心脏 MRI T 映射在特发性炎症性肌病中心肌受累的早期检测。
Early detection of myocardial involvement by T mapping of cardiac MRI in idiopathic inflammatory myopathy.
机构信息
Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
出版信息
J Magn Reson Imaging. 2018 Aug;48(2):415-422. doi: 10.1002/jmri.25945. Epub 2018 Jan 12.
BACKGROUND
Polymyositis (PM) and dermatomyositis (DM) are common types of idiopathic inflammatory myopathy (IIM), wherein patients are prone to adverse cardiovascular events.
PURPOSE
To explore the value of cardiac magnetic resonance imaging (MRI) for detecting cardiac involvement in PM/DM patients using a T mapping technique.
STUDY TYPE
Prospective observational study.
POPULATION
In all, 25 PM/DM patients free of cardiovascular symptoms and preserved ventricular systolic function and 25 healthy volunteers matched for age and sex served as controls.
FIELD STRENGTH/SEQUENCE: Cardiac MRI at 3T, including steady-state free precession (SSFP) cine imaging, late gadolinium enhancement (LGE), and T mapping with modified Look-Locker inversion recovery (MOLLI).
ASSESSMENT
Myocardial native T and extracellular volume (ECV) of the left ventricle as well as the correlations with disease activity were analyzed.
STATISTICAL TESTS
Independent sample's t-test, Fisher's exact test, or chi-square test, Pearson's correlation (r) were applied. P ≤ 0.05 was considered significant.
RESULTS
Left ventricular end-diastolic/end-systolic volume index (P = 0.643, P = 0.325, respectively), mass index (P = 0.719), and ejection fraction (P = 0.144) were not significantly different between PM/DM patients and controls. LGE was found in 19% of PM/DM patients and none of the control subjects. PM/DM patients showed significantly higher native T values (1263.7 ± 84.0 msec vs. 1200.6 ± 43.0 msec, P = 0.002) and expanded extracellular volume (ECV) (32.6 ± 3.7% vs. 26.7 ± 2.3%, P < 0.001) compared with control subjects. ECV values in PM/DM patients had a high proportion (60%) over the 95% percentile of normal controls. Meanwhile, there was a significant correlation between native T (r = 0.710, P = 0.0001) or ECV (r = 0.508, P = 0.01) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP).
DATA CONCLUSION
T mapping of cardiac MRI is valuable to detect subclinical myocardial involvement in PM/DM patients, and both myocardial native T and ECV could serve as early imaging markers for myocardial impairment in PM/DM.
LEVEL OF EVIDENCE
2 Technical Efficacy: Stage 3 J. MAGN. RESON. IMAGING 2018;48:415-422.
背景
多发性肌炎（PM）和皮肌炎（DM）是特发性炎性肌病（IIM）的常见类型，患者易发生不良心血管事件。
目的
使用 T 映射技术探讨心脏磁共振成像（CMR）检测 PM/DM 患者心脏受累的价值。
研究类型
前瞻性观察性研究。
人群
共纳入 25 例无心血管症状和左心室收缩功能正常的 PM/DM 患者和 25 名年龄和性别相匹配的健康志愿者作为对照组。
磁场强度/序列：3T 心脏 CMR，包括稳态自由进动（SSFP）电影成像、钆延迟增强（LGE）和改良 Look-Locker 反转恢复（MOLLI）的 T 映射。
评估
分析左心室心肌固有 T 值和细胞外容积（ECV）以及与疾病活动的相关性。
统计学检验
采用独立样本 t 检验、Fisher 确切检验或卡方检验、Pearson 相关系数（r）。P≤0.05 为差异有统计学意义。
结果
PM/DM 患者与对照组间左心室舒张末期/收缩末期容积指数（P=0.643，P=0.325）、质量指数（P=0.719）和射血分数（P=0.144）无显著差异。19%的 PM/DM 患者存在 LGE，而对照组无一例存在。PM/DM 患者的固有 T 值（1263.7±84.0msec 比 1200.6±43.0msec，P=0.002）和扩张的细胞外容积（ECV）（32.6±3.7%比 26.7±2.3%，P<0.001）明显高于对照组。PM/DM 患者的 ECV 值有 60%超过正常对照组的第 95 百分位数。同时，固有 T 值（r=0.710，P=0.0001）或 ECV（r=0.508，P=0.01）与 N 端脑钠肽前体（NT-proBNP）之间存在显著相关性。
数据结论
CMR 的 T 映射有助于检测 PM/DM 患者亚临床心肌受累，心肌固有 T 值和 ECV 均可作为 PM/DM 患者心肌损伤的早期影像学标志物。
证据水平
2 技术功效：3 级。J. MAGN. RESON. IMAGING 2018;48:415-422.
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