纵向弛豫时间定量成像在心肌淀粉样变性诊断中的初步研究  

Native T1 mapping for the diagnosis of cardiac amyloidosis：a pilot research

作　　者：程召平 陆敏杰 尹刚 程怀兵 兰天 戴琳琳 张岩 蒋世良 王锡明[2] 赵世华 Cheng Zhaoping Lu Minjie Yin Gang Cheng Huaibing Lan Tian Dai Linlin Zhang Yan Jiang Shiliang Wang Ximing Zhao Shihua(Department of MRI, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing100037,China Department of Radiology, Shandong Medical Imaging Institute, Jinan 250021, China)

机构地区：[1]中国医学科学院阜外医院北京协和医学院国家心血管病中心磁共振影像科,100037 [2] 山东省医学影像学研究所

出　　处：《中华放射学杂志》2016年第12期935-939,共5页Chinese Journal of Radiology

基　　金：国家自然科学基金（81130029）;中国博士后科学基金（2014M550658）

摘　　要：目的：初步探讨心脏MR初始纵向弛豫时间定量成像（T1 mapping）技术诊断心肌淀粉样变性（CA）的应用价值。方法回顾性收集2012年1月至2013年12月20例经生物学检查和超声确诊为CA患者的资料，随机选取正常组20名及肥厚型心肌病（HCM）40例患者作为对照。所有患者进行标准心脏1.5 T MR检查，包括初始T1 mapping改良Look？Locker反转恢复（MOLLI）序列和对比剂延迟强化（LGE）扫描，测量T1值及其心功能参数。3组间测量指标的比较采用单因素方差分析，采用ROC曲线分析T1弛豫时间识别CA的敏感度与特异度。T1与心功能指标之间的相关性评估采用Pearson检验。结果CA组心肌T1弛豫时间[（1124±49）ms]显著升高，其与正常组[（973±39 ms）]和HCM患者[（1045±50）ms]比较差异有统计学意义（F=44.75，P〈0.01）。T1=1082 ms时，诊断CA的特异度为80%，敏感度为75%。T1=1012 ms时，排除CA的敏感度为100%，特异度为40%。CA组患者T1弛豫时间与心脏收缩和舒张功能有相关关系，随着T1弛豫时间增加，左室射血分数降低（r=－0.51，P〈0.01），左心室质量指数增加（r=0.52，P〈0.01）。结论初始心肌T1 mapping是一种有潜在能力诊断和量化CA的诊断方法。Objective To explore the potential role of native cardiac T1 mapping by cardiac magnetic resonance for detection of cardiac amyloidosis （CA）. Methods Twenty patients with cardiac amyloidosis （with definite cardiac involvement based on standard biomarkers and echo cardiographic criteria） were studied at our hospital from 2012 to 2013. Comparisons were made with 20 healthy volunteers and 40 patients with hypertrophic cardiomyopathy （HCM）. All underwent CMR （1.5 T） including native T1 mapping MOLLI （modified Look-Locker inversion recovery） sequence and LGE （late gadolinium enhancement） imaging. Analysis of variance was performed to analyze the differences between groups regarding native T1 and LV mass.ROC curve analysis was performed to define a T1 relaxation time cutoff value that identifies CA with the greatest sum of sensitivity and specificity. Correlation between T 1 and cardiac function indices was assessed using Pearson test. Statistical significance was defined as P〈0.05. Results Cardiac T1 was significantly elevated in CA patients [（1 124±49） ms] compared to normal subjects [（973±39） ms] and patients with HCM [（1 045±50） ms]（F=44.75, P〈0.01）. The cut off value to diagnose CA was 1 082 ms with specificity 80%and sensitivity 75%. The cut off value to rule out CA was 1 012 ms with sensitivity 100% and specificity 40%）.There was significant correlation between native T1 relaxation times＆nbsp;and indices of systolic and diastolic function in the CA cohort. As T1 relaxation times increased, LV ejection fraction decreased （r=-0.51, P〈0.01） and LV mass index increased （r=0.52, P〈0.01）.Conclusion Native T1 mapping may have potential as a valuable method for diagnosing and quantifying CA.

关 键 词：淀粉样变性 心肌 磁共振成像 

分 类 号：R542.2[医药卫生—心血管疾病]