多发性肌炎或皮肌炎患者亚临床心脏受累的磁共振心肌分层应变特征及诊断价值  

Layer-Specific Strain Characteristic and Diagnostic Value for Detecting Subclinical Cardiac Dysfunction in Polymyositis and Dermatomyositis:A Cardiac Magnetic Resonance Imaging Study

作　　者：邓巧 余刘玉[3] 徐源蔚 徐紫谦 李为昊 孙家瑜 陈玉成 DENG Qiao;YU Liuyu;XU Yuanwei;XU Ziqian;LI Weihao;SUN Jiayu;CHEN Yucheng(Department of Cardiology,West China Hospital,Sichuan University,Chengdu 610041,China;不详)

机构地区：[1]四川大学华西医院放射科,四川成都610041 [2]川北医学院附属医院放射科,四川南充637001 [3]四川大学华西医院心内科,四川成都610041

出　　处：《中国医学影像学杂志》2022年第7期648-654,共7页Chinese Journal of Medical Imaging

摘　　要：目的采用基于心脏磁共振电影成像的形变配准算法(DRA)分层应变分析技术研究多发性肌炎或皮肌炎患者的左心室心肌分层应变特征,并进一步探讨其在该类患者亚临床心脏受累中的诊断价值。资料与方法前瞻性纳入2016年1月—2017年12月于四川大学华西医院确诊的37例左心室射血分数保留的多发性肌炎或皮肌炎(研究组),并纳入37例年龄、性别匹配的健康志愿者作为对照组。采用DRA心肌分层应变分析技术,分别在左心室基底、中部、近心尖3个平面短轴电影图像及左心室长轴电影图像上测量所有受检者的整体和分层心肌应变参数:整体径向应变(GRS)、整体周向应变(GCS)、整体纵向应变(GLS);心内膜下、中层、外膜下应变(RS/CS/LSsub-endo/mid/sub-epi),以及跨壁周向应变梯度(CSGendo-epi)、基底-心尖纵向应变梯度(LSGbase-apex)。比较两组各参数的差异,采用受试者工作特征曲线分析各应变参数对多发性肌炎/皮肌炎患者的诊断效能。结果与对照组比较,研究组GRS、GCS、GLS均较低(t=-2.144、2.432、2.435,P均<0.05);研究组左心室基底层面RSsub-endo、LSsub-endo、LSmid、LSepi较低(t=-2.493、4.381、3.148、2.260,P均<0.05);基底、中部、心尖3个层面的CSsub-endo均较低(t=4.575、2.232、2.901,P均<0.05);研究组CSGendo-epi、LSGbase-apex均较低(t=-6.269、-4.929,P均<0.05)。受试者工作特征曲线显示,在整体应变参数及应变梯度参数中,CSGendo-epi的曲线下面积最大(0.855),LSGbase-apex次之(0.776),GRS、GCS、GLS较低(分别为0.606、0.646、0.630)。结论基于DRA应变技术分析的应变梯度参数可以鉴别诊断多发性肌炎或皮肌炎患者亚临床心功能受损。Purpose To explore the characteristics of the layer-specific strain distribution based on deformation registration algorithm(DRA)for detecting subclinical cardiac dysfunction in patient with polymyositis or dermatomyositis(PM/DM).Materials and Methods Thirty-seven PM/DM patients with preserved systolic function(study group)and thirty-seven age-,sex-matched healthy volunteers(control group)were prospectively enrolled from January 2016 to December 2017 in West China Hospital,Sichuan University.Global and layer-specific myocardial strains assessment based on DRA measured by cine images of short and long axis of the heart at the basal,middle and apical level were analyzed,respectively.Global and layer-specific strain parameters were as follows:global radial strain(GRS),global circumferential strain(GCS),global longitudinal strain(GLS),layer-specific strains of circumferential,radial strain and longitudinal strain(CS/RS/LSsub-endo/mid/sub-epi),the transmural gradient of circumferential strain(CSGendo-epi)and the longitudinal gradient of longitudinal strain(LSGbase-apex).All global and layer-specific strain parameters were compared between the two groups.Receiver operating characteristic curve was used to evaluate the diagnostic efficiency in patient with PM/DM.Results Compared with control group,the study group showed significantly lower global radial strain,circumferential strain and longitudinal strain(t=-2.144,2.432,2.435,all P<0.05).RSsub-endo,LSsub-endo,LSmid,LSepi at the basal level of LV myocardium of study group were significantly lower than those of control group(t=-2.493,4.381,3.148,2.260,all P<0.05).Compared with control group,circumferential sub-endo myocardial strains(CSsub-endo)at three levels also significantly reduced in PM/DM patients(t=4.575,2.232,2.901,all P<0.05).Moreover,the CSGendo-epi and LSGbase-apex were significantly lower in PM/DM patients than those in controls subjects(t=-6.269,-4.929,all P<0.05).Receiver operating characteristic curve analysis showed that the area under the curve of CSGen

关 键 词：磁共振成像 多发性肌炎 皮肌炎 分层应变分析 

分 类 号：R445.2[医药卫生—影像医学与核医学] R542.2[医药卫生—诊断学]