MRI组织追踪技术在心脏淀粉样变性中的应用

王哲涛; 王春华; 陈榆舒; 孙家瑜; 朱桐; 张钰; 郜发宝

MRI组织追踪技术在心脏淀粉样变性中的应用

Magnetic Resonance Imaging Tissue Feature Tracking for Cardiac Amyloidosis

摘要

摘要:
目的通过心脏磁共振特征性追踪(CMR-FT)技术观察心脏淀粉样变性(CA)患者应变特点。
方法 43例确诊CA患者以及24例健康志愿者在注射钆造影剂后在3.0T MRI进行快速平衡稳态自由进动(SSFP)电影序列扫描。所得图像使用cvi42后处理软件进行分析，获得左心室功能参数〔左心室舒张末心肌质量(LVMD)及收缩末心肌质量(LVMS)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室每搏输出量(LVSV)、左心室射血分数(LVEF)〕和心肌应变参数〔3D整体纵向峰值应变(GLS)、环向峰值应变(GCS)、径向峰值应变(GRS)，2D内外膜纵向峰值应变、环向峰值应变、径向峰值应变(ENDO-LS，EPI-LS，ENDO-CS，EPI-CS，ENDO-RS，EPI-RS)〕。分析比较两组CA患者(LVEF＞50%、LVEF≤50%)以及对照组之间的心肌整体及分层应变参数差异。
结果在常规左心室功能参数中，两组CA患者心肌质量高于对照组(P＜0.05)，LVEF≤50%组LVESV高于LVEF＞50%组(P＜0.05)，LVEF≤50%组LVSV低于LVEF＞50%组(P＜0.05)。在整体心肌应变中，LVEF≤50%组、LVEF＞50%组与对照组GLS、GCS差异均有统计学意义(P＜0.05)。LVEF≤50%组、LVEF＞50%组GRS均与对照组差异有统计学意义(P＜0.05)，而LVEF≤50%组与LVEF＞50%组GRS比较差异无统计学意义(P＞0.05)。在分层应变中，3组人群ENDO-LS、EPI-LS、ENDO-CS、EPI-CS、ENDO-RS、EPI-RS差异均有统计学意义(P＜0.05)。CA患者LVEF与GLS(r=—0.404，P =0.016)、GCS(r=—0.602，P＜0.001)均有显著相关性。
结论 CMR-FT不仅能够通过整体应变还可以通过心内膜和心外膜应变对CA患者心肌功能进行评估。

Abstract:
Objective To detect cardiac amyloidosis (CA) using cardiac magnetic resonance feature tracking(CMR-FT).
Methods Forty-three CA patients and 24 healthy volunteers underwent steady-state free precession cine sequence on 3.0T MRI after injection of Magnevist. Software cvi 42 was used for analyzing the left ventricular function including left ventricular mass (diastole) (LVMD), left ventricular mass (systole) (LVMS), left ventricle end-diastolic volume (LVEDV), left ventricle end-systolic volume (LVESV), left ventricle stroke volume (LVSV), and left ventricular ejection fraction (LVEF), as well as myocardial strains including 3D global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS), and 2D endocardial and epicardial longitudinal strain, circumferential strain, and radial strain (ENDO-LS, EPI-LS, ENDO-CS, EPI-CS, ENDO-RS, and EPI-RS). The global and layer-specific strains were compared between the CA patients with LVEF >50%, the CA patients with LVEF ≤50%, and the healthy controls.
Results For the left ventricular function, the CA patients had greater myocardial mass than the healthy controls (P < 0.05); the CA patients with LVEF ≤50% had greater LVESV and lower LVSV than those with LVEF >50% (P < 0.05). For the global strains, significant differences also appeared in GLS and GCS among the three groups (all P < 0.05). The CA patients had lower GRS than the healthy controls (P < 0.05), while no significant difference was found in GRS between the CA patients with LVEF >50% and those with LVEF ≤50% (P>0.05). For the layer-specific strains, significant differences in ENDO-LS, EPI-LS, ENDO-CS, EPI-CS, ENDO-RS, and EPI-RS were found among the three groups (all P < 0.05). There were significant correlations between GLS and LVEF (r=-0.404, P=0.016), and between GCS and LVEF (r=-0.602, P < 0.001) in the CA patients.
Conclusion CMR-FT can assess not only global strains but also layer-specific strains for the myocardial function of CA patients.

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