多对比剂延迟强化（MCODE）可提高心脏磁共振钆延迟增强技术诊断心内膜下心肌梗死的准确性：一项临床验证研究。
MultiContrast Delayed Enhancement (MCODE) improves detection of subendocardial myocardial infarction by late gadolinium enhancement cardiovascular magnetic resonance: a clinical validation study.
机构信息
Advanced Cardiovascular Imaging Laboratory, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Department of Health and Human Services, Bethesda, MD, USA.
出版信息
J Cardiovasc Magn Reson. 2012 Nov 30;14(1):83. doi: 10.1186/1532-429X-14-83.
BACKGROUND
Myocardial infarction (MI) documented by late gadolinium enhancement (LGE) has clinical and prognostic importance, but its detection is sometimes compromised by poor contrast between blood and MI. MultiContrast Delayed Enhancement (MCODE) is a technique that helps discriminate subendocardial MI from blood pool by simultaneously providing a T2-weighted image with a PSIR (phase sensitive inversion recovery) LGE image. In this clinical validation study, our goal was to prospectively compare standard LGE imaging to MCODE in the detection of MI.
METHODS
Imaging was performed on a 1.5 T scanner on patients referred for CMR including a LGE study. Prospective comparisons between MCODE and standard PSIR LGE imaging were done by targeted, repeat imaging of slice locations. Clinical data were used to determine MI status. Images at each of multiple time points were read on separate days and categorized as to whether or not MI was present and whether an infarction was transmural or subendocardial. The extent of infarction was scored on a sector-by-sector basis.
RESULTS
Seventy-three patients were imaged with the specified protocol. The majority were referred for vasodilator perfusion exams and viability assessment (37 ischemia assessment, 12 acute MI, 10 chronic MI, 12 other diagnoses). Forty-six patients had a final diagnosis of MI (30 subendocardial and 16 transmural). MCODE had similar specificity compared to LGE at all time points but demonstrated better sensitivity compared to LGE performed early and immediately before and after the MCODE (p = 0.008 and 0.02 respectively). Conventional LGE only missed cases of subendocardial MI. Both LGE and MCODE identified all transmural MI. Based on clinical determination of MI, MCODE had three false positive MI's; LGE had two false positive MI's including two of the three MCODE false positives. On a per sector basis, MCODE identified more infarcted sectors compared to LGE performed immediately prior to MCODE (p < 0.001).
CONCLUSION
While both PSIR LGE and MCODE were good in identifying MI, MCODE demonstrated more subendocardial MI's than LGE and identified a larger number of infarcted sectors. The simultaneous acquisition of T1 and T2-weighted images improved differentiation of blood pool from enhanced subendocardial MI.
背景
通过晚期钆增强（LGE）证实的心肌梗死（MI）具有临床和预后意义，但由于血液与 MI 之间的对比度差，有时会影响其检测。多对比度延迟增强（MCODE）是一种通过同时提供 T2 加权图像和 PSIR（相位敏感反转恢复）LGE 图像来帮助区分心内膜下 MI 与血池的技术。在这项临床验证研究中，我们的目标是前瞻性比较标准 LGE 成像与 MCODE 在 MI 检测中的应用。
方法
在一台 1.5 T 扫描仪上对因 CMR 检查（包括 LGE 研究）而转诊的患者进行成像。通过靶向、重复对切片位置进行成像，对 MCODE 与标准 PSIR LGE 成像进行前瞻性比较。使用临床数据确定 MI 状态。在不同的日子对多个时间点的图像进行单独阅读，并根据是否存在 MI 以及是否存在透壁性或心内膜下梗死进行分类。以扇区为基础对梗死范围进行评分。
结果
共有 73 名患者按指定方案进行了成像。大多数患者因扩张性灌注检查和存活评估（37 例缺血评估，12 例急性 MI，10 例慢性 MI，12 例其他诊断）而转诊。46 例患者的最终诊断为 MI（30 例心内膜下和 16 例透壁性）。MCODE 在所有时间点的特异性与 LGE 相似，但与早期 LGE 以及 MCODE 前后即刻进行的 LGE 相比，敏感性更好（分别为 p = 0.008 和 0.02）。常规 LGE 仅漏诊了心内膜下 MI 病例。LGE 和 MCODE 均能识别所有透壁性 MI。根据 MI 的临床诊断，MCODE 有 3 例假阳性 MI，而 LGE 有 2 例假阳性 MI，其中包括 MCODE 假阳性中的 2 例。基于扇区，MCODE 识别的梗死扇区多于 MCODE 前即刻进行的 LGE（p < 0.001）。
结论
虽然 PSIR LGE 和 MCODE 都能很好地识别 MI，但 MCODE 在心内膜下 MI 方面的检出率高于 LGE，且能识别更多的梗死扇区。同时采集 T1 和 T2 加权图像可改善血池与增强的心内膜下 MI 的区分。
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