心脏磁共振延迟强化与组织学胶原纤维的关系-移植心脏离体研究  

Study of Relationship between Cardiac Magnetic Resonance Late Gadolinium Enhancement and Histological Myocardial Fibrosis based on the Transplanted Heart Specimen

作　　者：杨建昌 任冠敏 王慧敏 周小兵 陈锐[1] 刘辉[1] YANG Jianchang;REN Guanmin;HUANG Huimin(Department of Radiology,Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou,Guangdong Province 510080,P.R.China)

机构地区：[1]南方医科大学附属广东省人民医院(广东省医学科学)放射科,广州510080 [2]暨南大学附属第一医院医学影像中心,广州510630 [3]南方医科大学附属广东省人民医院(广东省医学科学)心脏超声科,广州510080 [4]中山大学附属第五医院放射科,珠海519099

出　　处：《临床放射学杂志》2023年第12期1900-1906,共7页Journal of Clinical Radiology

基　　金：国家自然科学基金面上项目(编号:81974262);广东省自然科学基金面上项目(编号:2020A1515010650);2020年心血管疾病研究专项项目(编号:2020XXG009)。

摘　　要：目的探索心脏磁共振成像(CMR)延迟强化(LGE)评估心肌胶原纤维与人类全心组织学的关系。方法对22例拟进行心脏移植手术的患者行术前CMR检查,对移植的离体心脏进行16节段取材、苦味酸天狼星红染色后,定量胶原纤维体积分数(CVF)。半自动后处理CMR-LGE序列图像,利用高于远处正常心肌平均信号2~8倍标准差(SD)灰阶阈值法及半峰全宽法计算LGE,用Bland-Altman分析及Pesarson或Spearman相关系数分析LGE与CVF的关系。结果13例患者出现LGE,各种半自动方法计算LGE与CVF有正相关性,其中6倍SD定量LGE与CVF相关性最好(r=0.783,P=0.02),且二者具有最小偏倚(偏倚:-0.95)。在亚组分析中,缺血性心肌病组半峰全宽法计算LGE与CVF有明显相关性(基于患者:r=0.932,P=0.002),而在非缺血性心肌病中,8倍SD定量LGE与CVF有中等相关性(基于LGE阳性节段:r=0.674,P<0.001)。结论磁共振LGE技术可无创地检测心肌胶原纤维,半峰全宽法计算缺血性心肌病LGE与组织学胶原纤维最接近,8倍SD计算非缺血性心肌病LGE与CVF最接近。Objective We evaluated the relationship of fibrosis assessment by Cardiac magnetic resonance(CMR)late gadolinium enhancement(LGE)techniques with human histology based on the ex-vivo whole heart specimen.Methods Preoperative CMR-LGE examination was performed on 22 patients with heart disease who were to undergo heart transplantation.After transplantation,16 segments of the whole heart were collected and stained with Sirius red,and the collagen volume fraction(CVF)was quantified.The relationships were observed between CVF and LGE measuredby“n”-standard deviations(SD)approach and full width half maximum(FWHM).Results For patients with LGE on CMR images(13 cases),significant correlations were observed between LGE and CVF,withstrongest correlation measured at 6 SD(r=0.783,P=0.02).Bland-Altman analysis revealed optimum agreementbetween CVF and LGE measured at 6 SD(bias:-0.95).In ischemic cardiomyopathy(ICM)group,strong correlation was observed between CVF and LGE measured by FWHM(pre patient,r=0.932,P=0.002).In non-ischemic cardiomyopathy(NICM)group,moderate correlation was observed between CVF and LGE measured at 8 SD(pre LGE+segment,r=0.674,P<0.001).Conclusion As a non-invasive examination to evaluate myocardial fibrosis,CMR-LGE measured by FWHM and 8 SD yields the closest approximation to the extent of patients with ICM and NICM fibrosis measured by the histopathological standard of reference.

关 键 词：心脏磁共振成像 延迟强化 移植心脏 心肌纤维化 灰阶阈值 

分 类 号：R654.2[医药卫生—外科学] R445.2[医药卫生—临床医学]