Benjamin Kelly, Sheyanth Mohanakumar, Brooke Ford, Christopher L Smith, Erin Pinto, David M Biko, Vibeke E Hjortdal, Yoav Dori
{"title":"对丰坦手术完成过程中淋巴异常的顺序 MRI 评估。","authors":"Benjamin Kelly, Sheyanth Mohanakumar, Brooke Ford, Christopher L Smith, Erin Pinto, David M Biko, Vibeke E Hjortdal, Yoav Dori","doi":"10.1148/ryct.230315","DOIUrl":null,"url":null,"abstract":"<p><p>Purpose To evaluate lymphatic abnormalities before and after Fontan completion using noncontrast lymphatic imaging and relate findings with postoperative outcomes. Materials and Methods This study is a retrospective review of noncontrast T2-weighted lymphatic imaging performed at The Children's Hospital of Philadelphia from June 2012 to February 2023 in patients with single ventricle physiology. All individuals with imaging at both pre-Fontan and Fontan stages were eligible. Lymphatic abnormalities were classified into four types based on severity and location of lymphatic vessels. Classifications were compared between images and related to clinical outcomes such as postoperative drainage and hospitalization, lymphatic complications, heart transplant, and death. Results Forty-three patients (median age, 10 years [IQR, 8-11]; 20 [47%] boys, 23 [53%] girls) were included in the study. Lymphatic abnormalities progressed in 19 individuals after Fontan completion (distribution of lymphatic classifications: type 1, 23; type 2, 11; type 3, 6; type 4, 3 vs type 1, 10; type 2, 18; type 3, 10; type 4, 5; <i>P</i> = .04). Compared with individuals showing no progression of lymphatic abnormalities, those progressing to a high-grade lymphatic classification had longer postoperative drainage (median time, 9 days [IQR, 6-14] vs 17 days [IQR, 10-23]; <i>P</i> = .04) and hospitalization (median time, 13 days [IQR, 9-25] vs 26 days [IQR, 18-30]; <i>P</i> = .03) after Fontan completion and were more likely to develop chylothorax (12% [three of 24] vs 75% [six of eight]; <i>P</i> < .01) and/or protein-losing enteropathy (0% [0 of 24] vs 38% [three of eight]; <i>P</i> < .01) during a median follow-up of 8 years (IQR, 5-9). Progression to any type was not associated with an increased risk of adverse events. Conclusion The study demonstrated that lymphatic structural abnormalities may progress in select individuals with single ventricle physiology after Fontan completion, and progression of abnormalities to a high-grade classification was associated with worse postoperative outcomes. <b>Keywords:</b> Congenital Heart Disease, Glenn, Fontan, Lymphatic Imaging, Cardiovascular MRI <i>Supplemental material is available for this article.</i> Published under a CC BY 4.0 license.</p>","PeriodicalId":21168,"journal":{"name":"Radiology. Cardiothoracic imaging","volume":"6 3","pages":"e230315"},"PeriodicalIF":3.8000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11211943/pdf/","citationCount":"0","resultStr":"{\"title\":\"Sequential MRI Evaluation of Lymphatic Abnormalities over the Course of Fontan Completion.\",\"authors\":\"Benjamin Kelly, Sheyanth Mohanakumar, Brooke Ford, Christopher L Smith, Erin Pinto, David M Biko, Vibeke E Hjortdal, Yoav Dori\",\"doi\":\"10.1148/ryct.230315\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Purpose To evaluate lymphatic abnormalities before and after Fontan completion using noncontrast lymphatic imaging and relate findings with postoperative outcomes. Materials and Methods This study is a retrospective review of noncontrast T2-weighted lymphatic imaging performed at The Children's Hospital of Philadelphia from June 2012 to February 2023 in patients with single ventricle physiology. All individuals with imaging at both pre-Fontan and Fontan stages were eligible. Lymphatic abnormalities were classified into four types based on severity and location of lymphatic vessels. Classifications were compared between images and related to clinical outcomes such as postoperative drainage and hospitalization, lymphatic complications, heart transplant, and death. Results Forty-three patients (median age, 10 years [IQR, 8-11]; 20 [47%] boys, 23 [53%] girls) were included in the study. Lymphatic abnormalities progressed in 19 individuals after Fontan completion (distribution of lymphatic classifications: type 1, 23; type 2, 11; type 3, 6; type 4, 3 vs type 1, 10; type 2, 18; type 3, 10; type 4, 5; <i>P</i> = .04). Compared with individuals showing no progression of lymphatic abnormalities, those progressing to a high-grade lymphatic classification had longer postoperative drainage (median time, 9 days [IQR, 6-14] vs 17 days [IQR, 10-23]; <i>P</i> = .04) and hospitalization (median