Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Col Sección XVI, 14080 Mexico City, Mexico.
J Cardiovasc Comput Tomogr. 2012 Sep-Oct;6(5):346-54. doi: 10.1016/j.jcct.2012.07.001. Epub 2012 Aug 16.
Left ventricular noncompaction (LVNC) is a cardiomyopathy characterized by a noncompacted myocardial layer in the left ventricle, primarily diagnosed by echocardiographic and magnetic resonance criteria. Multidetector computed tomography (MDCT) is an imaging method that has been increasingly used in cardiac evaluation. However, tomographic criteria to diagnose LVNC have not been determined.
We assessed the structural characteristics of LVNC with MDCT and proposed tomographic criteria that may differentiate LVNC from healthy subjects and patients with other cardiomyopathies that might be associated with increased myocardial trabeculation.
Between March 2007 and June 2009 we studied 10 consecutive patients with LVNC diagnosed by echocardiogram and/or magnetic resonance imaging who underwent electrocardiogram-gated coronary CT angiography. We evaluated the ratio of noncompacted to compacted myocardium (NC/C ratio) in end diastole in each of the 17 segments established by the American Heart Association (excluding the apex). The results were compared with 9 healthy subjects, 14 patients with hypertrophic cardiomyopathy, and 17 patients with dilated cardiomyopathy to determine the cutoff that would distinguish patients with LVNC.
When considering involvement of more than 1 segment, the NC/C ratio of 2.2 distinguished pathologic noncompaction, with sensitivity and specificity of 100% and 95%, respectively. In addition, the involvement of ≥2 segments allows the distinction of all patients with LVNC from other cardiomyopathies and from healthy subjects.
LVNC can be accurately diagnosed with MDCT when using a cutoff NC/C ratio of 2.2 at end diastole involving ≥2 segments.
左心室心肌致密化不全（LVNC）是一种以左心室心肌未致密化与致密化心肌层厚度比例异常为特征的心肌病，主要通过超声心动图和磁共振标准进行诊断。多排螺旋 CT（MDCT）是一种日益应用于心脏评估的成像方法。然而，尚未确定用于诊断 LVNC 的断层成像标准。
我们使用 MDCT 评估 LVNC 的结构特征，并提出可能有助于将 LVNC 与健康受试者和其他可能与心肌小梁增多相关的心肌病患者区分开来的断层成像标准。
我们连续纳入 2007 年 3 月至 2009 年 6 月间 10 例经超声心动图和/或磁共振成像诊断为 LVNC 的患者，所有患者均行心电门控冠状动脉 CT 血管造影。我们评估了 17 个节段（不包括心尖）的舒张末期非致密心肌与致密心肌厚度比值（NC/C 比值），这些节段是由美国心脏协会定义的。结果与 9 例健康受试者、14 例肥厚型心肌病患者和 17 例扩张型心肌病患者进行比较，以确定能够区分 LVNC 患者的临界值。
当考虑累及超过 1 个节段时，2.2 的 NC/C 比值可区分病理性非致密化心肌，其敏感性和特异性分别为 100%和 95%。此外，≥2 个节段受累可将所有 LVNC 患者与其他心肌病患者和健康受试者区分开来。
当舒张末期 NC/C 比值≥2 且累及≥2 个节段时，MDCT 可准确诊断 LVNC。
