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4D МР-визуализация потока: ценность и клинические перспективы у пациентов с патологией сердца и магистральных сосудов
Юрпольская Л.А. 4D МР-визуализация потока: ценность и клинические перспективы у пациентов с патологией сердца и магистральных сосудов.Терапевтический архив. 2024;96(4):391–395.
DOI: 10.26442/00403660.2024.04.202683
© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.
DOI: 10.26442/00403660.2024.04.202683
© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.
________________________________________________
Yurpolskaya LA. 4D flow MRI: value and clinical perspectives in patients with pathology of the heart and great vessels. A review. Terapevticheskii Arkhiv (Ter. Arkh.). 2024;96(4):391–395.
DOI: 10.26442/00403660.2024.04.202683
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Аннотация
Изучение кровотока становится новым трендом в кардиологии и сердечно-сосудистой хирургии. На основе литературных и собственных данных представлен обзор по применению 4D-магнитно-резонансной визуализации потока (4D flow) при заболеваниях сердца и сосудов. Подробно изложены особенности применения методики при разных патологиях сердечно-сосудистой системы, рассмотрены приоритеты, ограничения и перспективные направления использования методики с учетом целей практической медицины. Обзор состоит из двух частей. Первая посвящена общим вопросам, ограничениям методики и 4D-картированию потока у пациентов с поражением магистральных сосудов. Во второй части акцент сделан на использование 4D магнитно-резонансного томографического потока при изучении внутрижелудочкового кровотока и применение методики при врожденных пороках сердца и сосудов.
Ключевые слова: 4D-визуализация потока, заболевания сердца и сосудов, гемодинамика, магнитно-резонансная томография
Ключевые слова: 4D-визуализация потока, заболевания сердца и сосудов, гемодинамика, магнитно-резонансная томография
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The study of blood flow is becoming a new trend in cardiology and cardiovascular surgery. Based on the literature and our own data, a review is presented on the use of 4D flow in diseases of the heart and blood vessels. The main state of the question about the features of the application of the technique in various pathologies of the cardiovascular system is described in detail, the priorities, limitations and promising directions of the technique application are considered taking into account the goals of practical medicine. The review consists of two parts. The first is devoted to general issues, limitations of the technique, and issues of 4D flow mapping in patients with lesions of the great vessels. In the second part, the emphasis is on the use of 4D flow magnetic resonance imaging in the study of intraventricular blood flow and the application of the technique in congenital heart and vascular diseases.
Keywords: 4D flow, cardiovascular diseases, hemodynamics, magnetic resonance imaging
Полный текст
Список литературы
1. Takehara Y. 4D Flow when and how? Radiol Med. 2020;125(9):838-50. DOI:10.1007/s11547-020-01249-0
2. Itatani K, Sekine T, Yamagishi M, et al. Hemodynamic Parameters for Cardiovascular System in 4D Flow MRI: Mathematical Definition and Clinical Applications. Magn Res Med Sci. 2022;21(2):380-99. DOI:10.2463/mrms.rev.2021-0097
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DOI:10.21037/cdt-20-452
4. Oyama-Manabe N, Aikawа T, Tsuneta S, Manabe O. Clinical Applications of 4D Flow MR Imaging in Aortic Valvular and Congenital Heart Disease. Magn Reson Med Sci.
