循環器ジャーナル67巻3号

2019年07月発行

特集 循環器疾患の画像診断—現状と進歩 Ⅴ．肺循環疾患

MRIを用いた右室機能評価を知る

著者： 奥田茂男¹ 山田祥岳¹ 陣崎雅弘¹

所属機関： ¹慶應義塾大学医学部放射線科（診断）

ページ範囲：P.420 - P.426

Point
・右室容積計測や肺動脈弁逆流の評価は経胸壁エコーでは難しく，MRIにより行われる．
・右室容積計測に際しては輪郭描画，血流速度・血流量の計測に当たっては撮像断面とVENC設定の最適化が重要である．
・肺動脈弁閉鎖不全がある場合には，渦流やらせん流により血流量の計測値が影響を受けることがあり，大動脈と肺動脈血流の整合性を確認する必要がある．

参考文献

1) Kramer CM, Barkhausen J, Flamm SD, et al:Standardized cardiovascular magnetic resonance imaging（CMR）protocols, society for cardiovascular magnetic resonance:board of trustees task force on standardized protocols. J Cardiovasc Magn Reson 10:35, 2008

2) Kramer CM, Barkhausen J, Flamm SD, et al:Standardized cardiovascular magnetic resonance（CMR）protocols 2013 update. J Cardiovasc Magn Reson 15:91, 2013

3) Lotz J, Meier C, Leppert A, et al:Cardiovascular flow measurement with phase-contrast MR imaging:basic facts and implementation. Radiographics 22:651-671, 2002

4) Roeleveld RJ, Marcus JT, Faes TJ, et al:Interventricular septal configuration at mr imaging and pulmonary arterial pressure in pulmonary hypertension. Radiology 234:710-717, 2005

5) Goerne H, Batra K, Rajiah P:Imaging of pulmonary hypertension:an update. Cardiovascular diagnosis and therapy 8:279-296, 2018

6) Morikawa T, Murata M, Okuda S, et al:Quantitative analysis of right ventricular function in patients with pulmonary hypertension using three-dimensional echocardiography and a two-dimensional summation method compared to magnetic resonance imaging. Am J Cardiol 107:484-489, 2011

7) Valsangiacomo Buechel ER, Mertens LL:Imaging the right heart:the use of integrated multimodality imaging. Eur Heart J 33:949-960, 2012

8) Alfakih K, Plein S, Bloomer T, et al:Comparison of right ventricular volume measurements between axial and short axis orientation using steady-state free precession magnetic resonance imaging. J Magn Reson Imaging 18:25-32, 2003

9) Clarke CJ, Gurka MJ, Norton PT, et al:Assessment of the accuracy and reproducibility of RV volume measurements by CMR in congenital heart disease. JACC Cardiovasc Imaging 5:28-37, 2012

10) Johansson B, Babu-Narayan SV, Kilner PJ:The effects of breath-holding on pulmonary regurgitation measured by cardiovascular magnetic resonance velocity mapping. J Cardiovasc Magn Reson 11:1, 2009

11) Oosterhof T, van Straten A, Vliegen HW, et al:Preoperative thresholds for pulmonary valve replacement in patients with corrected tetralogy of Fallot using cardiovascular magnetic resonance. Circulation 116:545-551, 2007

12) Buechel ER, Dave HH, Kellenberger CJ, et al:Remodelling of the right ventricle after early pulmonary valve replacement in children with repaired tetralogy of Fallot:assessment by cardiovascular magnetic resonance. Eur Heart J 26:2721-2727, 2005

13) He F, Feng Z, Chen Q, et al:Whether Pulmonary Valve Replacement in Asymptomatic Patients With Moderate or Severe Regurgitation After Tetralogy of Fallot Repair Is Appropriate:A Case-Control Study. J Am Heart Assoc 8:e010689, 2019

14) Yamada Y, Okuda S, Kataoka M, et al:Prognostic value of cardiac magnetic resonance imaging for idiopathic pulmonary arterial hypertension before initiating intravenous prostacyclin therapy. Circ J 76:1737-1743, 2012

15) Baggen VJ, Leiner T, Post MC, et al:Cardiac magnetic resonance findings predicting mortality in patients with pulmonary arterial hypertension:a systematic review and meta-analysis. Eur Radiol 26:3771-3780, 2016

16) Reiter G, Reiter U, Kovacs G, et al:Blood flow vortices along the main pulmonary artery measured with MR imaging for diagnosis of pulmonary hypertension. Radiology 275:71-79, 2015

17) Marcus FI, McKenna WJ, Sherrill D, et al:Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia:proposed modification of the task force criteria. Circulation 121:1533-1541, 2010

18) Kochav J, Simprini L, Weinsaft JW:Imaging of the right heart--CT and CMR. Echocardiography 32 Suppl 1:S53-68, 2015

19) Sjoberg P, Bidhult S, Bock J, et al:Disturbed left and right ventricular kinetic energy in patients with repaired tetralogy of Fallot:pathophysiological insights using 4D-flow MRI. Eur Radiol 28:4066-4076, 2018

20) Lin ACW, Seale H, Hamilton-Craig C, et al:Quantification of biventricular strain and assessment of ventriculo-ventricular interaction in pulmonary arterial hypertension using exercise cardiac magnetic resonance imaging and myocardial feature tracking. J Magn Reson Imaging 49:1427-1436, 2019

21) Auger DA, Zhong X, Epstein FH, et al:Mapping right ventricular myocardial mechanics using 3D cine DENSE cardiovascular magnetic resonance. J Cardiovasc Magn Reson 14:4, 2012

22) Oyama-Manabe N, Sato T, Tsujino I, et al:The strain-encoded（SENC）MR imaging for detection of global right ventricular dysfunction in pulmonary hypertension. Int J Cardiovasc Imaging 29:371-378, 2013