Hansen Esben Søvsø Szocska, Pedersen Steen Fjord, Pedersen Steen Bønløkke, Bøtker Hans Erik, Kim Won Yong
The MR Research Centre and Department of Clinical Medicine, Aarhus University Hospital Skejby, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
Danish Diabetes Academy, Odense, Denmark.
Int J Cardiovasc Imaging. 2019 Jun;35(6):1039-1045. doi: 10.1007/s10554-019-01569-x. Epub 2019 Mar 9.
The purpose of the study was to validate by histopathology, contrast enhanced cine steady-state free precession and T2-weighted CMR for the assessment of ischemic myocardial area-at-risk (AAR) in the presence of microvascular obstruction (MVO). Eleven anesthetized pigs underwent CMR 7 to 10 days post infarction. The area-at-risk was measured from T2-weighted fast spin echo (T2-STIR) and contrast-enhanced steady-state free precession magnetic resonance imaging (CE-SSFP) images using semi-automated algorithms based on a priori knowledge of perfusion territory. Also, late gadolinium enhancement (LGE) was performed to measure final infarct size (FIS). Histopathological comparison with Evans blue dye to define AAR and triphenyltetrazolium chloride to define FIS served as the reference. All infarcts demonstrated MVO on LGE images. Bland-Altman analysis showed no significant bias in AAR or myocardial salvage between T2-STIR and CE-SSFP or between CMR and histopathology. The mean differences ± 2SD from Bland-Altman analysis were: AAR: Evans Blue vs. T2-STIR [0.7%; + 13.5%; - 12.1%]; AAR: Evans Blue vs. CE-SSFP [0.1%; + 13.8%; - 13.7%]; AAR: T2-STIR vs. CE-SSFP [0.7%; + 6.2%; - 4.9%]; Salvage: Evans Blue - TTC vs. T2-STIR-LGE [0.8%; + 11.1%; - 9.6%]; Salvage: Evans Blue - TTC vs. CE-SSFP-LGE [0.1%; + 9.9%; - 9.6%]; Salvage: CE-SSFP-LGE vs. T2-STIR-LGE [0.7%; + 6.2%; - 4.9%]. Both T2-STIR and CE-SSFP sequences allow for unbiased quantification of AAR in the presence of ischemia/reperfusion injury when analysed by semi-automated algorithms. These experimental data, which was validated by histopathology, supports the use of CMR for the assessment of myocardial salvage during the subacute phase.
本研究的目的是通过组织病理学、对比增强电影稳态自由进动序列和T2加权心脏磁共振成像（CMR）来验证在存在微血管阻塞（MVO）的情况下评估缺血心肌危险区（AAR）的方法。11只麻醉猪在梗死7至10天后接受CMR检查。使用基于灌注区域先验知识的半自动算法，从T2加权快速自旋回波（T2-STIR）和对比增强稳态自由进动磁共振成像（CE-SSFP）图像测量危险区。此外，进行延迟钆增强（LGE）以测量最终梗死面积（FIS）。用伊文思蓝染料确定AAR和用氯化三苯基四氮唑确定FIS的组织病理学比较作为参考。所有梗死灶在LGE图像上均显示有MVO。Bland-Altman分析显示，T2-STIR与CE-SSFP之间或CMR与组织病理学之间在AAR或心肌挽救方面无显著偏差。Bland-Altman分析的平均差异±2SD为：AAR：伊文思蓝与T2-STIR [0.7%；+13.5%；-12.1%]；AAR：伊文思蓝与CE-SSFP [0.1%；+13.8%；-13.7%]；AAR：T2-STIR与CE-SSFP [0.7%；+6.2%；-4.9%]；挽救：伊文思蓝-TTC与T2-STIR-LGE [0.8%；+11.1%；-9.6%]；挽救：伊文思蓝-TTC与CE-SSFP-LGE [0.1%；+9.9%；-9.6%]；挽救：CE-SSFP-LGE与T2-STIR-LGE [0.7%；+6.2%；-4.9%]。当通过半自动算法分析时，T2-STIR和CE-SSFP序列在存在缺血/再灌注损伤的情况下均能对AAR进行无偏量化。这些经组织病理学验证的实验数据支持在亚急性期使用CMR评估心肌挽救情况。
