1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.
1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.
JACC Cardiovasc Imaging. 2020 May;13(5):1221-1234. doi: 10.1016/j.jcmg.2019.06.030. Epub 2019 Sep 18.
Myocardial fibrosis, either focal or diffuse, is a common feature of many cardiac diseases and is associated with a poor prognosis for major adverse cardiovascular events. Although histological analysis remains the gold standard for confirming the presence of myocardial fibrosis, endomyocardial biopsy is invasive, has sampling errors, and is not practical in the routine clinical setting. Cardiac imaging modalities offer noninvasive surrogate biomarkers not only for fibrosis but also for myocardial edema and infiltration to varying degrees, and have important roles in the diagnosis and management of cardiac diseases. This review summarizes important pathophysiological features in the development of commonly encountered cardiac diseases, and the principles, advantages, and disadvantages of various cardiac imaging modalities (echocardiography, single-photon emission computer tomography, positron emission tomography, multidetector computer tomography, and cardiac magnetic resonance) for myocardial tissue characterization, with an emphasis on imaging focal and diffuse myocardial fibrosis.
心肌纤维化，无论是局灶性还是弥漫性，都是许多心脏疾病的共同特征，与主要不良心血管事件的预后不良相关。尽管组织学分析仍然是确认心肌纤维化存在的金标准，但心内膜心肌活检具有侵袭性、存在取样误差，并且在常规临床环境中不实用。心脏成像方式不仅为纤维化，也为心肌水肿和浸润提供了非侵入性的替代生物标志物，在心脏疾病的诊断和管理中具有重要作用。本综述总结了常见心脏疾病发展过程中的重要病理生理特征，以及各种心脏成像方式（超声心动图、单光子发射计算机断层扫描、正电子发射断层扫描、多排计算机断层扫描和心脏磁共振）在心肌组织特征描述方面的原理、优点和缺点，重点介绍了局灶性和弥漫性心肌纤维化的成像。