time, 13 days [IQR, 9-25] vs 26 days [IQR, 18-30]; <i>P</i> = .03) after Fontan completion and were more likely to develop chylothorax (12% [three of 24] vs 75% [six of eight]; <i>P</i> < .01) and/or protein-losing enteropathy (0% [0 of 24] vs 38% [three of eight]; <i>P</i> < .01) during a median follow-up of 8 years (IQR, 5-9). Progression to any type was not associated with an increased risk of adverse events. Conclusion The study demonstrated that lymphatic structural abnormalities may progress in select individuals with single ventricle physiology after Fontan completion, and progression of abnormalities to a high-grade classification was associated with worse postoperative outcomes. <b>Keywords:</b> Congenital Heart Disease, Glenn, Fontan, Lymphatic Imaging, Cardiovascular MRI <i>Supplemental material is available for this article.</i> Published under a CC BY 4.0 license.</p>\",\"PeriodicalId\":21168,\"journal\":{\"name\":\"Radiology. Cardiothoracic imaging\",\"volume\":\"6 3\",\"pages\":\"e230315\"},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2024-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11211943/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Radiology. Cardiothoracic imaging\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1148/ryct.230315\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Radiology. Cardiothoracic imaging","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1148/ryct.230315","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
引用次数: 0
摘要
目的 使用非对比淋巴成像评估丰坦手术完成前后的淋巴异常,并将结果与术后预后联系起来。材料和方法 本研究是对费城儿童医院自2012年6月至2023年2月对单心室生理学患者进行的非对比T2加权淋巴成像的回顾性研究。所有在Fontan前期和Fontan阶段进行成像的患者均符合条件。根据淋巴管的严重程度和位置,淋巴异常被分为四种类型。对不同图像的分类进行比较,并将其与术后引流和住院、淋巴并发症、心脏移植和死亡等临床结果联系起来。结果 研究共纳入 43 名患者(中位年龄 10 岁 [IQR,8-11];20 [47%] 男孩,23 [53%] 女孩)。19名患者在丰坦手术完成后出现淋巴异常(淋巴分类分布:1型,23人;2型,11人;3型,6人;4型,3人 vs 1型,10人;2型,18人;3型,10人;4型,5人;P = .04)。与淋巴异常没有进展的患者相比,淋巴异常进展为高级别的患者术后引流时间(中位时间,9 天 [IQR, 6-14] vs 17 天 [IQR, 10-23];P = .04)和住院时间(中位时间,13 天 [IQR, 9-25] vs 26 天 [IQR, 18-30];P = .在中位随访8年(IQR,5-9年)期间,患者在丰坦手术完成后更容易出现乳糜胸(12% [24例中的3例] vs 75% [8例中的6例];P < .01)和/或蛋白丢失性肠病(0% [24例中的0例] vs 38% [8例中的3例];P < .01)。进展为任何类型的肠病与不良事件风险增加无关。结论 该研究表明,单心室生理学的特定个体在完成丰坦手术后淋巴结构异常可能会进展,异常进展到高级别分类与术后预后较差有关。关键词:先天性心脏病先天性心脏病 格伦 Fontan 淋巴成像 心血管磁共振成像 本文有补充材料。以 CC BY 4.0 许可发布。
Sequential MRI Evaluation of Lymphatic Abnormalities over the Course of Fontan Completion.
Purpose To evaluate lymphatic abnormalities before and after Fontan completion using noncontrast lymphatic imaging and relate findings with postoperative outcomes. Materials and Methods This study is a retrospective review of noncontrast T2-weighted lymphatic imaging performed at The Children's Hospital of Philadelphia from June 2012 to February 2023 in patients with single ventricle physiology. All individuals with imaging at both pre-Fontan and Fontan stages were eligible. Lymphatic abnormalities were classified into four types based on severity and location of lymphatic vessels. Classifications were compared between images and related to clinical outcomes such as postoperative drainage and hospitalization, lymphatic complications, heart transplant, and death. Results Forty-three patients (median age, 10 years [IQR, 8-11]; 20 [47%] boys, 23 [53%] girls) were included in the study. Lymphatic abnormalities progressed in 19 individuals after Fontan completion (distribution of lymphatic classifications: type 1, 23; type 2, 11; type 3, 6; type 4, 3 vs type 1, 10; type 2, 18; type 3, 10; type 4, 5; P = .04). Compared with individuals showing no progression of lymphatic abnormalities, those progressing to a high-grade lymphatic classification had longer postoperative drainage (median time, 9 days [IQR, 6-14] vs 17 days [IQR, 10-23]; P = .04) and hospitalization (median time, 13 days [IQR, 9-25] vs 26 days [IQR, 18-30]; P = .03) after Fontan completion and were more likely to develop chylothorax (12% [three of 24] vs 75% [six of eight]; P < .01) and/or protein-losing enteropathy (0% [0 of 24] vs 38% [three of eight]; P < .01) during a median follow-up of 8 years (IQR, 5-9). Progression to any type was not associated with an increased risk of adverse events. Conclusion The study demonstrated that lymphatic structural abnormalities may progress in select individuals with single ventricle physiology after Fontan completion, and progression of abnormalities to a high-grade classification was associated with worse postoperative outcomes. Keywords: Congenital Heart Disease, Glenn, Fontan, Lymphatic Imaging, Cardiovascular MRI Supplemental material is available for this article. Published under a CC BY 4.0 license.