Department of Radiology, Johns Hopkins University, 600 North Wolfe Street, Blalock 524D1, Baltimore, MD 21287, USA.
Department of Cardiology and Radiology, Johns Hopkins University, 600 North Wolfe Street, Blalock 524D1, Baltimore, MD 21287, USA.
Nat Rev Cardiol. 2015 Jan;12(1):18-29. doi: 10.1038/nrcardio.2014.159. Epub 2014 Oct 28.
Fibrotic remodelling of the extracellular matrix is a healing mechanism necessary immediately after myocardial injury. However, prolonged increase in myocardial fibrotic activity results in stiffening of the myocardium and heralds adverse outcomes related to systolic and diastolic dysfunction, as well as arrhythmogenesis. Cardiac MRI provides a noninvasive phenotyping tool for accurate and easy detection and quantification of myocardial fibrosis by probing the retention of gadolinium-contrast agent in myocardial tissue. Late-gadolinium enhancement (LGE) cardiac MRI has been used extensively in a large number of studies for measurement of myocardial scarring. T1 mapping, a fairly new technique that can be used to identify the exact T1 value of the tissue, provides a direct measurement of the extracellular volume fraction of the myocardium. In contrast to LGE, T1 mapping can be used to measure diffuse myocardial fibrosis and differentiate between disease processes. In this Review, we describe the basic principles of imaging myocardial fibrosis using contrast-enhanced MRI and summarize its use for prognostic purposes.
细胞外基质的纤维化重塑是心肌损伤后即刻所需的一种愈合机制。然而，心肌纤维化活性的持续增加会导致心肌变硬，并预示着与收缩和舒张功能障碍以及心律失常发生相关的不良结局。心脏磁共振成像（cardiac magnetic resonance imaging，CMR）通过探测钆对比剂在心肌组织中的滞留，提供了一种非侵入性的表型分析工具，可用于准确、轻松地检测和量化心肌纤维化。迟发钆增强（late gadolinium enhancement，LGE）心脏磁共振成像已在大量研究中广泛用于测量心肌瘢痕。T1 映射是一种可用于识别组织确切 T1 值的新技术，它可以直接测量心肌细胞外容积分数。与 LGE 不同，T1 映射可用于测量弥漫性心肌纤维化并区分疾病过程。在这篇综述中，我们描述了使用对比增强磁共振成像成像心肌纤维化的基本原理，并总结了其用于预后评估的用途。