2022;21:319-26. DOI:10.2463/mrms.rev.2021-0030
5. Zhuang B, Sirajuddin A, Zhao S, Lu M. The role of 4D flow MRI for clinical applications in cardiovascular disease: current status and future perspectives. Quant Imaging Med Surg. 2021;11(9):4193-210. DOI:10.21037/ qims-20-1234
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11. Garcia J, Barker AJ, Markl M. The Role of Imaging of Flow Patterns by 4D flow MRI in Aortic Stenosis. JACC Cardiovasc Imaging. 2019;12:252-66. DOI:10.1016/j.jcmg.2018.10.034
12. Demirkiran Ah, van Ooij P, Westenberg JJM, et al. Clinical intra-cardiac 4D flow CMR: acquisition, analysis, and clinical applications. Еur Heart J Cardiovasc Imag. 2022;23:154-65. DOI:10.1093/ehjci/ jeab112
13. Blanken CPS, Farag ES, Boekholdt SM, et al. Advanced cardiac MRI techniques for evaluation of left-sided valvular heart disease. J Magn Reson Imaging. 2018;48:318-29. DOI:10.1002/jmri. 26204
14. Youssefi P, Sharma R, Figueroa CA, Jahangiri M. Functional assessment of thoracic aortic aneurysms – the future of risk prediction? Br Med Bull. 2017;121:61-71. DOI:10.1093/bmb/ldw049
15. Dux-Santoy L, Guala A, Teixido-Tura G, et al. Increased rotational flow in the proximal aortic arch is associated with its dilation in bicuspid aortic valve disease. Eur Heart J Cardiovasc Imaging. 2019;20:1407-17. DOI:10.1093/ehjci/jez046
16. Rodríguez-Palomares JF, Dux-Santoy L, Guala A, et al. Aortic flow patterns and wall shear stress maps by 4D-flow flow patterns and wall shear stress maps by 4D-flow cardiovascular magnetic resonance in the assessment of aortic dilatation in bicuspid aortic valve disease. J Cardiovasc Magn Reson. 2018;20:28. DOI:10.1186/s12968-018-0451-1
17. Ridley CH, Vallabhajosyula P, Bavaria JE, et al. The Sievers Classification of the Bicuspid Aortic Valve for the Perioperative Echocardiographer: The Importance of Valve Phenotype for Aortic Valve Repair in the Era of the Functional Aortic Annulus. J Cardiothorac Vasc Anesth. 2016;30:1142-51. DOI:10.1053/j. jvca.2016.02.009
18. Hattori K, Nakama N, Takada J, et al. Bicuspid aortic valve morphology and aortic valvular outflow jets: an experimental analysis using an MRI-compatible pulsatile flow circulation system. Sci Rep. 2021;11(1):2066. DOI:10.1038/s41598-021-81845-w
19. Komoriyama H, Tsuneta S, Oyama-Manabe N, et al. Four-dimensional flow magnetic resonance imaging visualizes sig-nificant changes in flow pattern and wall shear stress in the ascending aorta after transcatheter aortic valve implantationin a patient with severe aortic stenosis. Eur Heart J Cardiovasc Imaging. 2020;21(1):21. DOI:10.1093/ehjci/jez192
20. Odagiri K, Inui N, Hakamata A, et al. Non-invasive evaluation of pulmonary arterial blood flow and wall shear stress in pulmonary arterial hypertension with 3D phase contrast magnetic resonance imaging. Springerplus. 2016;5(1):1071. DOI:10.1186/s40064-016-2755-7
21. Cerne JW, Pathrose A, Gordon DZ, et al. Evaluation of Pulmonary Hypertension Using 4D Flow MRI. J Magn Reson Imaging. 2022;56(1):234-45. DOI:10.1002/jmri.27967
22 Reiter U, Kovacs G, Reiter C, et al. MR 4D flow-based mean pulmonary arterial pressure tracking in pulmonary hypertension. Eur Radiol. 2021;31:1883-93.
DOI:10.1007/s00330-020-07287-6
23. 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.
2015;275:71-9. DOI:10.1148/radiol. 14140849
24. Шляппо М.А., Глазкова Е.Ю., Александрова С.А., и др. Методика 4D-flow магнитно-резонансной томографии в оценке кровотока в коронарном синусе. Клиническая физиология кровообращения. 2019;16(1):30-5 [Shlyappo MA, Glazkova EYu, Aleksandrova SA, et al. Assessment of blood flow in the coronary sinus by the method of MR 4D-flow. Clinical Physiology of Circulation. 2019;16(1):30-5 (in Russian)]. DOI:10.24022/1814-6910-2019-16-1-30-35
25. Wiesemann St, Schmitter S, Demir A, et al. Impact of sequence type and field strength (1.5, 3, and 7T) on 4D flow MRI hemodynamic aortic parameters in healthy volunteers. Magn Reson Med. 2021;5(2):721-33. DOI:10.1002/mrm.28450
26. Corrias G, Cocco D, Suri JS, et al. Heart applications of 4D flow. Cardiovasc Diagn Ther. 2020;10(4):1140-9. DOI:10.21037/cdt.2020.02.08
27. Nakaza M, Matsumoto M, Sekine T, et al. Dual-VENC 4Dflow MRI can detect abnormal blood flow in the left atrium that potentially causes thrombosis formation after left upper lobectomy. Magn Reson Med Sci. 2021;21(3):433-43. DOI:10.2463/mrms.mp.2020-0170
28. Doyle CM, Orr J, Greenwood JP, et al. Four-Dimensional Flow Magnetic Resonance Imaging in the Assessment of Blood Flow in the Heart and Great Vessels: A Systematic Review. J Magn Reson Imaging. 2022;55(5):1301-21. DOI:10.1002/jmri.27874
2. Itatani K, Sekine T, Yamagishi M, et al. Hemodynamic Parameters for Cardiovascular System in 4D Flow MRI: Mathematical Definition and Clinical Applications. Magn Res Med Sci. 2022;21(2):380-99. DOI:10.2463/mrms.rev.2021-0097
3. Catapano F, Pambianchi G, Cundari G, et al. 4D flow imaging of the thoracic aorta: is there an added clinical value? Cardiovasc Diagn Ther. 2020;10(4):1068-89.
