Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.
Klinik und Poliklinik für Medizin I, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.
J Cardiovasc Magn Reson. 2018 May 24;20(1):33. doi: 10.1186/s12968-018-0454-y.
Characterization of tissue integrity and inflammatory processes after acute myocardial infarction (AMI) using non-invasive imaging is predictive of patient outcome. Quantitative cardiovascular magnetic resonance (CMR) techniques such as native T and extracellular volume (ECV) mapping as well as F-FDG positron emission tomography (PET) imaging targeting inflammatory cell populations are gaining acceptance, but are often applied without assessing their quantitative potential. Using simultaneously acquired PET/CMR data from patients early after AMI, this study quantitatively compares these three imaging markers and investigates links to blood markers of myocardial injury and systemic inflammatory activity.
A total of 25 patients without microvascular obstruction were retrospectively recruited. All imaging was simultaneously performed 5 ± 1 days after revascularization following AMI on an integrated 3T PET/MRI scanner. Native and post-contrast T data were acquired using a modified Look-Locker inversion recovery (MOLLI) sequence, ECV maps were calculated using individually sampled hematocrit. F-FDG PET was executed after 1 day of dietary preparation, 12 h of fasting, and administration of heparin. ECV, F-FDG and native T data were compared mutually as well as to peak counts of peripheral blood markers (creatine kinase, creatine kinase-MB, troponin, leukocytes, monocytes) and infarct size.
High intra-patient correlations of relative ECV, F-FDG PET and native T signal increases were observed in combination with no inter-patient correlation of maximum absolute values at the infarct center, suggesting well-colocalized but physiologically diverse processes begetting the respective image signals. Comparison of maximum image signals to markers of myocardial damage and systemic inflammation yielded highly significant correlations of ECV to peak creatine kinase-MB and overall infarct size as well as between native T and peak monocyte counts.
Absolute native T values at the infarct core early after AMI can be linked to the systemic inflammatory response independent of infarct size. Absolute ECV at the infarct core is related to both infarct size and blood markers of myocardial damage.
使用非侵入性成像技术对急性心肌梗死（AMI）后组织完整性和炎症过程进行特征描述可预测患者的预后。定量心血管磁共振（CMR）技术，如天然 T 和细胞外容积（ECV）映射以及针对炎症细胞群的 F-FDG 正电子发射断层扫描（PET）成像，正逐渐得到认可，但在应用时通常并未评估其定量潜力。本研究使用 AMI 后早期同时采集的 PET/CMR 数据，定量比较了这三种成像标志物，并研究了它们与心肌损伤和全身炎症活性的血液标志物之间的联系。
共回顾性招募了 25 名无微血管阻塞的患者。所有成像均在 AMI 后血管重建后 5±1 天在集成的 3T PET/MRI 扫描仪上同时进行。使用改良 Look-Locker 反转恢复（MOLLI）序列采集天然和对比后 T 数据，使用个体采集的红细胞压积计算 ECV 图。F-FDG PET 在进行 1 天的饮食准备、12 小时禁食和肝素给药后执行。ECV、F-FDG 和天然 T 数据相互比较，也与外周血标志物（肌酸激酶、肌酸激酶同工酶-MB、肌钙蛋白、白细胞、单核细胞）和梗死面积的峰值计数进行比较。
在组合中观察到相对 ECV、F-FDG PET 和天然 T 信号增加的患者内高相关性，而在梗死中心的最大绝对值没有患者间相关性，这表明存在具有不同生理特征的高度聚集但不同的过程，从而产生各自的图像信号。将最大图像信号与心肌损伤和全身炎症标志物进行比较，发现 ECV 与肌酸激酶同工酶-MB 的峰值和整体梗死面积以及天然 T 与单核细胞峰值计数之间具有高度显著的相关性。
AMI 后早期梗死核心处的绝对天然 T 值可与梗死大小无关的全身炎症反应相关联。梗死核心处的绝对 ECV 与梗死面积和心肌损伤的血液标志物均相关。
