Cardiovascular magnetic resonance by non contrast T1-mapping allows assessment of severity of injury in acute myocardial infarction.
Cardiovascular magnetic resonance by non contrast T1-mapping allows assessment of severity of injury in acute myocardial infarction.
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DOI：
10.1186/1532-429x-14-15
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发表时间：
2012-02-06
期刊：
影响因子：
--
通讯作者：
Neubauer S
中科院分区：
文献类型：
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作者：
Dall'Armellina E;Piechnik SK;Ferreira VM;Si QL;Robson MD;Francis JM;Cuculi F;Kharbanda RK;Banning AP;Choudhury RP;Karamitsos TD;Neubauer S
目前的心血管磁共振（CMR）方法，如晚期钆增强（LGE）和水肿成像（T2 W）用于描述心肌缺血，有局限性。新的定量T1映射技术有可能进一步表征缺血性损伤的组成部分。在心肌梗死（MI）患者中，我们试图研究最先进的造影前T1标测（1）是否能检测急性心肌损伤，（2）与标准技术（如LGE和T2 W）相比，是否能量化损伤的严重程度，（3）是否能预测长期功能恢复。对41例急性心肌梗死患者（其中78%为ST段抬高型心肌梗死（STEMI））在胸痛发作后12-48小时和6个月（6个月）时进行了3 T CMR，包括T2 W、T1标测和LGE。STEMI患者在CMR之前接受了直接PCI。在匹配的短轴切片上评估急性节段性室壁运动异常、T2 W和LGE的急性节段性损害分数以及平均节段性T1值。还获得了LGE和6个月时局部室壁运动的改善。我们发现，T1测量的变异性明显低于T2 W，而急性T1标测检测心肌损伤的诊断性能至少与STEMI患者的T2 W-CMR一样好，但在NSTEMI中上级T2 W成像。LGE和T2 W测量的节段性损伤分数与平均节段性T1值有显著相关性（P < 0.01）。急性T1标测和6 M LGE得出的挽救心肌指数与T2 W得出的挽救心肌指数无差异（P = 0.88）。此外，随着急性T1值的增加，6个月时节段性功能改善的可能性逐渐降低（P < 0.0004）。在急性心肌梗死中，造影前T1标测可以评估心肌损伤的程度。T1标测可能成为LGE和T2 W的重要补充技术，用于识别急性MI的可逆性心肌损伤和预测功能恢复。
Current cardiovascular magnetic resonance (CMR) methods, such as late gadolinium enhancement (LGE) and oedema imaging (T2W) used to depict myocardial ischemia, have limitations. Novel quantitative T1-mapping techniques have the potential to further characterize the components of ischemic injury. In patients with myocardial infarction (MI) we sought to investigate whether state-of the art pre-contrast T1-mapping (1) detects acute myocardial injury, (2) allows for quantification of the severity of damage when compared to standard techniques such as LGE and T2W, and (3) has the ability to predict long term functional recovery. 3T CMR including T2W, T1-mapping and LGE was performed in 41 patients [of these, 78% were ST elevation MI (STEMI)] with acute MI at 12-48 hour after chest pain onset and at 6 months (6M). Patients with STEMI underwent primary PCI prior to CMR. Assessment of acute regional wall motion abnormalities, acute segmental damaged fraction by T2W and LGE and mean segmental T1 values was performed on matching short axis slices. LGE and improvement in regional wall motion at 6M were also obtained. We found that the variability of T1 measurements was significantly lower compared to T2W and that, while the diagnostic performance of acute T1-mapping for detecting myocardial injury was at least as good as that of T2W-CMR in STEMI patients, it was superior to T2W imaging in NSTEMI. There was a significant relationship between the segmental damaged fraction assessed by either by LGE or T2W, and mean segmental T1 values (P < 0.01). The index of salvaged myocardium derived by acute T1-mapping and 6M LGE was not different to the one derived from T2W (P = 0.88). Furthermore, the likelihood of improvement of segmental function at 6M decreased progressively as acute T1 values increased (P < 0.0004). In acute MI, pre-contrast T1-mapping allows assessment of the extent of myocardial damage. T1-mapping might become an important complementary technique to LGE and T2W for identification of reversible myocardial injury and prediction of functional recovery in acute MI.