Contrast-free detection of myocardial fibrosis in hypertrophic cardiomyopathy patients with diffusion-weighted cardiovascular magnetic resonance.
Contrast-free detection of myocardial fibrosis in hypertrophic cardiomyopathy patients with diffusion-weighted cardiovascular magnetic resonance.
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弥散加权心血管磁共振无造影剂检测肥厚型心肌病患者心肌纤维化
DOI：
10.1186/s12968-015-0214-1
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发表时间：
2015-12-02
期刊：
影响因子：
--
通讯作者：
Li D
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文献类型：
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作者：
Nguyen C;Lu M;Fan Z;Bi X;Kellman P;Zhao S;Li D
既往研究表明弥散加权心血管磁共振（DW-CMR）对慢性心肌梗死的替代纤维化高度敏感。尽管对心肌梗死有这种敏感性，但DW-CMR尚未被确立为一种检测弥漫性心肌纤维化的方法。我们建议应用最近开发的DW-CMR技术来检测肥厚性心肌病（HCM）患者的弥漫性心肌纤维化，并将其性能与现有的CMR技术进行比较。招募HCM患者（N = 23），采用以下方案进行扫描：标准形态学定位仪、DW-CMR、细胞外体积（ECV） CMR和晚期钆增强（LGE）成像作为参考。表观扩散系数（ADC）和ECV图被分割成6个美国心脏协会（AHA）节段。心肌纤维化阳性区定义为：ADC > 2.0 μm2/ms, ECV > 30%。比较纤维化和非纤维化的平均ADC和ECV值，以及ADC衍生和ECV衍生的纤维化负担。此外，比较ADC和ECV之间的纤维化区域检测，计算灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV），以ECV作为金标准参考。纤维化区ADC(2.4±0.2 μm2/ms) （ADC > 2.0 μm2/ms）显著高于非纤维化区ADC(1.5±0.2 μm2/ms) （p < 0.01）。同样，纤维化区ECV(35±4%)（ECV bb0 30%）显著高于非纤维化区ECV(26±2%)（p < 0.01）。在ECV定义的纤维化区，ADC（2.2±0.3 μm2/ms）再次显著高于非纤维化区ADC(1.6±0.3 μm2/ms) （p < 0.05）。在ADC标准定义的纤维化区域，ECV（34±5%）明显高于非纤维化区域的ECV(28±3%)（p < 0.01）。adc来源和ecv来源的纤维化负担基本一致（类内相关性= 0.83）。ADC和ECV之间弥漫性纤维化的区域检测结果基本一致（κ = 0.66），具有较高的敏感性、特异性、PPV、NPV和准确性（分别为0.80、0.85、0.81、0.85和0.83）。DW-CMR对弥漫性心肌纤维化敏感，能够表征HCM患者的纤维化程度。
Previous studies have shown that diffusion-weighted cardiovascular magnetic resonance (DW-CMR) is highly sensitive to replacement fibrosis of chronic myocardial infarction. Despite this sensitivity to myocardial infarction, DW-CMR has not been established as a method to detect diffuse myocardial fibrosis. We propose the application of a recently developed DW-CMR technique to detect diffuse myocardial fibrosis in hypertrophic cardiomyopathy (HCM) patients and compare its performance with established CMR techniques. HCM patients (N = 23) were recruited and scanned with the following protocol: standard morphological localizers, DW-CMR, extracellular volume (ECV) CMR, and late gadolinium enhanced (LGE) imaging for reference. Apparent diffusion coefficient (ADC) and ECV maps were segmented into 6 American Heart Association (AHA) segments. Positive regions for myocardial fibrosis were defined as: ADC > 2.0 μm2/ms and ECV > 30 %. Fibrotic and non-fibrotic mean ADC and ECV values were compared as well as ADC-derived and ECV-derived fibrosis burden. In addition, fibrosis regional detection was compared between ADC and ECV calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) using ECV as the gold-standard reference. ADC (2.4 ± 0.2 μm2/ms) of fibrotic regions (ADC > 2.0 μm2/ms) was significantly (p < 0.01) higher than ADC (1.5 ± 0.2 μm2/ms) of non-fibrotic regions. Similarly, ECV (35 ± 4 %) of fibrotic regions (ECV > 30 %) was significantly (p < 0.01) higher than ECV (26 ± 2 %) of non-fibrotic regions. In fibrotic regions defined by ECV, ADC (2.2 ± 0.3 μm2/ms) was again significantly (p < 0.05) higher than ADC (1.6 ± 0.3 μm2/ms) of non-fibrotic regions. In fibrotic regions defined by ADC criterion, ECV (34 ± 5 %) was significantly (p < 0.01) higher than ECV (28 ± 3 %) in non-fibrotic regions. ADC-derived and ECV-derived fibrosis burdens were in substantial agreement (intra-class correlation = 0.83). Regional detection between ADC and ECV of diffuse fibrosis yielded substantial agreement (κ = 0.66) with high sensitivity, specificity, PPV, NPV, and accuracy (0.80, 0.85, 0.81, 0.85, and 0.83, respectively). DW-CMR is sensitive to diffuse myocardial fibrosis and is capable of characterizing the extent of fibrosis in HCM patients.