, University of Toronto, Toronto, Canada (C.Z.L., L.A.I., G.B.C., S.J.Y.); Joint Department of Medical Imaging, University Health Network, Toronto, Canada (R.M.W.); and Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, Toronto, Canada (R.M.W.).; Acosta Izquierdo L; Department of Diagnostic Imaging (C.Z.L., D.D., L.A.I., P.P., G.B.C., M.S., S.J.Y.), Division of Cardiology, Department of Paediatrics (A.I.D., E.J.S.M., R.R.C., R.M.W., M.S., S.J.Y.), and Division of Gastroenterology, Department of Paediatrics (S.C.L.), Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; Department of Medical Imaging, University of Toronto, Toronto, Canada (C.Z.L., L.A.I., G.B.C., S.J.Y.); Joint Department of Medical Imaging, University Health Network, Toronto, Canada (R.M.W.); and Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, Toronto, Canada (R.M.W.).; Pezeshkpour P; Department of Diagnostic Imaging (C.Z.L., D.D., L.A.I., P.P., G.B.C., M.S., S.J.Y.), Division of Cardiology, Department of Paediatrics (A.I.D., E.J.S.M., R.R.C., R.M.W., M.S., S.J.Y.), and Division of Gastroenterology, Department of Paediatrics (S.C.L.), Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; Department of Medical Imaging, University of Toronto, Toronto, Canada (C.Z.L., L.A.I., G.B.C., S.J.Y.); Joint Department of Medical Imaging, University Health Network, Toronto, Canada (R.M.W.); and Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, Toronto, Canada (R.M.W.).; Dipchand AI; Department of Diagnostic Imaging (C.Z.L., D.D., L.A.I., P.P., G.B.C., M.S., S.J.Y.), Division of Cardiology, Department of Paediatrics (A.I.D., E.J.S.M., R.R.C., R.M.W., M.S., S.J.Y.), and Division of Gastroenterology, Department of Paediatrics (S.C.L.), Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; Department of Medical Imaging, University of Toronto, Toronto, Canada (C.Z.L., L.A.I., G.B.C., S.J.Y.); Joint Department of Medical Imaging, University Health Network, Toronto, Canada (R.M.W.); and Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, Toronto, Canada (R.M.W.).; Jean-St-Michel E; Department of Diagnostic Imaging (C.Z.L., D.D., L.A.I., P.P., G.B.C., M.S., S.J.Y.), Division of Cardiology, Department of Paediatrics (A.I.D., E.J.S.M., R.R.C., R.M.W., M.S., S.J.Y.), and Division of Gastroenterology, Department of Paediatrics (S.C.L.), Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; Department of Medical Imaging, University of Toronto, Toronto, Canada (C.Z.L., L.A.I., G.B.C., S.J.Y.); Joint Department of Medical Imaging, University Health Network, Toronto, Canada (R.M.W.); and Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, Toronto, Canada (R.M.W.).; Chaturvedi RR; Department of Diagnostic Imaging (C.Z.L., D.D., L.A.I., P.P., G.B.C., M.S., S.J.Y.), Division of Cardiology, Department of Paediatrics (A.I.D., E.J.S.M., R.R.C., R.M.W., M.S., S.J.Y.), and Division of Gastroenterology, Department of Paediatrics (S.C.L.), Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; Department of Medical Imaging, University of Toronto, Toronto, Canada (C.Z.L., L.A.I., G.B.C., S.J.Y.); Joint Department of Medical Imaging, University Health Network, Toronto, Canada (R.M.W.); and Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, Toronto, Canada (R.M.W.).; Ling SC; Department of Diagnostic Imaging (C.Z.L., D.D., L.A.I., P.P., G.B.C., M.S., S.J.Y.), Division of Cardiology, Department of Paediatrics (A.I.D., E.J.S.M., R.R.C., R.M.W., M.S., S.J.Y.), and Division of Gastroenterology, Department of Paediatrics (S.C.L.), Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; Department of Medical Imaging, University of Toronto, Toronto, Canada (C.Z.L., L.A.I., G.B.C., S.J.Y.); Joint Department of Medical Imaging, University Health Network, Toronto, Canada (R.M.W.); and Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, Toronto, Canada (R.M.W.).; Wald RM; Department of Diagnostic Imaging (C.Z.L., D.D., L.A.I., P.P., G.B.C., M.S., S.J.Y.), Division of Cardiology, Department of Paediatrics (A.I.D., E.J.S.M., R.R.C., R.M.W., M.S., S.J.Y.), and Division of Gastroenterology, Department of Paediatrics (S.C.L.), Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; Department of Medical Imaging, University of Toronto, Toronto, Canada (C.Z.L., L.A.I., G.B.C., S.J.Y.); Joint Department of Medical Imaging, University Health Network, Toronto, Canada (R.M.W.); and Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, Toronto, Canada (R.M.W.).; Chavhan GB; Department of Diagnostic Imaging (C.Z.L., D.D., L.A.I., P.P., G.B.C., M.S., S.J.Y.), Division of Cardiology, Department of Paediatrics (A.I.D., E.J.S.M., R.R.C., R.M.W., M.S., S.J.Y.), and Division of Gastroenterology, Department of Paediatrics (S.C.L.), Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; Department of Medical Imaging, University of Toronto, Toronto, Canada (C.Z.L., L.A.I., G.B.C., S.J.Y.); Joint Department of Medical Imaging, University Health Network, Toronto, Canada (R.M.W.); and Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, Toronto, Canada (R.M.W.).; Seed M; Department of Diagnostic Imaging (C.Z.L., D.D., L.A.I., P.P., G.B.C., M.S., S.J.Y.), Division of Cardiology, Department of Paediatrics (A.I.D., E.J.S.M., R.R.C., R.M.W., M.S., S.J.Y.), and Division of Gastroenterology, Department of Paediatrics (S.C.L.), Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; Department of Medical Imaging, University of Toronto, Toronto, Canada (C.Z.L., L.A.I., G.B.C., S.J.Y.); Joint Department of Medical Imaging, University Health Network, Toronto, Canada (R.M.W.); and Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, Toronto, Canada (R.M.W.).; Yoo SJ; Department of Diagnostic Imaging (C.Z.L., D.D., L.A.I., P.P., G.B.C., M.S., S.J.Y.), Division of Cardiology, Department of Paediatrics (A.I.D., E.J.S.M., R.R.C., R.M.W., M.S., S.J.Y.), and Division of Gastroenterology, Department of Paediatrics (S.C.L.), Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; Department of Medical Imaging, University of Toronto, Toronto, Canada (C.Z.L., L.A.I., G.B.C., S.J.Y.); Joint Department of Medical Imaging, University Health Network, Toronto, Canada (R.M.W.); and Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, Toronto, Canada (R.M.W.).
Source
Publisher: Radiological Society of North America, Inc Country of Publication: United States NLM ID: 101748663 Publication Model: eCollection Cited Medium: Internet ISSN: 2638-6135 (Electronic) Linking ISSN: 26386135 NLM ISO Abbreviation: Radiol Cardiothorac Imaging Subsets: PubMed not MEDLINE
Subject
Language
English
Abstract
Purpose: To assess regional blood flow in fasting pediatric patients with Fontan circulation by using MRI and to explore associations with clinical parameters.
Materials and Methods: In this retrospective study, pediatric patients who had undergone the Fontan procedure (<18 years of age) and had undergone clinical cardiac MRI, performed after at least 4 hours of fasting, between 2018 and 2021 were included. Regional blood flow was compared with published healthy volunteer data ( n = 19) and assessed in relation to hemodynamic parameters and clinical status. Data are presented as medians, with first to third quartiles in parentheses. Mann-Whitney U , Kruskal-Wallis, χ2 , and Spearman rank correlation tests were used.
