双主动脉弓:胎儿 CMR、产后 CT 和手术结果的比较。

IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Milou P M van Poppel, David F A Lloyd, Johannes K Steinweg, Sujeev Mathur, James Wong, Vita Zidere, Simone Speggiorin, Haran Jogeesvaran, Reza Razavi, John M Simpson, Kuberan Pushparajah, Trisha V Vigneswaran
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引用次数: 0

摘要

背景:在双主动脉弓(DAA)中,其中一个主动脉弓在出生后可表现出闭锁部分,由于与孤立的右主动脉弓(RAA)变异重叠而导致诊断的不确定性。本研究的主要目的是利用三维胎儿心脏磁共振成像(CMR)和产后CT/CMR成像,展示不同DAA表型从出生前到出生后的形态演变。对所有经手术证实为 DAA 的病例进行回顾性研究,并将胎儿 CMR 的形态与产后 CT/CMR 和手术结果进行比较:结果:32 例经手术证实为 DAA 的胎儿接受了胎儿 CMR 检查。结果:32 例经手术确诊的 DAA 胎儿均接受了胎儿 CMR 检查。30/32(94%)的胎儿 RAA 为显性。中位年龄为 3.3 个月(IQR 2.0-3.9)时进行了产后 CT/CMR,结果显示 9/32 例(28%)患儿的 DAA 双侧动脉弓均通畅,其中 6 例出现左主动脉弓(LAA)闭塞的迹象。22/32(69%)例的 CT/CMR 未显示 LAA 峡,1 例未显示左颈动脉和左锁骨下动脉之间的横弓:胎儿CMR为DAA的围产期演变提供了新的见解。较小的 LAA 可因出生后动脉导管收缩而发生闭塞,这使得 DAA 的诊断对造影剂增强 CT/CMR 具有挑战性。这凸显了产前三维血管成像的潜在重要作用,并可能改善产后成像的解释。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Double aortic arch: a comparison of fetal cardiovascular magnetic resonance, postnatal computed tomography and surgical findings.

Background: In double aortic arch (DAA), one of the arches can demonstrate atretic portions postnatally, leading to diagnostic uncertainty due to overlap with isolated right aortic arch (RAA) variants. The main objective of this study is to demonstrate the morphological evolution of different DAA phenotypes from prenatal to postnatal life using three-dimensional (3D) fetal cardiac magnetic resonance (CMR) imaging and postnatal computed tomography (CT)/CMR imaging.

Methods: Three-dimensional fetal CMR was undertaken in fetuses with suspected DAA over a 6-year period (January 2016-January 2022). All cases with surgical confirmation of DAA were retrospectively studied and morphology on fetal CMR was compared to postnatal CT/CMR and surgical findings.

Results: Thirty-four fetuses with surgically confirmed DAA underwent fetal CMR. The RAA was dominant in 32/34 (94%). Postnatal CT/CMR was undertaken at a median age of 3.3 months (interquartile range 2.0-3.9) demonstrating DAA with patency of both arches in 10/34 (29%), with 7 showing signs of coarctation of the left aortic arch (LAA). The LAA isthmus was not present on CT/CMR in 22/34 (65%), and the transverse arch between left carotid and left subclavian artery was not present in 2 cases.

Conclusion: Fetal CMR provides novel insights into perinatal evolution of DAA. The smaller LAA can develop coarctation or atresia related to postnatal constriction of the arterial duct, making diagnosis of DAA challenging with contrast-enhanced CT/CMR. This highlights the potentially important role for prenatal 3D vascular imaging and might improve the interpretation of postnatal imaging.

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来源期刊
CiteScore
10.90
自引率
12.50%
发文量
61
审稿时长
6-12 weeks
期刊介绍: Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.
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