Diagnosis of Pulmonary Hypertension with Cardiac MRI: Derivation and Validation of Regression Models.
Diagnosis of Pulmonary Hypertension with Cardiac MRI: Derivation and Validation of Regression Models.
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DOI：
10.1148/radiol.2018180603
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发表时间：
2019-01
期刊：
影响因子：
19.7
通讯作者：
Swift AJ
中科院分区：
文献类型：
--
作者：
Johns CS;Kiely DG;Rajaram S;Hill C;Thomas S;Karunasaagarar K;Garg P;Hamilton N;Solanki R;Capener DA;Elliot C;Sabroe I;Charalamopopoulos A;Condliffe R;Wild JM;Swift AJ
目的：建立并检验肺动脉高压（PH）诊断的多参数心脏MRI模型。回顾性回顾2012年至2016年间连续接受心脏MRI和右侧心导管（RHC）检查的疑似PH患者的图像和患者数据。在识别的2437张MR图像中，603张符合纳入标准。患者平均年龄61岁（范围18-88岁），女性平均年龄60岁（范围18-84岁），男性平均年龄62岁（范围22-88岁）。在前300名患者（衍生队列）中，心脏MRI指标显示与平均肺动脉压（mPAP）相关，用于创建回归算法。在303例患者验证队列中，采用受试者工作特征（ROC）和χ2分析对模型的性能进行评价。衍生队列中，心脏MRI mPAP模型1（右心室和黑血）定义为：−179 + loge室间隔角× 42.7 + log10心室质量指数（右心室质量/左心室质量）× 7.57 +黑血慢流评分× 3.39。在验证队列中，心脏MRI mPAP模型1与rhc测量的mPAP具有很强的一致性，类内系数为0.78，诊断准确率高（ROC曲线下面积= 0.95；95%可信区间[CI]: 0.93, 0.98）。在验证队列中，至少25 mm Hg阈值的敏感性为93% (95% CI: 89%, 96%)，特异性为79% (95% CI: 65%, 89%)，阳性预测值为96% (95% CI: 93%, 98%)，阴性预测值为67% （95% CI: 53%, 78%）。第二种模型，心脏MRI mPAP模型2（右心室肺动脉），不包括黑血流量评分，具有相同的诊断准确性（ROC差异：P = 0.24）。多参数心脏MRI模型对疑似肺动脉高压患者具有较高的诊断准确性。在CC BY 4.0许可下发布。本文的在线补充材料是可用的。参见本期科勒蒂的社论。
To derive and test multiparametric cardiac MRI models for the diagnosis of pulmonary hypertension (PH). Images and patient data from consecutive patients suspected of having PH who underwent cardiac MRI and right-sided heart catheterization (RHC) between 2012 and 2016 were retrospectively reviewed. Of 2437 MR images identified, 603 fit the inclusion criteria. The mean patient age was 61 years (range, 18–88 years; mean age of women, 60 years [range, 18–84 years]; mean age of men, 62 years [range, 22–88 years]). In the first 300 patients (derivation cohort), cardiac MRI metrics that showed correlation with mean pulmonary arterial pressure (mPAP) were used to create a regression algorithm. The performance of the model was assessed in the 303-patient validation cohort by using receiver operating characteristic (ROC) and χ2 analysis. In the derivation cohort, cardiac MRI mPAP model 1 (right ventricle and black blood) was defined as follows: −179 + loge interventricular septal angle × 42.7 + log10 ventricular mass index (right ventricular mass/left ventricular mass) × 7.57 + black blood slow flow score × 3.39. In the validation cohort, cardiac MRI mPAP model 1 had strong agreement with RHC-measured mPAP, an intraclass coefficient of 0.78, and high diagnostic accuracy (area under the ROC curve = 0.95; 95% confidence interval [CI]: 0.93, 0.98). The threshold of at least 25 mm Hg had a sensitivity of 93% (95% CI: 89%, 96%), specificity of 79% (95% CI: 65%, 89%), positive predictive value of 96% (95% CI: 93%, 98%), and negative predictive value of 67% (95% CI: 53%, 78%) in the validation cohort. A second model, cardiac MRI mPAP model 2 (right ventricle pulmonary artery), which excludes the black blood flow score, had equivalent diagnostic accuracy (ROC difference: P = .24). Multiparametric cardiac MRI models have high diagnostic accuracy in patients suspected of having pulmonary hypertension. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Colletti in this issue.
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