心脏MR T_(1ρ)定量技术在肥厚型心肌病心肌纤维化评估中的初步应用  

T_(1)rho mapping for assessment of myocardial fibrosis in hypertrophic cardiomyopathy

作　　者：尹刚 董志翔 杨新令 崔辰 杨凯 陈秀玉 张岩 陆敏杰 赵世华 Yin Gang;Dong Zhixiang;Yang Xinling;Cui Chen;Yang Kai;Chen Xiuyu;Zhang Yan;Lu Minjie;Zhao Shihua(Department of MRI,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院磁共振影像科,北京100037

出　　处：《中华放射学杂志》2023年第10期1087-1093,共7页Chinese Journal of Radiology

基　　金：国家自然科学基金(81930044);国家重点研发计划(2021YFF0501400,2021YFF0501404)。

摘　　要：目的探讨T_(1ρ)mapping在肥厚型心肌病(HCM)患者心肌纤维化评估中的应用价值。方法前瞻性纳入2021年12月至2022年5月在阜外医院进行心脏MR(CMR)检查的HCM患者40例和健康志愿者(HC)16名。在HCM患者中进行T_(1ρ)mapping,增强前、后T_(1)mapping和钆对比延迟增强(LGE)成像,在HC组中进行T_(1ρ)mapping、T_(1)mapping成像。依据有无LGE进一步将HCM患者分为LGE阳性和LGE阴性组。测量HCM患者和HC的左心室整体心肌的T_(1ρ)值、初始T_(1)值,并通过HCM患者增强前、后的T_(1)mapping进一步测量左心室整体心肌的细胞外间质容积分数(ECV)。采用单因素方差分析比较LGE阳性组、LGE阴性组和HC组3组T_(1ρ)、初始T_(1)值,进一步两两比较采用Bonferroni法校正。通过受试者操作特征曲线(ROC)分析初始T_(1)值及T_(1ρ)值在LGE阳性组和HC组、LGE阴性组和HC组的诊断效能。分类变量比较采用χ^(2)检验或Fisher确切概率法。以Pearson相关系数评价T_(1ρ)值与初始T_(1)值、ECV的相关性。结果40例HCM患者中LGE阳性组25例,LGE阴性组15例,LGE阳性、LGE阴性及HC组的年龄、性别及体重指数差异无统计学意义(P均>0.05)。与HC组比,LGE阳性组T_(1ρ)值(t=5.74,P<0.001)、初始T_(1)值(t=3.99,P<0.001)均升高,LGE阴性组T_(1ρ)值(t=4.19,P<0.001)、初始T_(1)值(t=2.06,P<0.044)均升高,差异具有统计学意义。ROC分析显示,T_(1ρ)值及初始T_(1)值区分LGE阳性患者与HC组的曲线下面积分别为0.93(灵敏度84.0%,特异度93.8%)、0.87(灵敏度84.0%,特异度87.5%);T_(1ρ)值及初始T_(1)值区分LGE阴性患者与HC组的曲线下面积分别为0.84(灵敏度86.7%,特异度68.8%)、0.68(灵敏度60%,特异度68.0%)。相关性分析显示,左心室整体T_(1ρ)值与初始T_(1)值(r=0.31,P=0.02)、ECV值(r=0.38,P=0.02)均呈正相关。结论在不使用对比剂的条件下,T_(1ρ)mapping对HCM患者心肌替代性纤维化及弥漫性纤维化均有良好识别能力。Objective To investigate the value of T_(1ρ)mapping in the assessment of myocardial fibrosis in patients with hypertrophic cardiomyopathy(HCM).Methods Forty HCM patients and 16 healthy volunteers who underwent CMR examination between December 2021 and May 2022 were prospectively enrolled.T_(1ρ)mapping,pre-and post-contrast T_(1)mapping,and gadolinium contrast-enhanced delayed enhancement(LGE)imaging were performed in HCM patients,while T_(1ρ)mapping and T_(1)mapping were performed in volunteers.HCM patients were further divided into LGE-positive(LGE+)and LGE-negative(LGE-)groups based on the presence or absence of LGE.The T_(1ρ)and pre-contrast T_(1)values of the left ventricular myocardium of HCM patients and volunteers were measured,and the extracellular volume fraction(ECV)of the left ventricular myocardium of HCM patients was measured using pre-and post-contrast T_(1)mapping.One-way ANOVA was used to compare the T_(1ρ)and pre-contrast T_(1)values among the LGE+,LGE-,and volunteer groups,and pairwise comparisons were further corrected using the Bonferroni method.Receiver operating characteristic(ROC)analysis was used to evaluate the diagnostic performance of pre-contrast T_(1)and T_(1ρ)values in distinguishing LGE+and LGE-patients from volunteers.The chi-square test or Fisher′s exact probability test was used for categorical variable comparisons.Pearson correlation coefficient was used to evaluate the correlation between T_(1ρ)and pre-contrast T_(1),and ECV.Results There were no significant differences in age,gender,and body surface area among the LGE+,LGE-,and healthy control groups(P>0.05).Compared to the HC group,both the T_(1ρ)value(t=5.74,P<0.001)and the pre-contrast T_(1)value(t=3.99,P<0.001)increased in LGE positive group,as well as in the LGE negative group(T_(1ρ):t=4.19,P<0.001;T_(1):t=2.06,P<0.044).ROC analysis showed that the area under the curve(AUC)of T_(1ρ)and pre-contrast T_(1)in distinguishing LGE+patients from healthy controls were 0.93(sensitivity 84.0%,specificity 93.8%)and 0.87(

关 键 词：磁共振成像 肥厚型心肌病 T_(1)mapping T_(1ρ)mapping 心肌纤维化 

分 类 号：R542.2[医药卫生—心血管疾病]