From the Department of Clinical Radiology (F.B., E.L., R.P.M., D.T., M.F.R., S.W.) and Department of Internal Medicine II (K.G.P.), Ludwig Maximilians University, Klinikum Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Department of Cardiology, University Hospital RWTH Aachen, Aachen, Germany (F.B., H.M.F.); Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (U.H., C.L.S.); Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Mannheim, Germany (S.O.S.); and Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany (S.W., C.L.S.).
Radiology. 2013 Dec;269(3):730-7. doi: 10.1148/radiol.13130371. Epub 2013 Oct 28.
To study the predictive value of whole-body magnetic resonance (MR) imaging for the occurrence of cardiac and cerebrovascular events in a cohort of patients with diabetes mellitus (DM).
This HIPAA-compliant study was approved by the institutional review board. Informed consent was obtained from all patients before enrollment into the study. The authors followed up 65 patients with DM (types 1 and 2) who underwent a comprehensive, contrast material-enhanced whole-body MR imaging protocol, including brain, cardiac, and vascular sequences at baseline. Follow-up was performed by phone interview. The primary endpoint was a major adverse cardiac and cerebrovascular event (MACCE), which was defined as composite cardiac-cerebrovascular death, myocardial infarction, cerebrovascular event, or revascularization. MR images were assessed for the presence of systemic atherosclerotic vessel changes, white matter lesions, and myocardial changes. Kaplan-Meier survival and Cox regression analyses were performed to determine associations.
Follow-up was completed in 61 patients (94%; median age, 67.5 years; 30 women [49%]; median follow-up, 70 months); 14 of the 61 patients (23%) experienced MACCE. Although normal whole-body MR imaging excluded MACCE during the follow-up period (0%; 95% confidence interval [CI]: 0%, 17%), any detectable ischemic and/or atherosclerotic changes at whole-body MR imaging (prevalence, 66%) conferred a cumulative event rate of 20% at 3 years and 35% at 6 years. Whole-body MR imaging summary estimate of disease was strongly predictive for MACCE (one increment of vessel score and each territory with atherosclerotic changes: hazard ratio, 13.2 [95% CI: 4.5, 40.1] and 3.9 [95% CI: 2.2, 7.5], respectively), also beyond clinical characteristics as well as individual cardiac or cerebrovascular MR findings.
These initial data indicate that disease burden as assessed with whole-body MR imaging confers strong prognostic information in patients with DM. Online supplemental material is available for this article.
研究全身磁共振成像（MR）对糖尿病（DM）患者发生心脑血管事件的预测价值。
本 HIPAA 合规性研究获得了机构审查委员会的批准。在将患者纳入研究之前，所有患者均获得了知情同意。作者对 65 例 1 型和 2 型糖尿病患者进行了随访，这些患者接受了全面的、对比增强的全身 MR 成像方案，包括基线时的脑、心脏和血管序列。通过电话访谈进行随访。主要终点是主要不良心脑血管事件（MACCE），定义为复合心脑血管死亡、心肌梗死、脑血管事件或血运重建。评估 MR 图像是否存在系统性动脉粥样硬化血管改变、脑白质病变和心肌变化。进行 Kaplan-Meier 生存分析和 Cox 回归分析以确定相关性。
61 例患者（94%）完成了随访（中位年龄 67.5 岁，30 例女性[49%]，中位随访时间 70 个月）；61 例患者中有 14 例（23%）发生 MACCE。尽管正常的全身 MR 成像在随访期间排除了 MACCE（0%；95%置信区间[CI]：0%，17%），但全身 MR 成像上任何可检测到的缺血和/或动脉粥样硬化改变（患病率 66%）在 3 年内累积事件发生率为 20%，6 年内为 35%。全身 MR 成像疾病综合评估对 MACCE 具有很强的预测价值（血管评分每增加一个增量和每个有动脉粥样硬化改变的区域：危险比分别为 13.2[95%CI：4.5，40.1]和 3.9[95%CI：2.2，7.5]），甚至超过了临床特征以及单独的心脏或脑血管 MR 发现。
这些初步数据表明，糖尿病患者全身 MR 成像评估的疾病负担提供了强有力的预后信息。本文提供了在线补充材料。