DOI:10.21037/cdt-20-452
4. Oyama-Manabe N, Aikawа T, Tsuneta S, Manabe O. Clinical Applications of 4D Flow MR Imaging in Aortic Valvular and Congenital Heart Disease. Magn Reson Med Sci.
2022;21:319-26. DOI:10.2463/mrms.rev.2021-0030
5. Zhuang B, Sirajuddin A, Zhao S, Lu M. The role of 4D flow MRI for clinical applications in cardiovascular disease: current status and future perspectives. Quant Imaging Med Surg. 2021;11(9):4193-210. DOI:10.21037/ qims-20-1234
6. Takahashi K, Sekine T, Ando T, et al. Utility of 4D Flow MRI in Thoracic Aortic Diseases: A Literature Review of Clinical Applications and Current Evidence. Magn Res Med Sci. 2022;21;327-39. DOI:10.2463/mrms. rev.2021-0046
7. Harloff A, Mirzaee H, Lodemann T, et al. Determination of aortic stiffness using 4D flow cardiovascular magnetic resonance – a population-based study. J Cardiovasc Magn Res. 2018;20(1):43. DOI:10.1186/s12968-018-0461-z
8. Scott MB, Huh H, van Ooij P, et al. Impact of age, sex, and global function on normal aortic hemodynamics. Magn Reson Med. 2020;84(4):2088-102. DOI:10.1002/mrm.28250
9. Takehara Y, Isoda H, Takahashi M, et al. Abnormal Flow Dynamics Result in Low Wall Shear Stress and High Oscillatory Shear Index in Abdominal Aortic Dilatation: Initial in vivo Assessment with 4D-flow MRI. Magn Reson Med Sci. 2020;19:235-46. DOI:10.2463/mrms.mp. 2019-0188
10. Condemi F, Campisi S, Viallon M, et al. Relationship Between Ascending Thoracic Aortic Aneurysms Hemodynamics and Biomechanical Properties. IEEE Trans Biomed Eng. 2020;67:949-56. DOI:10.1109/TBME.2019. 2924955
11. Garcia J, Barker AJ, Markl M. The Role of Imaging of Flow Patterns by 4D flow MRI in Aortic Stenosis. JACC Cardiovasc Imaging. 2019;12:252-66. DOI:10.1016/j.jcmg.2018.10.034
12. Demirkiran Ah, van Ooij P, Westenberg JJM, et al. Clinical intra-cardiac 4D flow CMR: acquisition, analysis, and clinical applications. Еur Heart J Cardiovasc Imag. 2022;23:154-65. DOI:10.1093/ehjci/ jeab112
13. Blanken CPS, Farag ES, Boekholdt SM, et al. Advanced cardiac MRI techniques for evaluation of left-sided valvular heart disease. J Magn Reson Imaging. 2018;48:318-29. DOI:10.1002/jmri. 26204
14. Youssefi P, Sharma R, Figueroa CA, Jahangiri M. Functional assessment of thoracic aortic aneurysms – the future of risk prediction? Br Med Bull. 2017;121:61-71. DOI:10.1093/bmb/ldw049
15. Dux-Santoy L, Guala A, Teixido-Tura G, et al. Increased rotational flow in the proximal aortic arch is associated with its dilation in bicuspid aortic valve disease. Eur Heart J Cardiovasc Imaging. 2019;20:1407-17. DOI:10.1093/ehjci/jez046
16. Rodríguez-Palomares JF, Dux-Santoy L, Guala A, et al. Aortic flow patterns and wall shear stress maps by 4D-flow flow patterns and wall shear stress maps by 4D-flow cardiovascular magnetic resonance in the assessment of aortic dilatation in bicuspid aortic valve disease. J Cardiovasc Magn Reson. 2018;20:28. DOI:10.1186/s12968-018-0451-1
17. Ridley CH, Vallabhajosyula P, Bavaria JE, et al. The Sievers Classification of the Bicuspid Aortic Valve for the Perioperative Echocardiographer: The Importance of Valve Phenotype for Aortic Valve Repair in the Era of the Functional Aortic Annulus. J Cardiothorac Vasc Anesth. 2016;30:1142-51. DOI:10.1053/j. jvca.2016.02.009
