两种钆延迟强化缺血性瘢痕定量的黑暗血法的临床评估。

Clinical evaluation of two dark blood methods of late gadolinium quantification of ischemic scar.

机构信息

Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.

Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK.

出版信息

J Magn Reson Imaging. 2019 Jul;50(1):146-152. doi: 10.1002/jmri.26613. Epub 2019 Jan 3.

DOI:10.1002/jmri.26613

PMID:30604492

Abstract

BACKGROUND

Late gadolinium enhancement (LGE) imaging was validated for diagnosis and quantification of myocardial infarction (MI). Despite good contrast between scar and normal myocardium, contrast between blood pool and myocardial scar can be limited. Dark blood LGE sequences attempt to overcome this issue.

PURPOSE

To evaluate T rho (T ρ)-prepared dark blood sequence and compare to blood nulled (BN) phase sensitive inversion recovery (PSIR) and standard myocardium nulled (MN) PSIR for detection and quantification of scar.

STUDY TYPE

Prospective.

POPULATION

Thirty patients with prior MI.

FIELD STRENGTH/SEQUENCE: Patients underwent identical 1.5 T MRI protocols. Following routine LGE imaging, a slice with scar, remote myocardium, and blood pool was selected. PSIR LGE was repeated with inversion time set to MN, to BN, and T ρ FIDDLE (flow-independent dark-blood delayed enhancement) in random order.

ASSESSMENT

Three observers. Qualitative assessment of confidence scores in scar detection and degree of transmurality. Quantitative assessment of myocardial scar mass (grams), and contrast-to-noise ratio (CNR) measurements between scar, blood pool, and myocardium.

STATISTICAL TESTS

Repeated-measures analysis of variance (ANOVA) with Bonferroni correction, coefficient of variation, and the Cohen κ statistic.

RESULTS

CNR was significantly increased for both BN (27.1 ± 10.4) and T ρ (30.2 ± 15.1) compared with MN (15.3 ± 8.4 P < 0.001 for both sequences). There was no significant difference in CNR between BN (55.9 ± 17.3) and MN (51.1 ± 17.8 P = 0.512); both had significantly higher CNR compared with the T ρ (42.6 ± 16.9 P = 0.007 and P = 0.014, respectively). No significant difference in scar size between LGE methods: MN (2.28 ± 1.58 g) BN (2.16 ± 1.57 g) and T ρ (2.29 ± 2.5 g). Confidence scores were significantly higher for BN (3.87 ± 0.346) compared with MN (3.1 ± 0.76 P < 0.001) and T ρ (3.20 ± 0.71 P < 0.001).

DATA CONCLUSION

PSIR with inversion time (TI) set for blood nulling and the T ρ LGE sequence demonstrated significantly higher scar to blood CNR compared with routine MN. PSIR with TI set for blood nulling demonstrated significantly higher reader confidence scores compared with routine MN and T ρ LGE, suggesting routine adoption of a BN PSIR approach might be appropriate for LGE imaging.

LEVEL OF EVIDENCE

2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:146-152.

摘要

背景

钆延迟增强（LGE）成像已被验证可用于诊断和量化心肌梗死（MI）。尽管瘢痕组织与正常心肌之间具有良好的对比度，但血液池与心肌瘢痕之间的对比度可能有限。黑血 LGE 序列试图克服这个问题。

目的

评估 T rho（T ρ）制备的黑血序列，并与血液排空（BN）相位敏感反转恢复（PSIR）和标准心肌排空（MN）PSIR 进行比较，以检测和量化瘢痕组织。

研究类型

前瞻性。

人群

30 名有 MI 病史的患者。

场强/序列：患者接受了相同的 1.5T MRI 方案。在进行常规 LGE 成像后，选择包含瘢痕、远侧心肌和血液池的切片。以 MN、BN 和 T ρ FIDDLE（血流无关的黑血延迟增强）的随机顺序重复 PSIR LGE 扫描，反转时间设置为 PSIR LGE。

评估

由 3 名观察者进行。对瘢痕检测的置信度评分和透壁程度进行定性评估。对心肌瘢痕质量（克）和瘢痕、血液池和心肌之间的对比噪声比（CNR）测量值进行定量评估。

统计检验

采用重复测量方差分析（ANOVA），并进行 Bonferroni 校正、变异系数和 Cohen κ 统计检验。

结果

与 MN（15.3 ± 8.4）相比，BN（27.1 ± 10.4）和 T ρ（30.2 ± 15.1）的 CNR 均显著增加（P < 0.001）。BN（55.9 ± 17.3）与 MN（51.1 ± 17.8）之间的 CNR 无显著差异（P = 0.512）；与 T ρ（42.6 ± 16.9）相比，BN 和 MN 的 CNR 均显著更高（P = 0.007 和 P = 0.014）。LGE 方法之间的瘢痕大小无显著差异：MN（2.28 ± 1.58 g）、BN（2.16 ± 1.57 g）和 T ρ（2.29 ± 2.5 g）。BN 的置信度评分（3.87 ± 0.346）明显高于 MN（3.1 ± 0.76，P < 0.001）和 T ρ（3.20 ± 0.71，P < 0.001）。