孤立性左室心肌致密化不全患者心脏MRI影像学表现  

Cardiac MRI characteristics of isolated left ventricular noncompaction

作　　者：田圆 赵泽豫 葛英辉 张继良 郭智萍 TIAN Yuan;ZHAO Ze-yu;GE Ying-hui;ZHANG Ji-liang;GUO Zhi-ping(Department of Radiology,Heart Center of Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Fuwai Central China Cardiovascular Hospital,Zhengzhou,Henan 451464,China)

机构地区：[1]郑州大学人民医院河南省人民医院心脏中心阜外华中心血管病医院放射科,河南郑州451464

出　　处：《中华实用诊断与治疗杂志》2022年第11期1086-1090,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划省部共建项目(SB201901097);河南省心脏病影像医学重点实验室(豫卫科教函[2021]44号序号16)。

摘　　要：目的 观察孤立性左室心肌致密化不全(isolated left ventricular noncompaction, ILVNC)患者心脏MRI影像学表现及左心室各心肌节段致密化特征,探讨其临床应用价值。方法 心脏MRI诊断为ILVNC患者22例为ILVNC组,同期行心脏MRI检查正常者18例为对照组。总结ILVNC组左心室心肌MRI表现,记录共374个心肌节段致密化不全和延迟强化显像情况,计算左心室舒张末期第1~16心肌节段致密化不全厚度/正常致密化厚度值。比较ILVNC组与对照组左室射血分数、左心室收缩末期容积指数、左心室舒张末期容积指数、左心室质量指数、心肌初始T1-mapping值。以ILVNC组发生延迟强化的心肌节段为延迟强化组,未发生延迟强化的心肌节段为未发生延迟强化组,比较延迟强化组、未延迟强化组与对照组各心肌节段初始T1-mapping值。结果 ILVNC患者病变心肌呈明显异常的双层结构,外层为压薄的致密化心肌;内层为增厚、肌小梁增粗紊乱、交织成网格状致密化不全心肌,可见小梁间隐窝血液充盈,并与心室腔相通。22例患者左心室舒张末期第1~16心肌节段致密化不全厚度/正常致密化厚度值均>2.5;374个心肌节段中133个节段发生致密化不全,心尖帽(第17段)及侧壁心尖段(第16段)均有受累,前壁心尖段(第13段)受累18例;20例(90.90%)共62个心肌节段发生延迟强化,其中正常致密化心肌54个节段,致密化不全心肌8个节段,主要位于基底段室间隔(第2、3节段)、中间段室间隔(第8、9节段)。ILVNC组左室射血分数[(24.77±12.46)%]低于对照组[(58.55±5.81)%](t=-11.308,P<0.001),左心室舒张末期容积指数[(155.32±45.69)mL/m^(2)]、左心室收缩末期容积指数[(120.45±43.85)mL/m^(2)]、左心室质量指数[(120.41±51.7)g/m^(2)]、初始T1-mapping值[(1 307.72±64.02)ms]均大于对照组[(66.94±10.19)mL/m^(2)、(27.8±6.02)mL/m^(2)、(55.22±14.2)g/m^(2)、(1 192.88±67.46)ms](t=8.807,P<0.001;t=9.794,P<0.001;t=Objective To observe the cardiac MRI findings in patients with isolated left ventricular noncompaction(ILVNC)and the characteristics of left ventricular compaction,and to investigate its clinical application value.Methods Twenty-two patients were diagnosed with ILVNC by cardiac MRI(ILVNC group),and 18 healthy volunteers underwent cardiac MRI examination at the same time(control group).The cardiac MRI features of left ventricular myocardium in ILVNC group were observed,374 segments with noncompaction and delayed enhancement were recorded,the noncompaction/compaction ratio of left ventricular myocardial segment 1 to 16 was calculated.Left ventricular ejection fraction,left ventricular end-systolic volume index,left ventricular end-diastolic volume index,left ventricular mass index and native T1-mapping value were compared between two groups.The native T1-mapping value was compared in the segments with delayed enhancement in ILVNC group(delayed enhancement group),the segments without delayed enhancement(non-delayed enhancement group),and control group.Results The myocardium of ILVNC patients had a significantly abnormal bilayer structure,the outer layer was the compressed dense myocardium,and the inner layer was the noncompact myocardium,which was thickened,trabecular muscle thickened and disorganized,interwoven into a grid.Blood filling was seen in the intertrabecular crypts,which communicated with the ventricular lumen.The noncompaction/compaction value of left ventricular end-diastolic myocardial segment 1 to 16 was>2.5.In 374 myocardial segments,there were 133 noncompact segments,apical cap (segment 17)and lateral wall apical segment(segment 16)were all involved,and anterior wall apical segment (segment 13)was involved in 18 cases.Delayed enhancement myocardial perfusion imaging showed delayed enhancement in 62 segments in 20 patients (90.90%),including 54 segments of normal compact myocardium and 8 segments of noncompact myocardium,mainly located in the basal septum (segment 2 and 3)and the intermediate septum

关 键 词：孤立性左室心肌致密化不全 心脏MRI 心力衰竭 T1-mapping 

分 类 号：R445.2[医药卫生—影像医学与核医学] R541.1[医药卫生—诊断学]