Extracellular volume imaging by magnetic resonance imaging provides insights into overt and sub-clinical myocardial pathology
Extracellular volume imaging by magnetic resonance imaging provides insights into overt and sub-clinical myocardial pathology
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DOI：
10.1093/eurheartj/ehr481
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发表时间：
2012-05-01
影响因子：
39.3
通讯作者：
Arai, Andrew E.
中科院分区：
文献类型：
--
作者：
Ugander, Martin;Oki, Abiola J.;Arai, Andrew E.
常规晚期钆增强（LGE）心脏磁共振可以检测心肌梗死和某些形式的非缺血性心肌纤维化。然而，细胞外体积分数（ECV）的定量成像可能能够检测细微的异常，如弥漫性纤维化或梗死后远端心肌重构。目的是(1)测量心肌梗死和非缺血性心肌纤维化时的ECV，(2)确定ECV是否随年龄变化，(3)检测远离梗死区域的正常心肌的亚临床异常。对126例患者在注射钆造影剂前后进行心脏磁共振ECV成像T1定位。获取左心室常规LGE图像。在既往有心肌梗死的患者中，梗死区ECV为518，与远端正常心肌ECV为273没有重叠（P 0.001, n 36）。在非缺血性心肌病患者中，非典型LGE的ECV为376，而外观正常心肌的ECV为263 （P < 0.001, n < 30）。外观正常心肌的ECV随年龄增大而升高（r 0.28, P 0.01, n 60）。随着左室射血分数的降低，远离心肌梗死的正常心肌的ECV升高（r 0.50, P 0.02）。细胞外体积分数成像可以定量表征心肌梗死、非典型弥漫性纤维化和在LGE图像上不明显的细微心肌异常。在先前文献的背景下，这些细微的ECV异常与年龄相关的弥漫性纤维化和远离梗死的变化是一致的。
Conventional late gadolinium enhancement (LGE) cardiac magnetic resonance can detect myocardial infarction and some forms of non-ischaemic myocardial fibrosis. However, quantitative imaging of extracellular volume fraction (ECV) may be able to detect subtle abnormalities such as diffuse fibrosis or post-infarct remodelling of remote myocardium. The aims were (1) to measure ECV in myocardial infarction and non-ischaemic myocardial fibrosis, (2) to determine whether ECV varies with age, and (3) to detect sub-clinical abnormalities in onormal appearing' myocardium remote from regions of infarction.Cardiac magnetic resonance ECV imaging was performed in 126 patients with T1 mapping before and after injection of gadolinium contrast. Conventional LGE images were acquired for the left ventricle. In patients with a prior myocardial infarction, the infarct region had an ECV of 51 8 which did not overlap with the remote onormal appearing' myocardium that had an ECV of 27 3 (P 0.001, n 36). In patients with non-ischaemic cardiomyopathy, the ECV of atypical LGE was 37 6, whereas the onormal appearing' myocardium had an ECV of 26 3 (P 0.001, n 30). The ECV of onormal appearing' myocardium increased with age (r 0.28, P 0.01, n 60). The ECV of onormal appearing' myocardium remote from myocardial infarctions increased as left ventricular ejection fraction decreased (r 0.50, P 0.02).Extracellular volume fraction imaging can quantitatively characterize myocardial infarction, atypical diffuse fibrosis, and subtle myocardial abnormalities not clinically apparent on LGE images. Taken within the context of prior literature, these subtle ECV abnormalities are consistent with diffuse fibrosis related to age and changes remote from infarction.