Histological validation of cardiacmagnetic resonance analysis of regional and diffuse interstitial myocardial fibrosis
Histological validation of cardiacmagnetic resonance analysis of regional and diffuse interstitial myocardial fibrosis
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DOI：
10.1093/ehjci/jeu182
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发表时间：
2015-01-01
影响因子：
6.2
通讯作者：
Taylor, Andrew J.
中科院分区：
文献类型：
--
作者：
Iles, Leah M.;Ellims, Andris H.;Taylor, Andrew J.
目的心肌纤维化是心衰发病的基础。晚期钆增强（LGE）与心脏磁共振（CMR）成像通常被认为代表心肌纤维化；然而，比较人类组织学数据有限，特别是在非缺血性心脏病中。弥漫性间质性心肌纤维化越来越被认为是心肌病发病机制的核心，可以使用新的CMR技术（如T-1制图）进行量化。我们评估了CMR评估区域性和弥漫性纤维化与人类组织学的关系。方法和结果招募了11例等待心脏移植的患者（43.5 +/- 7.6岁，64%男性）和8例因梗阻性肥厚性心肌病手术切除肌肌的患者（57.1 +/- 8.6岁，63%男性），并在心脏移植或肌肌切除术前进行了CMR。使用数字分析的马松三色染色玻片对外植心脏的纤维化进行量化，与使用Image J分析的小天狼星红染色玻片进行了验证，具有很好的相关性（R = 0.95, P < 0.0001）。在移植心脏的信号强度阈值范围内（范围：高于参考心肌2-10个标准差），观察到LGE与组织学纤维化之间存在显著相关性，阈值的最大准确性为6 SD （R = 0.91, P < 0.001）。对比后T-1次评估间质性心肌纤维化在节段（R = 20.64, P = 0.002）和每例（R = 20.78, P = 0.003）分析中均有显著相关性。结论CMR使用LGE对局部心肌纤维化提供准确、无创的评估，而弥漫性间质心肌纤维化则通过对比后T-1制图准确评估。
Aim Myocardial fibrosis is fundamental in the pathogenesis of heart failure. Late gadolinium enhancement (LGE) with cardiac magnetic resonance (CMR) imaging is commonly assumed to represent myocardial fibrosis; however, comparative human histological data are limited, especially in non-ischaemic cardiac disease. Diffuse interstitial myocardial fibrosis is increasingly recognized as central in the pathogenesis of cardiomyopathy and can be quantified using newer CMR techniques such as T-1 mapping. We evaluated the relationship of CMR assessment of regional and diffuse fibrosis with human histology.Methods and results Eleven patients on the waiting list for heart transplantation (43.5 +/- 7.6 years, 64% male) and eight patients undergoing surgical myectomy for obstructive hypertrophic cardiomyopathy (57.1 +/- 8.6 years, 63% male) were recruited and underwent CMR prior to cardiac transplantation or myectomy. Quantification of fibrosis in explanted hearts using digitally analysed Masson-trichrome-stained slides was validated against picrosirius red-stained slides analysed using Image J, with an excellent correlation (R = 0.95, P < 0.0001). Significant correlations were observed between LGE and histological fibrosis across a range of signal intensity thresholds in the explanted hearts (range: 2-10 standard deviations above reference myocardium), with maximal accuracy at a threshold of 6 SD (R = 0.91, P < 0.001). Assessment of interstitial myocardial fibrosis with post-contrast T-1 times demonstrated a significant correlation on both segmental (R = 20.64, P = 0.002) and per-patient (R = 20.78, P = 0.003) analyses.Conclusion CMR provides accurate, non-invasive assessment of regional myocardial fibrosis using LGE, while diffuse interstitial myocardial fibrosis is accurately assessed with post-contrast T-1 mapping.