18. Hattori K, Nakama N, Takada J, et al. Bicuspid aortic valve morphology and aortic valvular outflow jets: an experimental analysis using an MRI-compatible pulsatile flow circulation system. Sci Rep. 2021;11(1):2066. DOI:10.1038/s41598-021-81845-w
19. Komoriyama H, Tsuneta S, Oyama-Manabe N, et al. Four-dimensional flow magnetic resonance imaging visualizes sig-nificant changes in flow pattern and wall shear stress in the ascending aorta after transcatheter aortic valve implantationin a patient with severe aortic stenosis. Eur Heart J Cardiovasc Imaging. 2020;21(1):21. DOI:10.1093/ehjci/jez192
20. Odagiri K, Inui N, Hakamata A, et al. Non-invasive evaluation of pulmonary arterial blood flow and wall shear stress in pulmonary arterial hypertension with 3D phase contrast magnetic resonance imaging. Springerplus. 2016;5(1):1071. DOI:10.1186/s40064-016-2755-7
21. Cerne JW, Pathrose A, Gordon DZ, et al. Evaluation of Pulmonary Hypertension Using 4D Flow MRI. J Magn Reson Imaging. 2022;56(1):234-45. DOI:10.1002/jmri.27967
22 Reiter U, Kovacs G, Reiter C, et al. MR 4D flow-based mean pulmonary arterial pressure tracking in pulmonary hypertension. Eur Radiol. 2021;31:1883-93.
DOI:10.1007/s00330-020-07287-6
23. 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.
2015;275:71-9. DOI:10.1148/radiol. 14140849
24. Шляппо М.А., Глазкова Е.Ю., Александрова С.А., и др. Методика 4D-flow магнитно-резонансной томографии в оценке кровотока в коронарном синусе. Клиническая физиология кровообращения. 2019;16(1):30-5 [Shlyappo MA, Glazkova EYu, Aleksandrova SA, et al. Assessment of blood flow in the coronary sinus by the method of MR 4D-flow. Clinical Physiology of Circulation. 2019;16(1):30-5 (in Russian)]. DOI:10.24022/1814-6910-2019-16-1-30-35
25. Wiesemann St, Schmitter S, Demir A, et al. Impact of sequence type and field strength (1.5, 3, and 7T) on 4D flow MRI hemodynamic aortic parameters in healthy volunteers. Magn Reson Med. 2021;5(2):721-33. DOI:10.1002/mrm.28450
26. Corrias G, Cocco D, Suri JS, et al. Heart applications of 4D flow. Cardiovasc Diagn Ther. 2020;10(4):1140-9. DOI:10.21037/cdt.2020.02.08
27. Nakaza M, Matsumoto M, Sekine T, et al. Dual-VENC 4Dflow MRI can detect abnormal blood flow in the left atrium that potentially causes thrombosis formation after left upper lobectomy. Magn Reson Med Sci. 2021;21(3):433-43. DOI:10.2463/mrms.mp.2020-0170
28. Doyle CM, Orr J, Greenwood JP, et al. Four-Dimensional Flow Magnetic Resonance Imaging in the Assessment of Blood Flow in the Heart and Great Vessels: A Systematic Review. J Magn Reson Imaging. 2022;55(5):1301-21. DOI:10.1002/jmri.27874
________________________________________________
1. Takehara Y. 4D Flow when and how? Radiol Med. 2020;125(9):838-50. DOI:10.1007/s11547-020-01249-0
2. Itatani K, Sekine T, Yamagishi M, et al. Hemodynamic Parameters for Cardiovascular System in 4D Flow MRI: Mathematical Definition and Clinical Applications. Magn Res Med Sci. 2022;21(2):380-99. DOI:10.2463/mrms.rev.2021-0097
3. Catapano F, Pambianchi G, Cundari G, et al. 4D flow imaging of the thoracic aorta: is there an added clinical value? Cardiovasc Diagn Ther. 2020;10(4):1068-89.
