心脏磁共振T1 mapping和特征追踪技术定量评价肥厚型心肌病患者心肌纤维化和形变  

Quantification of left ventricular myocardial fibrosis and deformation using cardiovascular magnetic resonance T1 mapping and feature tracking technique in hypertrophic cardiomyopathy patients

作　　者：崔越 曹玉坤 刘佳[1] 韩小雨 邵国柱 孔祥闯 史河水[1] 韩萍[1] 刘晓庆 CUI Yue;CAO Yukun;LIU Jia;HAN Xiaoyu;SHAO Guozhu;KONG Xiangchuan;SHI Heshui;HAN Ping;LIU Xiaoqing(Department of Radiology,Union Hospital,Tongji Medical College.Huazhong University of Science and Technology,Wuhan,430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院放射科,武汉430022

出　　处：《临床心血管病杂志》2020年第9期856-862,共7页Journal of Clinical Cardiology

基　　金：湖北省分子影像重点实验室基金(No:02.03.2018-90)。

摘　　要：目的:探讨心脏磁共振(CMR)T1 mapping和特征追踪(FT-CMR)技术定量肥厚型心肌病(HCM)患者心肌纤维化和心肌形变的诊断价值及其相关性。方法:本研究共纳入25例HCM患者(HCM组)和28例健康志愿者(对照组)行1.5-T心脏磁共振检查。CMR T1 mapping扫描采用改良的Look-Locker反转恢复(MOLLI)序列,扫描范围包括左室基底、中间和心尖段的T1 mapping图。按照美国心脏病协会(AHA)左室心肌分段方法将左室心肌分为16段,并测量每段心肌的初始T1值、增强后T1值和心肌细胞外容积(ECV)值。将心脏长轴二、三和四腔心和全部短轴位电影图像导入心肌应力分析软件,通过分析得到左室整体纵向(GLS)、周向(GCS)和径向(GRS)心肌收缩应力。比较HCM组和对照组的T1值、ECV值和心肌收缩应变的差异,并分析其相关性。结果:HCM组左室整体心肌平均初始T1值和ECV值均高于对照组,差异有统计学意义[初始T1值:(1 047.3±43.7) ms∶(1 013.8±26.9) ms,P=0.001;ECV值:(28.2±4.7)%∶(24.0±1.9)%,P<0.001]。HCM组左室GLS和GCS均低于对照组,差异有统计学意义[GLS:(-13.6±3.7)%∶(-16.9±1.9)%,P<0.001;GCS:(-16.3±4.8)%∶(-19.2±2.7)%,P=0.011]。多变量回归分析显示,HCM患者性别和GRS与左室心肌ECV均存在独立相关性(性别:标准化β=0.429,P=0.012;GRS:标准化β=-0.471,P=0.007)。与初始T1时间和心肌应力相比,ROC曲线分析示心肌ECV对HCM诊断价值最大(AUC=0.846,P<0.001),ECV诊断HCM的敏感性、特异性、阳性预测值(PPV)和阴性预测值(NPV)分别为80.0%、85.7%、83.3%和82.8%。结论:HCM患者的心肌初始T1值和ECV增高,与心肌弥漫性纤维化有关。HCM患者与健康对照比较射血分数(EF)正常而GLS和GCS降低,提示心肌应力比EF能更早地反映心功能受损。HCM患者的心肌纤维化与性别和GRS相关。相对于初始T1时间和心肌应力,心肌ECV诊断HCM的价值较大。Objective:The aim of this study was to investigate the diagnostic performance of myocardial native T1 time,extracellular volume(ECV) and strain for differentiating hypertrophic cardiomyopathy(HCM) patients from healthy volunteers and explore the relationships among them.Method:A total of 25 HCM patients and 28 healthy volunteers who underwent cardiovascular magnetic resonance(CMR) were enrolled in the present study.CMR T1 mapping was performed with the Modified Look-Locker Inversion recovery(MOLLI) sequence in three short-axis slices(apex,mid and basic ventricular levels).The myocardial T1 time and ECV were measured by drawing region-of-interest(ROI) in each segment of left ventricular three short-axis slices according to the American Heart Association(AHA) 16-segment model.Myocardial systolic strain,including left ventricular global longitudinal(GLS),circumferential(GCS) and radial strain(GRS),were quantified using CMR cine images by feature tracking analysis software.The differences of T1 time,ECV value and myocardial systolic strain were compared between HCM patients and healthy volunteers,and their relationships were analyzed.Result:The mean left ventricular global native T1 time and ECV of HCM patients were significantly higher than that of control group\[(1047.3±43.7) ms vs.(1013.8±26.9) ms,P=0.001 and(28.2±4.7)% vs.(24.0±1.9)%,P<0.001,respectively\].The mean GLS and GCS in HCM patients were significantly lower than that in control group \[(-13.6±3.7)% vs.(-16.9±1.9)%,P<0.001 and(-16.3±4.8)% vs.(-19.2±2.7)%,P=0.011,respectively\].In the multivariate regression analysis,the sex and GRS were independent determines for ECV in HCM patients(standardized β=0.429,P=0.012 and standardized β=-0.471,P=0.007,respectively).Compared with native T1 time and myocardial strain,ROC curve analysis indicated that ECV provided greatest distinction between HCM patients and controls(AUC=0.846,P<0.001).At the optimal cutoff value,ECV identified HCM patients with 80.0% sensitivity,85.7% specificity,83.3% positive predict

关 键 词：心脏磁共振 T1 mapping 特征追踪 肥厚型心肌病 

分 类 号：R542.2[医药卫生—心血管疾病]