Tissue Characterization by Mapping and Strain Cardiac MRI to Evaluate Myocardial Inflammation in Fulminant Myocarditis
Tissue Characterization by Mapping and Strain Cardiac MRI to Evaluate Myocardial Inflammation in Fulminant Myocarditis
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通过标测和应变心脏 MRI 进行组织表征以评估暴发性心肌炎的心肌炎症
DOI：
10.1002/jmri.27094
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发表时间：
2020-02-20
影响因子：
4.4
通讯作者：
Xia, Liming
中科院分区：
文献类型：
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作者：
Li, Haojie;Zhu, Hui;Xia, Liming
背景 新型标测技术和应变测量方法在评估暴发性心肌炎（FM）心肌炎症方面的临床价值尚未得到充分探究。
目的 评估心脏磁共振成像（MRI）的标测和应变技术对FM患者心肌炎症的评估能力，以及应变指标与心肌水肿的关联程度。
研究类型 前瞻性研究。
研究对象 29例FM患者（年龄37±16岁，男性占48%）和29例非暴发性急性心肌炎（NFAM）患者（年龄29±14岁，男性占69%）。
场强/序列 3.0T；采用电影成像、黑血T2加权成像、T1标测、T2标测及延迟钆增强成像。
评估内容 测量原生T1值、细胞外容积（ECV）和T2值。通过特征追踪法评估心肌应变。
统计检验 采用Student's t检验或Mann - Whitney U检验。进行Spearman相关性分析。
结果 与NFAM组相比，FM患者的心肌水肿率（2.6±0.7 对 1.6±0.2，P < 0.001）和延迟钆增强（LGE）质量（16.5 [11.7, 41.7] 对 6.9 [2.2, 15.8] g，P < 0.001）显著升高。FM组的LGE主要位于室间隔，38%的患者呈现弥漫性LGE模式。FM组的原生T1值、ECV和T2值显著高于NFAM组，而整体径向、圆周和纵向峰值应变值显著降低（均P < 0.001）。圆周应变与ECV的相关性最强（r = 0.72，P < 0.001）。
数据结论 与NFAM患者相比，FM患者在LGE模式、水肿增加及应变测量值降低方面存在显著差异。圆周应变与心肌炎症的心脏MRI定量参数存在显著关联。
证据等级 2级
技术效能阶段 2级
Background The clinical value of novel mapping techniques and strain measures to assess myocardial inflammation in fulminant myocarditis (FM) has not been fully explored.Purpose To evaluate the ability of mapping and strain cardiac MRI to assess myocardial inflammation in patients with FM, and to which degree the strain metrics correlate with myocardial edema.Study Type Prospective.Population Twenty-nine patients (37 +/- 16 years, 48% male) with FM and 29 patients with nonfulminant acute myocarditis (NFAM) (29 +/- 14 years, 69% male).Field Strength/Sequence 3.0T; Cine imaging, black blood T-2-weighted imaging, T(1)mapping, T-2 mapping, and late gadolinium enhancement.Assessment Native T-1, extracellular volume (ECV), and T-2 were measured. Myocardial strain was evaluated by feature tracking.Statistical Tests Student's t- or Mann-Whitney U-test. Spearman correlation analysis.Results The myocardial edema rate (2.6 +/- 0.7 vs. 1.6 +/- 0.2, P < 0.001) and late gadolinium enhancement (LGE) mass (16.5 [11.7, 41.7] vs. 6.9 [2.2, 15.8] g, P < 0.001) were significantly increased in FM patients when compared to the NFAM group. LGE in the FM group was predominantly located in the septal wall, and 38% of the patients showed a diffuse LGE pattern. Native T-1, ECV, and T-2 values in the FM group were significantly more elevated than those with NFAM, while global peak radial, circumferential, and longitudinal strain values were significantly reduced (all P < 0.001). Circumferential strain showed the strongest correlations with ECV (r = 0.72, P < 0.001).Data Conclusion Patients with FM showed significant differences in LGE patterns, increased edema, and decreased strain measurements compared to those with NFAM. Circumferential strain showed significant associations with quantitative cardiac MRI parameters of myocardial inflammation.Level of Evidence 2Technical Efficacy Stage 2