DOI:10.21037/cdt-20-452
4. Oyama-Manabe N, Aikawа T, Tsuneta S, Manabe O. Clinical Applications of 4D Flow MR Imaging in Aortic Valvular and Congenital Heart Disease. Magn Reson Med Sci.
2022;21:319-26. DOI:10.2463/mrms.rev.2021-0030
5. Zhuang B, Sirajuddin A, Zhao S, Lu M. The role of 4D flow MRI for clinical applications in cardiovascular disease: current status and future perspectives. Quant Imaging Med Surg. 2021;11(9):4193-210. DOI:10.21037/ qims-20-1234
6. Takahashi K, Sekine T, Ando T, et al. Utility of 4D Flow MRI in Thoracic Aortic Diseases: A Literature Review of Clinical Applications and Current Evidence. Magn Res Med Sci. 2022;21;327-39. DOI:10.2463/mrms. rev.2021-0046
7. Harloff A, Mirzaee H, Lodemann T, et al. Determination of aortic stiffness using 4D flow cardiovascular magnetic resonance – a population-based study. J Cardiovasc Magn Res. 2018;20(1):43. DOI:10.1186/s12968-018-0461-z
8. Scott MB, Huh H, van Ooij P, et al. Impact of age, sex, and global function on normal aortic hemodynamics. Magn Reson Med. 2020;84(4):2088-102. DOI:10.1002/mrm.28250
9. Takehara Y, Isoda H, Takahashi M, et al. Abnormal Flow Dynamics Result in Low Wall Shear Stress and High Oscillatory Shear Index in Abdominal Aortic Dilatation: Initial in vivo Assessment with 4D-flow MRI. Magn Reson Med Sci. 2020;19:235-46. DOI:10.2463/mrms.mp. 2019-0188
10. Condemi F, Campisi S, Viallon M, et al. Relationship Between Ascending Thoracic Aortic Aneurysms Hemodynamics and Biomechanical Properties. IEEE Trans Biomed Eng. 2020;67:949-56. DOI:10.1109/TBME.2019. 2924955
11. Garcia J, Barker AJ, Markl M. The Role of Imaging of Flow Patterns by 4D flow MRI in Aortic Stenosis. JACC Cardiovasc Imaging. 2019;12:252-66. DOI:10.1016/j.jcmg.2018.10.034
12. Demirkiran Ah, van Ooij P, Westenberg JJM, et al. Clinical intra-cardiac 4D flow CMR: acquisition, analysis, and clinical applications. Еur Heart J Cardiovasc Imag. 2022;23:154-65. DOI:10.1093/ehjci/ jeab112
13. Blanken CPS, Farag ES, Boekholdt SM, et al. Advanced cardiac MRI techniques for evaluation of left-sided valvular heart disease. J Magn Reson Imaging. 2018;48:318-29. DOI:10.1002/jmri. 26204
14. Youssefi P, Sharma R, Figueroa CA, Jahangiri M. Functional assessment of thoracic aortic aneurysms – the future of risk prediction? Br Med Bull. 2017;121:61-71. DOI:10.1093/bmb/ldw049
15. Dux-Santoy L, Guala A, Teixido-Tura G, et al. Increased rotational flow in the proximal aortic arch is associated with its dilation in bicuspid aortic valve disease. Eur Heart J Cardiovasc Imaging. 2019;20:1407-17. DOI:10.1093/ehjci/jez046
16. Rodríguez-Palomares JF, Dux-Santoy L, Guala A, et al. Aortic flow patterns and wall shear stress maps by 4D-flow flow patterns and wall shear stress maps by 4D-flow cardiovascular magnetic resonance in the assessment of aortic dilatation in bicuspid aortic valve disease. J Cardiovasc Magn Reson. 2018;20:28. DOI:10.1186/s12968-018-0451-1
17. Ridley CH, Vallabhajosyula P, Bavaria JE, et al. The Sievers Classification of the Bicuspid Aortic Valve for the Perioperative Echocardiographer: The Importance of Valve Phenotype for Aortic Valve Repair in the Era of the Functional Aortic Annulus. J Cardiothorac Vasc Anesth. 2016;30:1142-51. DOI:10.1053/j. jvca.2016.02.009
