Extracellular volume fraction mapping in the myocardium, part 2: initial clinical experience.
Extracellular volume fraction mapping in the myocardium, part 2: initial clinical experience.
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DOI：
10.1186/1532-429x-14-64
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发表时间：
2012-09-11
期刊：
影响因子：
--
通讯作者：
Arai AE
中科院分区：
文献类型：
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作者：
Kellman P;Wilson JR;Xue H;Bandettini WP;Shanbhag SM;Druey KM;Ugander M;Arai AE
弥漫性心肌纤维化和较小程度的全局性心肌水肿是心脏病的重要过程，难以用常规晚期钆增强（LGE）或t1定位的心血管磁共振（CMR）来评估或量化。心肌细胞外体积分数（ECV）的测量绕过了混淆t1加权图像或t1图的因素。我们假设心肌ECV的定量评估将在临床上用于检测各种常见和不常见心脏病的局灶性和弥漫性心肌异常。共对156例受试者进行影像学检查，其中正常62例，慢性心肌梗死（MI） 33例，肥厚型心肌病（HCM） 33例，非缺血性扩张型心肌病（DCM） 15例，急性心肌炎7例，心脏淀粉样变性4例，系统性毛细血管渗漏综合征（SCLS） 2例。运动校正后的ECV图是由血液比容校正后获得的t1图自动生成的。异常升高的ECV被定义为与正常个体的平均ECV相比bb0 - 2SD。在HCM中，LGE区域的大小被量化为远端>.2 SD区域。62例正常人平均ECV为25.4±2.5% (m±SD)，正常范围20.4% ~ 30.4%。慢性心肌梗死核心（无MVO） （N = 33）的平均ECV为68.5±8.6% （p < 0.001）。在HCM中，ECV异常升高的程度与LGE的程度相关（r = 0.72, p < 0.001），但ECV异常升高的程度更大（平均差19±7%）。16例非缺血性DCM患者中有4例出现异常升高的ECV(38.1±1.9%)(p < 0.001)，其中2例同一切片的LGE显示“正常”。其他疾病的平均ECV值为心肌淀粉样变性32-60% (N = 4)，全身性毛细血管渗漏综合征40-41% (N = 2)，心肌炎影响的异常区域39-56% （N = 7）。在更均匀扩散的疾病中，ECV作图有望补充LGE成像。以生理上直观的单位显示ECV图的能力，可以在绝对尺度上进行解释，为检测弥漫性疾病和测量异常区域的范围和严重程度提供了潜力。
Diffuse myocardial fibrosis, and to a lesser extent global myocardial edema, are important processes in heart disease which are difficult to assess or quantify with cardiovascular magnetic resonance (CMR) using conventional late gadolinium enhancement (LGE) or T1-mapping. Measurement of the myocardial extracellular volume fraction (ECV) circumvents factors that confound T1-weighted images or T1-maps. We hypothesized that quantitative assessment of myocardial ECV would be clinically useful for detecting both focal and diffuse myocardial abnormalities in a variety of common and uncommon heart diseases. A total of 156 subjects were imaged including 62 with normal findings, 33 patients with chronic myocardial infarction (MI), 33 with hypertrophic cardiomyopathy (HCM), 15 with non-ischemic dilated cardiomyopathy (DCM), 7 with acute myocarditis, 4 with cardiac amyloidosis, and 2 with systemic capillary leak syndrome (SCLS). Motion corrected ECV maps were generated automatically from T1-maps acquired pre- and post-contrast calibrated by blood hematocrit. Abnormally-elevated ECV was defined as >2SD from the mean ECV in individuals with normal findings. In HCM the size of regions of LGE was quantified as the region >2 SD from remote. Mean ECV of 62 normal individuals was 25.4 ± 2.5% (m ± SD), normal range 20.4%-30.4%. Mean ECV within the core of chronic myocardial infarctions (without MVO) (N = 33) measured 68.5 ± 8.6% (p < 0.001 vs normal). In HCM, the extent of abnormally elevated ECV correlated to the extent of LGE (r = 0.72, p < 0.001) but had a systematically greater extent by ECV (mean difference 19 ± 7% of slice). Abnormally elevated ECV was identified in 4 of 16 patients with non-ischemic DCM (38.1 ± 1.9% (p < 0.001 vs normal) and LGE in the same slice appeared “normal” in 2 of these 4 patients. Mean ECV values in other disease entities ranged 32-60% for cardiac amyloidosis (N = 4), 40-41% for systemic capillary leak syndrome (N = 2), and 39-56% within abnormal regions affected by myocarditis (N = 7). ECV mapping appears promising to complement LGE imaging in cases of more homogenously diffuse disease. The ability to display ECV maps in units that are physiologically intuitive and may be interpreted on an absolute scale offers the potential for detection of diffuse disease and measurement of the extent and severity of abnormal regions.