T（Rho）与磁化传递及反转恢复（TRAMINER）准备成像：一种用于评估心肌梗死患者心肌延迟钆增强的新型对比增强血流无关型黑血技术。
T(Rho) and magnetization transfer and INvErsion recovery (TRAMINER)-prepared imaging: A novel contrast-enhanced flow-independent dark-blood technique for the evaluation of myocardial late gadolinium enhancement in patients with myocardial infarction.
作者信息
Muscogiuri Giuseppe, Rehwald Wolfgang G, Schoepf U Joseph, Suranyi Pal, Litwin Sheldon E, De Cecco Carlo N, Wichmann Julian L, Mangold Stefanie, Caruso Damiano, Fuller Stephen R, Bayer Nd Richard R, Varga-Szemes Akos
机构信息
Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Imaging, Bambino Gesu Children's Hospital IRCCS, Rome, Italy.
出版信息
J Magn Reson Imaging. 2017 May;45(5):1429-1437. doi: 10.1002/jmri.25498. Epub 2016 Sep 30.
PURPOSE
To evaluate a new dark-blood late gadolinium enhancement (LGE) technique called "T(Rho) And Magnetization transfer and INvErsion Recovery" (TRAMINER) for the ability to detect myocardial LGE versus standard "bright-blood" inversion recovery (SIR) imaging.
MATERIALS AND METHODS
This Institutional Review Board (IRB)-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant prospective study included 40 patients (62 ± 14 years [mean ± standard deviation (SD)], 29 males) with suspected myocardial infarction (MI) referred for the assessment of myocardial viability. The patients underwent a 1.5T cardiac magnetic resonance imaging (MRI) including postcontrast SIR and TRAMINER acquisitions. Normalized images were evaluated by two readers. Subjective (3-point Likert scale) and objective image qualities were compared using Mann-Whitney U-test and paired t-test, respectively. Interobserver agreement, LGE detection rate, and level of certainty were compared using Cohen's kappa, Wilcoxon-test, and Mann-Whitney U-test, respectively. Results are reported as mean ± SD or mean [95% confidence interval].
RESULTS
Overall, image quality was rated similar between TRAMINER and SIR; however, TRAMINER performed better on a visual assessment of the ability to differentiate LGE from blood (Likert scale: 3.0 [3.0-3.0] vs. 2.0 [1.7-2.2], P < 0.0001). TRAMINER provided significantly higher signal intensity range (69.8 ± 10.2 vs. 9.6 ± 7.6, P < 0.0001) and a 4-fold higher signal intensity ratio (4.2 ± 1.9 vs. 1.1 ± 0.1, P < 0.0001) between LGE and blood signals. TRAMINER detected more patients (19/40 vs. 17/40) and segments (91/649 vs. 79/649) with LGE with higher level of certainty (2.9 [2.8-3.0] vs. 2.7 [2.5-2.8], P = 0.0185). Interobserver agreement was good to excellent for LGE detection.
CONCLUSION
TRAMINER provides better contrast between LGE and blood and consequently may have increased ability to discriminate thin subendocardial and papillary muscle enhancement from the blood signal, which can have an indistinct appearance using SIR.
LEVEL OF EVIDENCE
2 J. MAGN. RESON. IMAGING 2017;45:1429-1437.
目的
评估一种名为“T（Rho）与磁化传递及反转恢复”（TRAMINER）的新型黑血延迟钆增强（LGE）技术检测心肌LGE的能力，并与标准的“亮血”反转恢复（SIR）成像进行比较。
材料与方法
本前瞻性研究经机构审查委员会（IRB）批准，符合健康保险流通与责任法案（HIPAA）规定，纳入40例疑似心肌梗死（MI）患者（年龄62±14岁[均值±标准差（SD）]，男性29例），这些患者因评估心肌存活性而接受检查。患者接受了1.5T心脏磁共振成像（MRI）检查，包括对比剂增强后的SIR和TRAMINER采集。由两名阅片者对标准化图像进行评估。分别使用曼-惠特尼U检验和配对t检验比较主观（3级李克特量表）和客观图像质量。分别使用科恩kappa检验、威尔科克森检验和曼-惠特尼U检验比较观察者间一致性、LGE检测率和确定程度。结果以均值±SD或均值[95%置信区间]报告。
结果
总体而言，TRAMINER和SIR的图像质量评级相似；然而，在视觉评估区分LGE与血液的能力方面，TRAMINER表现更佳（李克特量表：3.0[3.0 - 3.0]对2.0[1.7 - 2.2]，P < 0.0001）。TRAMINER在LGE与血液信号之间提供了显著更高的信号强度范围（69.8±10.2对9.6±7.6，P < 0.0001）和高4倍的信号强度比（4.2±1.9对1.1±0.1，P < 0.0001）。TRAMINER检测到更多有LGE的患者（19/40对17/40）和节段（91/649对79/649），且确定程度更高（2.9[2.8 - 3.0]对2.7[2.5 - 2.8]，P = 0.0185）。观察者间在LGE检测方面的一致性良好至优秀。
结论
TRAMINER在LGE与血液之间提供了更好的对比度，因此可能增强了区分心内膜下薄强化和乳头肌强化与血液信号的能力，而使用SIR时这些强化可能表现不清晰。
证据水平
2 J. MAGN. RESON. IMAGING 2017;45:1429 - 1437。
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