用于评估左心室舒张功能障碍的常规临床心脏磁共振成像的自动分割

Automated segmentation of routine clinical cardiac magnetic resonance imaging for assessment of left ventricular diastolic dysfunction.

作者信息

Kawaji Keigo, Codella Noel C F, Prince Martin R, Chu Christopher W, Shakoor Aqsa, LaBounty Troy M, Min James K, Swaminathan Rajesh V, Devereux Richard B, Wang Yi, Weinsaft Jonathan W

机构信息

Department of Radiology and the Division of Cardiology, Weill Cornell Medical College, New York, NY 10021, USA.

出版信息

Circ Cardiovasc Imaging. 2009 Nov;2(6):476-84. doi: 10.1161/CIRCIMAGING.109.879304. Epub 2009 Sep 21.

DOI:10.1161/CIRCIMAGING.109.879304

PMID:19920046

Abstract

BACKGROUND

Cardiac magnetic resonance (CMR) is established for assessment of left ventricular (LV) systolic function but has not been widely used to assess diastolic function. This study tested performance of a novel CMR segmentation algorithm (LV-METRIC) for automated assessment of diastolic function.

METHODS AND RESULTS

A total of 101 patients with normal LV systolic function underwent CMR and echocardiography (echo) within 7 days. LV-METRIC generated LV filling profiles via automated segmentation of contiguous short-axis images (204+/-39 images, 2:04+/-0:53 minutes). Diastolic function by CMR was assessed via early:atrial filling ratios, peak diastolic filling rate, time to peak filling rate, and a novel index-diastolic volume recovery (DVR), calculated as percent diastole required for recovery of 80% stroke volume. Using an echo standard, patients with versus without diastolic dysfunction had lower early:atrial filling ratios, longer time to peak filling rate, lower stroke volume-adjusted peak diastolic filling rate, and greater DVR (all P<0.05). Prevalence of abnormal CMR filling indices increased in relation to clinical symptoms classified by New York Heart Association functional class (P=0.04) or dyspnea (P=0.006). Among all parameters tested, DVR yielded optimal performance versus echo (area under the curve: 0.87+/-0.04, P<0.001). Using a 90% specificity cutoff, DVR yielded 74% sensitivity for diastolic dysfunction. In multivariate analysis, DVR (odds ratio, 1.82; 95% CI, 1.13 to 2.57; P=0.02) was independently associated with echo-evidenced diastolic dysfunction after controlling for age, hypertension, and LV mass (chi(2)=73.4, P<0.001).

CONCLUSIONS

Automated CMR segmentation can provide LV filling profiles that may offer insight into diastolic dysfunction. Patients with diastolic dysfunction have prolonged diastolic filling intervals, which are associated with echo-evidenced diastolic dysfunction independent of clinical and imaging variables.

摘要

背景

心脏磁共振成像（CMR）已被用于评估左心室（LV）收缩功能，但尚未广泛用于评估舒张功能。本研究测试了一种用于自动评估舒张功能的新型CMR分割算法（LV-METRIC）的性能。

方法与结果

共有101例左心室收缩功能正常的患者在7天内接受了CMR和超声心动图（echo）检查。LV-METRIC通过对连续短轴图像（204±39幅图像，2:04±0:53分钟）进行自动分割生成左心室充盈曲线。通过早期：心房充盈率、舒张期最大充盈速率、达到最大充盈速率的时间以及一个新指标——舒张期容积恢复（DVR）来评估CMR的舒张功能，DVR计算为恢复80%每搏输出量所需的舒张期百分比。以超声心动图为标准，有舒张功能障碍和无舒张功能障碍的患者相比，前者的早期：心房充盈率更低、达到最大充盈速率的时间更长、每搏输出量校正后的舒张期最大充盈速率更低以及DVR更高（所有P<0.05）。CMR充盈指数异常的患病率随纽约心脏协会功能分级（P=0.04）或呼吸困难（P=0.006）分类的临床症状增加。在所有测试参数中，与超声心动图相比，DVR表现最佳（曲线下面积：0.87±0.04，P<0.001）。使用90%的特异性临界值，DVR对舒张功能障碍的敏感性为74%。在多变量分析中，在控制年龄、高血压和左心室质量后，DVR（比值比，1.82；95%置信区间，1.13至2.57；P=0.02）与超声心动图证实的舒张功能障碍独立相关（χ2=73.4，P<0.001）。