Results: Fifty-five patients (38 boys) with median age at MRI of 14 years (IQR, 11-16 years) and median time from Fontan procedure to MRI of 10 years (IQR, 8-12 years) were included. Patients after Fontan procedure had lower ascending aortic, inferior vena cava, and total systemic blood flow compared with healthy volunteers (3.00 L/min/m2 [IQR, 2.75-3.30 L/min/m 2 ] vs 3.61 L/min/m 2 [IQR, 3.29-4.07 L/min/m 2 ]; 1.73 L/min/m 2 [IQR, 1.40-1.94 L/min/m 2 ] vs 2.24 L/min/m 2 [IQR, 2.06-2.75 L/min/m 2 ]; 2.78 L/min/m 2 [IQR, 2.45-3.10 L/min/m 2 ] vs 3.95 L/min/m 2 [IQR, 3.20-4.30 L/min/m 2 ], respectively; P < .001). Portal vein flow was greater than hepatic vein flow in 25% of patients. Fontan blood flow was inversely correlated with pre-Fontan mean pulmonary artery pressure (Spearman rank correlation coefficient [ r s ]= -0.42, P = .005) and ventricular end diastolic pressure ( r s = -0.33, P = .04) and positively correlated with post-Fontan percent predicted oxygen consumption at peak workload ( r s = 0.34, P = .02).
Conclusion: Reference ranges are provided for regional systemic blood flow derived by using MRI in fasting pediatric patients with Fontan circulation, who had lower systemic blood flow compared with healthy volunteers. Lower fasting Fontan blood flow correlated with lower exercise capacity. Keywords : Pediatrics, Heart, Congenital, MR Imaging, Hemodynamics/Flow Dynamics, Cardiac Supplemental material is available for this article. © RSNA, 2022.
Competing Interests: Disclosures of conflicts of interest: C.Z.L. Grant-funded reimbursement from Additional Ventures as the site primary investigator at the Hospital for Sick Children for participation in the Fontan Outcomes Registry using CMR Extractions (FORCE); member of the executive leadership team for FORCE. D.D. No relevant relationships. L.A.I. No relevant relationships. P.P. No relevant relationships. A.I.D. No relevant relationships. E.J.S.M. No relevant relationships. R.R.C. No relevant relationships. S.C.L. No relevant relationships. R.M.W. No relevant relationships. G.B.C. Service on the Society for Pediatric Radiology Board. M.S. No relevant relationships. S.J.Y. No relevant relationships.
(© 2022 by the Radiological Society of North America, Inc.)
Materials and Methods: In this retrospective study, pediatric patients who had undergone the Fontan procedure (<18 years of age) and had undergone clinical cardiac MRI, performed after at least 4 hours of fasting, between 2018 and 2021 were included. Regional blood flow was compared with published healthy volunteer data ( n = 19) and assessed in relation to hemodynamic parameters and clinical status. Data are presented as medians, with first to third quartiles in parentheses. Mann-Whitney U , Kruskal-Wallis, χ
Results: Fifty-five patients (38 boys) with median age at MRI of 14 years (IQR, 11-16 years) and median time from Fontan procedure to MRI of 10 years (IQR, 8-12 years) were included. Patients after Fontan procedure had lower ascending aortic, inferior vena cava, and total systemic blood flow compared with healthy volunteers (3.00 L/min/m
Conclusion: Reference ranges are provided for regional systemic blood flow derived by using MRI in fasting pediatric patients with Fontan circulation, who had lower systemic blood flow compared with healthy volunteers. Lower fasting Fontan blood flow correlated with lower exercise capacity. Keywords : Pediatrics, Heart, Congenital, MR Imaging, Hemodynamics/Flow Dynamics, Cardiac Supplemental material is available for this article. © RSNA, 2022.
Competing Interests: Disclosures of conflicts of interest: C.Z.L. Grant-funded reimbursement from Additional Ventures as the site primary investigator at the Hospital for Sick Children for participation in the Fontan Outcomes Registry using CMR Extractions (FORCE); member of the executive leadership team for FORCE. D.D. No relevant relationships. L.A.I. No relevant relationships. P.P. No relevant relationships. A.I.D. No relevant relationships. E.J.S.M. No relevant relationships. R.R.C. No relevant relationships. S.C.L. No relevant relationships. R.M.W. No relevant relationships. G.B.C. Service on the Society for Pediatric Radiology Board. M.S. No relevant relationships. S.J.Y. No relevant relationships.
(© 2022 by the Radiological Society of North America, Inc.)