Improved detection of myocardial involvement in acute inflammatory cardiomyopathies using T2 mapping.
Improved detection of myocardial involvement in acute inflammatory cardiomyopathies using T2 mapping.
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DOI：
10.1161/circimaging.111.967836
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发表时间：
2012-01
期刊：
影响因子：
--
通讯作者：
Raman SV
中科院分区：
文献类型：
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作者：
Thavendiranathan P;Walls M;Giri S;Verhaert D;Rajagopalan S;Moore S;Simonetti OP;Raman SV
T2加权心脏磁共振（CMR）是有用的诊断急性炎症性心肌疾病，如心肌炎和tako-tsubo心肌病（TTCM）。我们假设定量T2标测比T2加权成像能更好地描述这些疾病的心肌受累。30例符合既定诊断标准的疑似心肌炎或TTCM转介CMR的患者接受了心肌T2标测。对受累和远端心肌节段的T2值取平均值，两者均由对T2数据不知情的审查者定义。在心肌炎中，受累心肌的T2为65.2±3.2ms，远端心肌的T2为53.5±2.1（p<0.001）。在TTCM中，受累心肌的T2为65.6±4.0ms，远段为53.6±2.7ms（p<0.001）。患者远端心肌节段和对照组所有心肌节段的T2值相似（均为p>0.05）。T2标测图提供了诊断数据，即使是在屏气困难的患者中。T2截止值为59 ms时，心肌受累的敏感性和特异性分别为94%和97%。T2标测显示了室壁运动异常或LGE阳性以外的T2异常区域。7例患者的常规T2加权短tau反转恢复（T2 W-STIR）图像由于伪影而无法解释，2例T2值升高的患者的图像不明显。30例患者中仅17例在T2准备的稳态自由进动（T2 p-SSFP）图像中显示高信号区。定量T2标测可靠地识别心肌炎和TTCM患者的心肌受累。与室壁运动异常、T2 W-STIR、T2 p-SSFP或LGE相比，T2标测描绘了两种情况下更大程度的心肌病变。定量T2标测值得考虑作为一种可靠的技术，以确定急性心肌炎或TTCM患者的心肌损伤。
T2-weighted cardiac magnetic resonance (CMR) is useful in diagnosing acute inflammatory myocardial diseases such as myocarditis and tako-tsubo cardiomyopathy (TTCM). We hypothesized that quantitative T2 mapping could better delineate myocardial involvement in these disorders vs. T2-weighted imaging. Thirty patients with suspected myocarditis or TTCM referred for CMR who met established diagnostic criteria underwent myocardial T2 mapping. T2 values were averaged in involved and remote myocardial segments, both defined by a reviewer blinded to T2 data. In myocarditis, T2 was 65.2±3.2ms in the involved myocardium vs. 53.5±2.1 in remote myocardium (p<0.001). In TTCM, T2 was 65.6±4.0ms in the involved myocardium vs. 53.6±2.7ms in remote segments (p<0.001). T2 values were similar across remote myocardial segments in patients and all myocardial segments in controls (p>0.05 for all). T2 maps provided diagnostic data even in patients with difficulty breath-holding. A T2 cutoff of 59ms identified areas of myocardial involvement with sensitivity and specificity of 94% and 97%, respectively. T2 mapping revealed regions of abnormal T2 beyond those identified by wall motion abnormalities or LGE-positivity. Conventional T2-weighted short tau inversion recovery (T2W-STIR) images were uninterpretable in 7 patients due to artifact and unremarkable in 2 who had elevated T2 values. T2-prepared steady state free precession (T2p-SSFP) images showed areas of signal hyperintensity in only17/30 patients. Quantitative T2 mapping reliably identifies myocardial involvement in patients with myocarditis and TTCM. T2 mapping delineated greater extent of myocardial disease in both conditions compared to that identified by wall motion abnormalities, T2W-STIR, T2p-SSFP or LGE. Quantitative T2 mapping warrants consideration as a robust technique to identify myocardial injury in patients with acute myocarditis or TTCM.