From the Academic Department of Radiology, University of Sheffield, Floor C, Royal Hallamshire Hospital, Glossop Rd, Sheffield S10 2JF, England (C.S.J., P.G., R.S., D.A.C., J.M.W., A.J.S.); and Sheffield Pulmonary Vascular Disease Unit (D.G.K., S.R., N.H., C.E., I.S., A.C., R.C.) and Department of Radiology (C.S.J., C.H., S.T., K.K., A.J.S.), Sheffield Teaching Hospitals, Sheffield, England.
Radiology. 2019 Jan;290(1):61-68. doi: 10.1148/radiol.2018180603. Epub 2018 Oct 23.
Purpose To derive and test multiparametric cardiac MRI models for the diagnosis of pulmonary hypertension (PH). Materials and Methods Images and patient data from consecutive patients suspected of having PH who underwent cardiac MRI and right-sided heart catheterization (RHC) between 2012 and 2016 were retrospectively reviewed. Of 2437 MR images identified, 603 fit the inclusion criteria. The mean patient age was 61 years (range, 18-88 years; mean age of women, 60 years [range, 18-84 years]; mean age of men, 62 years [range, 22-88 years]). In the first 300 patients (derivation cohort), cardiac MRI metrics that showed correlation with mean pulmonary arterial pressure (mPAP) were used to create a regression algorithm. The performance of the model was assessed in the 303-patient validation cohort by using receiver operating characteristic (ROC) and χ analysis. Results In the derivation cohort, cardiac MRI mPAP model 1 (right ventricle and black blood) was defined as follows: -179 + log interventricular septal angle × 42.7 + log ventricular mass index (right ventricular mass/left ventricular mass) × 7.57 + black blood slow flow score × 3.39. In the validation cohort, cardiac MRI mPAP model 1 had strong agreement with RHC-measured mPAP, an intraclass coefficient of 0.78, and high diagnostic accuracy (area under the ROC curve = 0.95; 95% confidence interval [CI]: 0.93, 0.98). The threshold of at least 25 mm Hg had a sensitivity of 93% (95% CI: 89%, 96%), specificity of 79% (95% CI: 65%, 89%), positive predictive value of 96% (95% CI: 93%, 98%), and negative predictive value of 67% (95% CI: 53%, 78%) in the validation cohort. A second model, cardiac MRI mPAP model 2 (right ventricle pulmonary artery), which excludes the black blood flow score, had equivalent diagnostic accuracy (ROC difference: P = .24). Conclusion Multiparametric cardiac MRI models have high diagnostic accuracy in patients suspected of having pulmonary hypertension. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Colletti in this issue.
目的 旨在建立并验证用于诊断肺动脉高压（PH）的多参数心脏 MRI 模型。
材料与方法 回顾性分析了 2012 年至 2016 年间连续接受心脏 MRI 和右心导管检查（RHC）的疑似 PH 患者的图像和患者数据。在 2437 份 MRI 图像中，有 603 份符合纳入标准。患者平均年龄 61 岁（范围：18-88 岁；女性平均年龄 60 岁[范围：18-84 岁]；男性平均年龄 62 岁[范围：22-88 岁]）。在前 300 例患者（推导队列）中，使用与平均肺动脉压（mPAP）相关的心脏 MRI 指标创建回归算法。通过使用受试者工作特征（ROC）和卡方分析，在随后的 303 例患者验证队列中评估模型性能。
结果 在推导队列中，心脏 MRI mPAP 模型 1（右心室和黑血）定义如下：-179 + 室间隔角度的对数×42.7 + 心室质量指数（右心室质量/左心室质量）的对数×7.57 + 黑血慢血流评分×3.39。在验证队列中，心脏 MRI mPAP 模型 1 与 RHC 测量的 mPAP 具有较强的一致性，组内相关系数为 0.78，且具有较高的诊断准确性（ROC 曲线下面积=0.95；95%置信区间[CI]：0.93，0.98）。验证队列中，mPAP 阈值≥25mmHg 的灵敏度为 93%（95%CI：89%，96%），特异性为 79%（95%CI：65%，89%），阳性预测值为 96%（95%CI：93%，98%），阴性预测值为 67%（95%CI：53%，78%）。排除黑血流评分的第二个模型，心脏 MRI mPAP 模型 2（右心室肺动脉），具有同等的诊断准确性（ROC 差值：P=.24）。
结论 多参数心脏 MRI 模型在疑似 PH 患者中具有较高的诊断准确性。
此内容受版权保护。在互联网上的任何地方重新分发都需要获得许可。
Zotero 插件
