Cui Qian, Yu Jing, Shen Wen
Department of Radiology, Tianjin First Center Hospital, Tianjin 300192, China. Corresponding author: Shen Wen, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019 Dec;31(12):1538-1541. doi: 10.3760/cma.j.issn.2095-4352.2019.12.021.
To explore the role of late gadolinium enhancement (LGE) and T1 mapping for detection of cardiac amyloidosis.
Nine cases of cardiac amyloidosis who had diagnosed by renal biopsy diagnosed type light-chain (AL) amyloidosis and acute heart failure suspected involvement of the heart in Tianjin First Central Hospital from May 2018 to March 2019 were enrolled, and at the same time 14 cases of non-obstructive hypertrophic cardiomyopathy patients, 12 cases of healthy physical examination at the same period were enrolled as the control. All patients underwent Philips 3.0-T including plain scan as cine, T2WI, native T1 mapping and enhanced scan as perfusion, LGE imaging, post T1 mapping. For LGE cardiac magnetic resonance imaging (CMRI), a bolus of 0.1 mL/kg of gadolinium-based contrast followed by a 20 mL saline flush was administered. After a 7-minutes delay, ECG-gated images were acquired in 3 long-axis and a stack of short-axis slices identical to those of cine images using a breath-hold gradient recalled echo phase-sensitive or magnitude only inversion recovery sequence. LGE and T1 mapping CMRI observation, including cardiac function index [left ventricle end-diastolic volume (LVEDV), left ventricle end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), valvular regurgitation], cardiac morphological index [including left ventricular wall thickness, left ventricular weight (LVM)], myocardial histological characteristics and markers N-terminal pro-brain natriuretic peptide (NT-proBNP) and accompanying signs (including pericardial effusion, pleural effusion) were performed.
The predominant LGE pattern in amyloidosis was diffuse left ventricular sub endocardial enhancement (3/9), diffuse in left ventricular wall enhancement (3/9), and transmural delayed enhancement in left ventricular (2/9) and non-typical delayed enhancement (1/9). Myocardial T1 was significantly elevated in cardiac AL amyloidosis patients compared to normal subjects and hypertrophic cardiomyopathy (ms: 1 497.3±22.0 vs. 1 273.3±30.1, 1 329.3±42.6, both P < 0.05). Myocardial T1 was increased in AL amyloid before LGE. A post-contrast myocardial T1 was significantly elevated in cardiac AL amyloidosis patients compared to normal subjects and hypertrophic cardiomyopathy (ms: 476.7±44.2 vs. 516.1±41.5, 569.9±12.3, both P > 0.05). Three of 9 amyloidosis patients with review images showing T1 value and cardiac function was no significantly different with the first check (ms: 1 484.8±6.5 vs. 1 497.3±22.0, P = 0.11).
One-stop CMRI can improve the diagnosis of cardiac amyloidosis, LGE can display the myocardial scarring and fibrosis, and T1 mapping is sensitive to myocardial edema and diffuse fibrosis. LGE and T1 mapping can improve the diagnostic accuracy, which is very meaningful for diagnosis and follow-up of patients.
探讨延迟钆增强（LGE）及T1 mapping在心脏淀粉样变检测中的作用。
选取2018年5月至2019年3月在天津市第一中心医院经肾活检确诊为轻链（AL）型淀粉样变且疑似心脏受累的急性心力衰竭患者9例，同时选取14例非梗阻性肥厚型心肌病患者、同期12例健康体检者作为对照。所有患者均行飞利浦3.0-T检查，包括电影序列平扫、T2WI、T1 mapping及灌注、LGE成像、T1 mapping增强扫描。对于LGE心脏磁共振成像（CMRI），静脉注射钆对比剂，剂量为0.1 mL/kg，随后用20 mL生理盐水冲管。延迟7分钟后，采用屏气梯度回波相位敏感或仅幅度反转恢复序列，获取与电影序列相同的3个长轴及一系列短轴层面的心电图门控图像。观察LGE及T1 mapping CMRI，包括心功能指标[左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）、左心室射血分数（LVEF）、瓣膜反流]、心脏形态学指标[包括左心室壁厚度、左心室重量（LVM）]、心肌组织学特征及标志物N末端脑钠肽前体（NT-proBNP）以及伴随征象（包括心包积液、胸腔积液）。
淀粉样变患者中LGE的主要表现为弥漫性左心室心内膜下强化（3/9）、左心室壁弥漫性强化（3/9）、左心室透壁延迟强化（2/9）及非典型延迟强化（1/9）。与正常受试者及肥厚型心肌病患者相比，心脏AL淀粉样变患者的心肌T1显著升高（均值：1497.3±22.0 vs. 1273.3±30.1、1329.3±42.6，均P<0.05）。LGE前AL淀粉样变患者的心肌T1升高。与正常受试者及肥厚型心肌病患者相比，心脏AL淀粉样变患者的对比剂注射后心肌T1显著升高（均值：476.7±44.2 vs. 516.1±41.5、569.9±12.3，均P>0.05）。9例淀粉样变患者中3例复查图像显示T1值及心功能与首次检查无显著差异（均值：1484.8±6.5 vs. 1497.3±22.0，P = 0.11）。
一站式CMRI可提高心脏淀粉样变的诊断，LGE可显示心肌瘢痕及纤维化，T1 mapping对心肌水肿及弥漫性纤维化敏感。LGE及T1 mapping可提高诊断准确性，对患者的诊断及随访具有重要意义。
