使用T1映射技术对ST段抬高型心肌梗死的梗死相关心肌面积和急性心肌梗死面积进行定量分析。
Quantification of both the area-at-risk and acute myocardial infarct size in ST-segment elevation myocardial infarction using T1-mapping.
作者信息
Bulluck Heerajnarain, Hammond-Haley Matthew, Fontana Marianna, Knight Daniel S, Sirker Alex, Herrey Anna S, Manisty Charlotte, Kellman Peter, Moon James C, Hausenloy Derek J
机构信息
The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, UK.
National Amyloidosis Centre, University College London, Royal Free Hospital, London, UK.
出版信息
J Cardiovasc Magn Reson. 2017 Aug 1;19(1):57. doi: 10.1186/s12968-017-0370-6.
BACKGROUND
A comprehensive cardiovascular magnetic resonance (CMR) in reperfused ST-segment myocardial infarction (STEMI) patients can be challenging to perform and can be time-consuming. We aimed to investigate whether native T1-mapping can accurately delineate the edema-based area-at-risk (AAR) and post-contrast T1-mapping and synthetic late gadolinium (LGE) images can quantify MI size at 1.5 T. Conventional LGE imaging and T2-mapping could then be omitted, thereby shortening the scan duration.
METHODS
Twenty-eight STEMI patients underwent a CMR scan at 1.5 T, 3 ± 1 days following primary percutaneous coronary intervention. The AAR was quantified using both native T1 and T2-mapping. MI size was quantified using conventional LGE, post-contrast T1-mapping and synthetic magnitude-reconstructed inversion recovery (MagIR) LGE and synthetic phase-sensitive inversion recovery (PSIR) LGE, derived from the post-contrast T1 maps.
RESULTS
Native T1-mapping performed as well as T2-mapping in delineating the AAR (41.6 ± 11.9% of the left ventricle [% LV] versus 41.7 ± 12.2% LV, P = 0.72; R 0.97; ICC 0.986 (0.969-0.993); bias -0.1 ± 4.2% LV). There were excellent correlation and inter-method agreement with no bias, between MI size by conventional LGE, synthetic MagIR LGE (bias 0.2 ± 2.2%LV, P = 0.35), synthetic PSIR LGE (bias 0.4 ± 2.2% LV, P = 0.060) and post-contrast T1-mapping (bias 0.3 ± 1.8% LV, P = 0.10). The mean scan duration was 58 ± 4 min. Not performing T2 mapping (6 ± 1 min) and conventional LGE (10 ± 1 min) would shorten the CMR study by 15-20 min.
CONCLUSIONS
T1-mapping can accurately quantify both the edema-based AAR (using native T1 maps) and acute MI size (using post-contrast T1 maps) in STEMI patients without major cardiovascular risk factors. This approach would shorten the duration of a comprehensive CMR study without significantly compromising on data acquisition and would obviate the need to perform T2 maps and LGE imaging.
背景
对再灌注 ST 段抬高型心肌梗死（STEMI）患者进行全面的心血管磁共振（CMR）检查可能具有挑战性且耗时。我们旨在研究在 1.5T 场强下，基于 T1 弛豫时间的心肌水肿危险区（AAR）是否可以通过 T1 加权成像准确界定，以及对比剂增强后的 T1 加权成像和合成延迟钆增强（LGE）图像是否可以量化心肌梗死面积。这样就可以省略传统的 LGE 成像和 T2 加权成像，从而缩短扫描时间。
方法
28 例 STEMI 患者在接受直接经皮冠状动脉介入治疗后 3±1 天，接受了 1.5T 场强的 CMR 扫描。使用 T1 加权成像和 T2 加权成像对 AAR 进行量化。使用传统的 LGE 成像、对比剂增强后的 T1 加权成像以及从对比剂增强后的 T1 加权图像中衍生出的合成幅度重建反转恢复（MagIR）LGE 和合成相位敏感反转恢复（PSIR）LGE 对心肌梗死面积进行量化。
结果
在界定 AAR 方面，基于 T1 弛豫时间的心肌水肿危险区（AAR）与 T2 加权成像表现相当（分别为左心室的 41.6±11.9%和 41.7±12.2%，P = 0.72；R = 0.97；组内相关系数 ICC = 0.986（0.969 - 0.993）；偏差为 -0.1±4.2%左心室）。传统 LGE 成像、合成 MagIR LGE（偏差 0.2±2.2%左心室，P = 0.35）、合成 PSIR LGE（偏差 0.4±2.2%左心室，P = 0.060）和对比剂增强后的 T1 加权成像（偏差 0.3±1.8%左心室，P = 0.10）在量化心肌梗死面积方面具有极好的相关性和方法间一致性，且无偏差。平均扫描时间为 58±4 分钟。不进行 T2 加权成像（6±1 分钟）和传统 LGE 成像（10±1 分钟）可将 CMR 检查时间缩短 15 - 20 分钟。
结论
对于无重大心血管危险因素的 STEMI 患者，T1 加权成像可以准确量化基于水肿的 AAR（使用 T1 加权图像）和急性心肌梗死面积（使用对比剂增强后的 T1 加权图像）。这种方法可以缩短全面 CMR 检查的时间，而不会显著影响数据采集，并且无需进行 T2 加权成像和 LGE 成像。
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