糖尿病：全身磁共振成像对心脑血管事件发生的长期预后价值。
Diabetes mellitus: long-term prognostic value of whole-body MR imaging for the occurrence of cardiac and cerebrovascular events.
机构信息
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.).
出版信息
Radiology. 2013 Dec;269(3):730-7. doi: 10.1148/radiol.13130371. Epub 2013 Oct 28.
PURPOSE
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).
MATERIALS AND METHODS
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.
RESULTS
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.
CONCLUSION
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.
目的
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。
材料和方法
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。
结果
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。
结论
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。
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