Cardiac computed tomographic imaging to evaluate myocardial scarring/fibrosis in patients with hypertrophic cardiomyopathy: a comparison with cardiac magnetic resonance imaging
Cardiac computed tomographic imaging to evaluate myocardial scarring/fibrosis in patients with hypertrophic cardiomyopathy: a comparison with cardiac magnetic resonance imaging
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DOI：
10.1007/s10554-012-0048-y
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发表时间：
2013-01-01
影响因子：
2.1
通讯作者：
Choudhury, Lubna
中科院分区：
文献类型：
--
作者：
Berliner, Jennifer I.;Kino, Aya;Choudhury, Lubna
对比增强磁共振成像（CeMRI）可靠地识别肥厚性心肌病（HCM）患者的心肌纤维化。然而，许多患者有ceMRI的禁忌症。先前的研究表明，对比增强多探测器计算机断层扫描（ceMDCT）可以在实验动物和患者中看到心肌梗死后的局灶性疤痕。本文的目的是评估ceMDCT检测HCM患者局灶性心肌疤痕的能力。12例HCM患者接受了ceMRI和ceMDCT。心肌纤维化区被定义为局灶性或弥漫性纤维化区。采用定性和定量分析方法测定纤维化区、正常心肌和左心室血池对比的ceMRI平均信号强度和ceMDCT衰减值。用这两种技术计算局灶性疤痕肿块。9例患者发现局灶性瘢痕，所有患者均可见弥漫性纤维化。在ceMRI和ceMDCT中，正常心肌与局灶性瘢痕、正常纤维化区与弥漫性纤维化区、弥漫性纤维化区与局灶性瘢痕归一化SI值差异均有统计学意义（p < 0.05）。弥漫性纤维化在ceMDCT上表现不佳，但通过定量测量可以检测到。CeMDCT有潜力检测有ceMRI研究禁忌症的HCM患者的局灶性心肌疤痕。然而，ceMDCT不能充分显示弥漫性心肌纤维化，因此在评估纤维化总负荷方面不如ceMRI合适。使用定量方法可以克服这一限制。
Contrast enhanced magnetic resonance imaging (CeMRI) reliably identifies myocardial fibrosis in patients with hypertrophic cardiomyopathy (HCM). However, many patients have contraindications to ceMRI. Previous studies have shown that contrast enhanced multi-detector computed tomography (ceMDCT) can visualize focal scars following myocardial infarction in experimental animals and patients. The purpose of this manuscript is to assess the ability of ceMDCT to detect focal myocardial scars in patients with HCM. Twelve HCM patients underwent ceMRI and ceMDCT. Fibrotic areas of myocardium were defined as focal or diffuse areas of fibrosis. The mean signal intensity in ceMRI and attenuation values in ceMDCT of the fibrotic regions, normal myocardium and left ventricle blood pool contrast were measured using qualitative and quantitative analysis. Focal scar mass was calculated using both techniques. Focal scars were detected in 9 patients and diffuse fibrosis was visualized in all patients by ceMRI. Differences between normalized SI of normal myocardium and focal scars, normal and diffuse areas of fibrosis, and diffuse fibrosis and focal scars were significant for both ceMRI and ceMDCT (p < 0.05). Diffuse fibrosis was poorly visualized by ceMDCT but was detectable using quantitative measurements. CeMDCT has potential to detect focal myocardial scars in patients with HCM who have contraindications to ceMRI study. However, ceMDCT does not enable adequate visualization of diffuse myocardial fibrosis, and thus is less well suited than ceMRI for assessment of total burden of fibrosis. This limitation may be overcome using quantitative methodology.