MRI、3D-STE、ECV检测对成人肥厚型心肌病心肌弥漫性纤维化的评估价值  

Value of MRI,3D-STE and ECV in the Evaluation of Diffuse Myocardial Fibrosis in Adult Patients with Hypertrophic Cardiomyopathy

作　　者：顾娟 柏根基[2] 韦成相 GU Juan;BAI Genji;WEI Chengxiang(Department of Radiology,Huaian Hongze District People′s Hospital,Huaian,Jiangsu 223100,China;Department of Radiolo-gy,The Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University,Huaian,Jiangsu 223300,China)

机构地区：[1]江苏省洪泽区人民医院影像科,江苏淮安223100 [2]南京医科大学附属淮安第一医院影像科,江苏淮安223300

出　　处：《岭南心血管病杂志》2023年第3期302-306,318,共6页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨心脏核磁共振(magnetic resonance imaging,MRI)、三维斑点追踪超声心动图(three-dimensional speckle tracking echocardiography,3D-STE)、细胞外容积(extracellular volume,ECV)检测对肥厚型心肌病心肌弥漫性纤维化的评估价值。方法选取2018年1月至2020年12月于洪泽区人民医院就诊的成人肥厚型心肌病心肌纤维化患者120例为观察组,同时选取同期肥厚型心肌病患者120例为对照组,所有患者均进行MRI、3DSTE、ECV检测,观察MRI、3D-STE、ECV检测对肥厚型心肌病心肌弥漫性纤维化的评估价值。结果3D-STE检查结果显示观察组患者整体纵向应变(overall longitudinal strain,GLS)、整体径向应变(overall radial strain,GRS)明显小于对照组,整体圆周应变(overall circumferential strain,GCS)明显大于对照组,差异有统计学意义(P<0.05);两组患者左心室收缩期整体应变(overall strain,GS)比较,差异无统计学意义(P>0.05)。观察组患者增强前T1、增强后0.5 h T1、ECV明显大于对照组,差异有统计学意义(P<0.05)。Logistic回归分析结果显示GCS(OR=1.036,P=0.001)、增强后0.5 h T1(OR=1.096,P=0.003)、ECV(OR=3.106,P=0.000)是肥厚型心肌病心肌弥漫性纤维化的危险因素。GCS诊断心肌弥漫性纤维化的敏感度为0.666,特异度为0.625;增强后0.5 h T1诊断心肌弥漫性纤维化的敏感度为0.650,特异度为0.666;ECV诊断心肌弥漫性纤维化的敏感度为0.633,特异度为0.675;三者联合诊断心肌弥漫性纤维化的敏感度为0.816,特异度为0.616。结论MRI、3D-STE、ECV检测在评估成人肥厚型心肌病心肌弥漫性纤维化方面具有一定的临床价值。Objectives To investigate the value of magnetic resonance imaging(MRI),three-dimensional speckle tracking echocardiography(3D-STE)and extracellular volume(ECV)in the evaluation of myocardial diffuse fibrosis in adult patients with hypertrophic cardiomyopathy.Methods Totally 120 cases of adult patients with hypertrophic cardiomyopathy and myocardial fibrosis in Huaian Hongze District People′s Hospital from January 2018 to December 2020 were selected as observation group,and 120 cases of patients with hypertrophic cardiomyopathy in the same period were selected as control group.All the patients were detected by MRI,3D-STE and ECV,and the evaluation value of MRI,3D-STE and ECV detection on myocardial diffuse fibrosis in hypertrophic cardiomyopathy was observed.Results The results of 3D-STE examination showed that over all longitudinal strain(GLS)and overall radial strain(GRS)in observation group were significantly lower than those in control group,and overall circamferential strain(GCS)was significantly higher than that in control group(P<0.05).There was no significant difference in overall strain(GS)between the two groups(P>0.05).The T1 before and half an hour after enhancement and ECV of observation group were significantly higher than those of control group(P<0.05).Logistic regression analysis showed that GCS(OR=1.036,P=0.001),T1 half an hour after enhancement(OR=1.096,P=0.003)and ECV(OR=3.106,P=0.000)were risk factors of myocardial diffuse fibrosis in hypertrophic cardiomyopathy.The sensitivity and specificity of GCS were 0.666 and 0.625 respectively;the sensitivity and specificity of T1 half an hour after enhancement were 0.650 and 0.666 respectively;the sensitivity and specificity of ECV were 0.633 and 0.675 respectively;the combined sensitivity and specificity of the three were 0.816 and 0.616 respectively.Conclusions MRI,3D-STE,ECV detection have certain clinical value in the evaluation of myocardial diffuse fibrosis in adult patients with hypertrophic cardiomyopathy.

关 键 词：心脏核磁共振 三维斑点追踪超声心动图 细胞外容积 肥厚型心肌病 心肌弥漫性纤维化 

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