磁共振体素内不相干运动扩散加权成像评估心肌灌注的动态状态的诊断性能。
Diagnostic performance of intravoxel incoherent motion diffusion-weighted imaging in the assessment of the dynamic status of myocardial perfusion.
机构信息
Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
出版信息
J Magn Reson Imaging. 2018 Dec;48(6):1602-1609. doi: 10.1002/jmri.26179. Epub 2018 May 7.
BACKGROUND
Acute myocardial infarction (AMI) is a major cause of morbidity and mortality worldwide and places a significant financial burden on our society.
PURPOSE
To determine the feasibility of cardiac intravoxel incoherent motion (IVIM) in the consecutive evaluation of myocardial perfusion in myocardial infarction patients postpercutaneous coronary intervention (PCI) and to investigate the dynamic biological phenomena in myocardial perfusion after AMI.
STUDY TYPE
Prospective observational study.
POPULATION
Twenty ST-segment elevation myocardial infarction (STEMI) patients after reperfusion therapy and 12 healthy volunteers served as controls.
FIELD STRENGTH/SEQUENCE: Cardiac MRI at 3T, including steady-state free precession (SSFP) cine imaging, T -short time inversion recovery (T -STIR), late gadolinium enhancement (LGE), T mapping, and IVIM diffusion-weighted imaging (DWI) were performed.
ASSESSMENT
Myocardial T value and IVIM-DWI-associated parameters (ADC , ADC , and f value) of the infarcted myocardium at different timepoints, remote myocardium, and normal myocardium were analyzed by two experienced radiologists.
STATISTICAL TESTS
Independent sample's t-test, Pearson's, and Spearman's correlation and interobserver variability were applied. P ≤ 0.05 was considered significant.
RESULTS
The T value in ischemic myocardium measured on day 3 (73.58 ± 4.37 msec) was greater than at any other timepoint (24 hours, day 7, day 30; 66.66 ± 4.71 msec, 68.36 ± 4.18 msec, 64.98 ± 5.39 msec, respectively, P < 0.001). ADC and f values were significantly lower in ischemic myocardium than in the remote myocardium as well. The f value in ischemic myocardium at day 3 (0.0989 ± 0.02) was lower than at any other timepoint (24 hours, 7 day, 30 day; 0.1203 ± 0.02, 0.1109 ± 0.02, 0.1213 ± 0.02, respectively, P < 0.001.
DATA CONCLUSION
This preliminary study demonstrated that a dynamic process exists in the status of myocardial edema and myocardial perfusion in MI patients after PCI. The findings suggest myocardial perfusion would be best evaluated between day 3 and day 7.
LEVEL OF EVIDENCE
2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:1602-1609.
背景
急性心肌梗死（AMI）是全球发病率和死亡率的主要原因，给我们的社会带来了巨大的经济负担。
目的
确定心脏体素内不相干运动（IVIM）在经皮冠状动脉介入治疗（PCI）后心肌梗死后连续评估心肌灌注中的可行性，并研究 AMI 后心肌灌注中的动态生物学现象。
研究类型
前瞻性观察性研究。
人群
20 名接受再灌注治疗的 ST 段抬高型心肌梗死（STEMI）患者和 12 名健康志愿者作为对照。
磁场强度/序列：在 3T 上进行心脏 MRI，包括稳态自由进动（SSFP）电影成像、T 短时间反转恢复（T-STIR）、晚期钆增强（LGE）、T 映射和 IVIM 扩散加权成像（DWI）。
评估
由两位有经验的放射科医生分析不同时间点、远程心肌和正常心肌梗死心肌的 T 值和 IVIM-DWI 相关参数（ADC、ADC 和 f 值）。
统计检验
应用独立样本 t 检验、Pearson 和 Spearman 相关和观察者间变异性。P≤0.05 被认为具有统计学意义。
结果
缺血心肌在第 3 天（73.58±4.37msec）测量的 T 值大于任何其他时间点（24 小时、第 7 天、第 30 天；66.66±4.71msec、68.36±4.18msec、64.98±5.39msec，P<0.001）。缺血心肌的 ADC 和 f 值也明显低于远程心肌。第 3 天缺血心肌的 f 值（0.0989±0.02）低于任何其他时间点（24 小时、7 天、30 天；0.1203±0.02、0.1109±0.02、0.1213±0.02，P<0.001）。
数据结论
本初步研究表明，PCI 后 MI 患者心肌水肿和心肌灌注状态存在动态过程。研究结果表明，心肌灌注在第 3 天至第 7 天之间评估最佳。
证据水平
2 技术功效：第 2 阶段 J. 磁共振成像 2018;48:1602-1609.
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