T2 mapping评估ST段抬高心肌梗死患者心肌改变的预后意义  

Prognostic significance of T2 mapping in evaluating myocardium alterations in patients with ST segment elevation myocardial infarction

作　　者：崔倩[1,2] 何强[3] 葛夕洪[2] 高光峰[2] 刘洋[1] 于静[2] 王洪乐 沈文[1,2] Cui Qian;He Qiang;Ge Xihong;Gao Guangfeng;Liu Yang;Yu Jing;Wang Hongle;Shen Wen(The First Central Clinical School,Tianjin Medical University,Tianjin 300192,China;Department of Radiology,Tianjin First Central Hospital,Tianjin 300192,China;Department of Cardiology,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津医科大学一中心临床学院,天津300192 [2]天津市第一中心医院放射科,天津300192 [3]天津市第一中心医院心血管内科,天津300192

出　　处：《中华危重病急救医学》2023年第12期1304-1308,共5页Chinese Critical Care Medicine

基　　金：天津市卫生健康委员会科技人才培育项目(KJ20219);天津市医学重点学科(专科)建设项目(TJYXZDXK-041A)。

摘　　要：目的探讨磁共振横向弛豫时间定量成像(T2 mapping)对急性ST段抬高心肌梗死(STEMI)患者心肌改变的评估作用及预后意义。方法采用回顾性研究方法,纳入2021年1月至2022年3月天津市第一中心医院收治的30例急性STEMI患者作为试验组,并选取同期年龄、性别匹配的30例健康志愿者和门诊非特异性胸痛而心脏磁共振(CMR)检查无异常者作为对照组。在明确诊断STEMI后于2周内行CMR检查,做为首诊参照,并于6个月后(即慢性心肌梗死,CMI)进行平扫CMR复查。平扫检查包括电影序列、T2加权压脂序列(T2-STIR)、增强前纵向弛豫时间定量成像(T1 mapping)和T2 mapping;增强检查包括首过灌注、钆延迟增强(LGE)及增强后T1 mapping。对比两组间、STEMI心肌梗死前后心肌定量参数;用受试者工作特征曲线(ROC曲线)评估心肌增强前T1值和T2值区分STEMI与6个月后CMI的诊断效能。结果两组间年龄、性别、心率、体质量指数(BMI)等差异均无统计学意义,具有可比性。试验组患者增强前T1值、T2值及细胞外容积(ECV)均较对照组明显升高〔增强前T1值(ms):1434.5±165.3比1237.0±102.5,T2值(ms):48.3±15.6比21.8±13.1,ECV:(39.6±13.8)%比(22.8±5.0)%,均P<0.05〕。试验组中有12例患者于6个月后复查了CMR平扫,T2-STIR上高信号仍可见,但范围较急性期减小,增强前T1值和T2值均较急性期明显减低〔增强前T1值(ms):1271.0±26.9比1434.5±165.3,T2值(ms):34.2±11.2比48.3±15.6,均P<0.05〕。ROC曲线分析得出,增强前T1值和T2值区分STEMI急性期与CMI的ROC曲线下面积(AUC)分别为0.71、0.80,增强前T1截断值为1316.0 ms时特异度为100%,敏感度为53.3%,T2截断值为46.7 ms时特异度为100%,敏感度为73.8%。结论T2 mapping是诊断急性STEMI患者心肌改变的非侵入式评估手段,并可对患者预后随访进行评估。Objective To investigate the value of T2 mapping in the assessment of myocardial changes and prognosis in patients with acute ST segment elevation myocardial infarction(STEMI).Methods A retrospective study was conducted.A total of 30 patients with acute STEMI admitted to Tianjin First Central Hospital from January 2021 to March 2022 were enrolled as the experimental group.At the same time,30 age-and sex-matched healthy volunteers and outpatients with non-specific chest pain with no abnormalities in cardiac magnetic resonance(CMR)examination were selected as the control group.CMR was performed within 2 weeks after the diagnosis of STEMI,as the initial reference.A plain CMR review was performed 6 months later(chronic myocardial infarction,CMI).Plain scanning includes film sequence(CINE),T2 weighted short tau inversion recovery(T2-STIR),native-T1 mapping,and T2 mapping.Enhanced scanning includes first-pass perfusion,late gadolinium enhancement(LGE),and post-contrast T1 mapping.Quantitative myocardial parameters were compared between the two groups,before and after STEMI myocardial infarction.The receiver operator characteristic curve(ROC curve)was used to evaluate the diagnostic efficacy of native-T1 before myocardial contrast enhancement and T2 values in differentiating STEMI and CMI after 6 months.Results There were no statistically significant differences in age,gender,heart rate and body mass index(BMI)between the two groups,which were comparable.The native-T1 value,T2 value and extracellular volume(ECV)were significantly higher than those in the control group[native-T1 value(ms):1434.5±165.3 vs.1237.0±102.5,T2 value(ms):48.3±15.6 vs.21.8±13.1,ECV:(39.6±13.8)%vs.(22.8±5.0)%,all P<0.05].In the experimental group,12 patients were re-examined by plain CMR scan 6 months later.After 6 months,the high signal intensity on T2-STIR was still visible,but the range was smaller than that in the acute phase,and the native-T1 and T2 values were significantly lower than those in the acute phase[native-T1 value(ms):1271.0

关 键 词：横向弛豫时间定量成像 ST段抬高心肌梗死 心肌改变 

分 类 号：R542.22[医药卫生—心血管疾病]