延迟增强CT评估肥厚型心肌病心肌纤维化的意义  

Myocardial Fibrosis in Hypertrophic Cardiomyopathy: Assessed by Delayed-enhanced CT

作　　者：马晓海[1] 赵蕾[1] 葛海龙[2] 张臣[1] 陆东旭[1] 范占明[1] 

机构地区：[1]首都医科大学附属北京安贞医院医学影像科,北京100029 [2]首都医科大学附属北京安贞医院干部病房,北京100029

出　　处：《中国医学影像学杂志》2015年第2期100-104,113,共6页Chinese Journal of Medical Imaging

基　　金：国家自然科学基金项目(81101173);北京市卫生系统高层次卫生技术人才培养计划(2013-3-005)

摘　　要：目的以心脏MRI作为参照标准,评估双源CT在诊断肥厚型心肌病心肌延迟强化和左心室壁厚度的诊断准确性。资料与方法选取80例经临床诊断确诊为肥厚型心肌病患者,所有患者行双源CT动脉期、延迟期扫描及心脏MRI形态和延迟增强检查。根据美国心脏病协会17节段分析方法,左心室室壁厚度、延迟强化的位置得到确认,分析2种检查诊断心肌延迟强化的相关性。结果 80例患者共1360个心肌节段进行评估,CT与MRI测量的左心室室壁平均厚度间呈显著相关(r=0.88,P<0.01)。延迟增强检查证实CT与MRI在检出心肌纤维化病灶方面一致性较好(患者74例,Kappa=0.751,P<0.05;心肌节段1238个节段,Kappa=0.746,P<0.01)。CT与MRI测量的延迟强化病灶体积呈良好的相关性(r=0.89,P<0.01),但CT图像低估纤维化病灶范围。Bland-Altman分析显示,CT和MRI在测量延迟强化病灶容积的差异,平均标准差为2.71%。结论心脏CT检查可以提供关于心肌和冠状动脉的综合信息,延迟增强CT可作为评估心肌纤维化的检查方法,是诊断肥厚型心肌病潜在的有效诊断方法。PurposeTo determine the feasibility and accuracy of dual source CT （DSCT） in assessing myocardial delayed-enhancement and left ventricular wall thickness of hypertrophic cardiomyopathy （HCM） in comparison with cardiac magnetic resonance （CMR）.Materials and MethodsEighty patients with HCM confirmed by clinical diagnosis were enrolled in the study. DSCT images and CMR images were acquired at the arterial and lag phases. According to 17-segment model provided by American Heart Association, the left ventricular wall thickness and location of delayed-enhancement were verified, and the correlation of these two methods were analyzed in terms of the diagnosis of myocardial delayed enhancement （MDE）.Results1360 myocardial segments for 80 patients were assessed. The left ventricular wall thickness determined by DSCT was significantly correlated with MR results （r=0.88,P〈0.01）. DSCT and MDE showed substantial agreement on per-patient （n=74,Kappa=0.751,P〈0.05） and per-segment （n=1238, Kappa=0.746,P〈0.01） levels. For dense myocardial delayed enhancement, CT findings were significantly correlated with those of CMR （r=0.89, P〈0.01）, but CT scan slightly underestimated the lesion scope of fibrosis. Bland-Altman analysis showed that CT and MRI were different in measuring the lesion volume of myocardial delayed enhancement （mean standard deviation was 2.71%）.ConclusionThe cardiac CT examination provides comprehensive information in coronary artery and myocardial assessment, and MDE-DSCT is also effective in the diagnosis of myocardial fibrosis in HCM since it can be used in assessing myocardial fibrosis.

关 键 词：心肌病 肥厚性 体层摄影术 螺旋计算机 磁共振成像 心内膜心肌纤维化症 图像增强 

分 类 号：R445.2[医药卫生—影像医学与核医学] R445.3[医药卫生—诊断学]