18. Hattori K, Nakama N, Takada J, et al. Bicuspid aortic valve morphology and aortic valvular outflow jets: an experimental analysis using an MRI-compatible pulsatile flow circulation system. Sci Rep. 2021;11(1):2066. DOI:10.1038/s41598-021-81845-w
19. Komoriyama H, Tsuneta S, Oyama-Manabe N, et al. Four-dimensional flow magnetic resonance imaging visualizes sig-nificant changes in flow pattern and wall shear stress in the ascending aorta after transcatheter aortic valve implantationin a patient with severe aortic stenosis. Eur Heart J Cardiovasc Imaging. 2020;21(1):21. DOI:10.1093/ehjci/jez192
20. Odagiri K, Inui N, Hakamata A, et al. Non-invasive evaluation of pulmonary arterial blood flow and wall shear stress in pulmonary arterial hypertension with 3D phase contrast magnetic resonance imaging. Springerplus. 2016;5(1):1071. DOI:10.1186/s40064-016-2755-7
21. Cerne JW, Pathrose A, Gordon DZ, et al. Evaluation of Pulmonary Hypertension Using 4D Flow MRI. J Magn Reson Imaging. 2022;56(1):234-45. DOI:10.1002/jmri.27967
22 Reiter U, Kovacs G, Reiter C, et al. MR 4D flow-based mean pulmonary arterial pressure tracking in pulmonary hypertension. Eur Radiol. 2021;31:1883-93.
DOI:10.1007/s00330-020-07287-6
23. 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.
2015;275:71-9. DOI:10.1148/radiol. 14140849
24. Shlyappo MA, Glazkova EYu, Aleksandrova SA, et al. Assessment of blood flow in the coronary sinus by the method of MR 4D-flow. Clinical Physiology of Circulation. 2019;16(1):30-5 (in Russian). DOI:10.24022/1814-6910-2019-16-1-30-35
25. Wiesemann St, Schmitter S, Demir A, et al. Impact of sequence type and field strength (1.5, 3, and 7T) on 4D flow MRI hemodynamic aortic parameters in healthy volunteers. Magn Reson Med. 2021;5(2):721-33. DOI:10.1002/mrm.28450
26. Corrias G, Cocco D, Suri JS, et al. Heart applications of 4D flow. Cardiovasc Diagn Ther. 2020;10(4):1140-9. DOI:10.21037/cdt.2020.02.08
27. Nakaza M, Matsumoto M, Sekine T, et al. Dual-VENC 4Dflow MRI can detect abnormal blood flow in the left atrium that potentially causes thrombosis formation after left upper lobectomy. Magn Reson Med Sci. 2021;21(3):433-43. DOI:10.2463/mrms.mp.2020-0170
28. Doyle CM, Orr J, Greenwood JP, et al. Four-Dimensional Flow Magnetic Resonance Imaging in the Assessment of Blood Flow in the Heart and Great Vessels: A Systematic Review. J Magn Reson Imaging. 2022;55(5):1301-21. DOI:10.1002/jmri.27874
Авторы
Л.А. Юрпольская*
ФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии им. А.Н. Бакулева» Минздрава России, Москва, Россия
*layurpolskaya@bakulev.ru
ФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии им. А.Н. Бакулева» Минздрава России, Москва, Россия
*layurpolskaya@bakulev.ru
________________________________________________
Lyudmila A. Yurpolskaya*
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russia
*layurpolskaya@bakulev.ru
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.