多中心研究：3T 场强下心脏磁共振心肌梗死后自然 T1 值的诊断性能。
Multicenter Study on the Diagnostic Performance of Native-T1 Cardiac Magnetic Resonance of Chronic Myocardial Infarctions at 3T.
机构信息
Department of Biomedical Sciences, Biomedical Imaging Research Institute (G.W., Q.Y., V.S., S.P., H.-J.Y., B.S., A.K., I.C., D.L., D.S.B., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA.
Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang (G.W.).
出版信息
Circ Cardiovasc Imaging. 2020 Jun;13(6):e009894. doi: 10.1161/CIRCIMAGING.119.009894. Epub 2020 Jun 8.
BACKGROUND
Preclinical studies and pilot patient studies have shown that chronic infarctions can be detected and characterized from cardiac magnetic resonance without gadolinium-based contrast agents using native-T1 maps at 3T. We aimed to investigate the diagnostic capacity of this approach for characterizing chronic myocardial infarctions (MIs) in a multi-center setting.
METHODS
Patients with a prior MI (n=105) were recruited at 3 different medical centers and were imaged with native-T1 mapping and late gadolinium enhancement (LGE) at 3T. Infarct location, size, and transmurality were determined from native-T1 maps and LGE. Sensitivity, specificity, receiver-operating characteristic metrics, and inter- and intraobserver variabilities were assessed relative to LGE.
RESULTS
Across all subjects, T1 of MI territory was 1621±110 ms, and remote territory was 1225±75 ms. Sensitivity, specificity, and area under curve for detecting MI location based on native-T1 mapping relative to LGE were 88%, 92%, and 0.93, respectively. Native-T1 maps were not different for measuring infarct size (native-T1 maps: 12.1±7.5%; LGE: 11.8±7.2%, =0.82) and were in agreement with LGE (=0.92, bias, 0.09±2.6%). Corresponding inter- and intraobserver assessments were also highly correlated (interobserver: =0.90, bias, 0.18±2.4%; and intraobserver: =0.91, bias, 0.28±2.1%). Native T1 maps were not different for measuring MI transmurality (native-T1 maps: 49.1±15.8%; LGE: 47.2±19.0%, =0.56) and showed agreement (=0.71; bias, 1.32±10.2%). Corresponding inter- and intraobserver assessments were also in agreement (interobserver: =0.81, bias, 0.1±9.4%; and intraobserver: =0.91, bias, 0.28±2.1%, respectively). While the overall accuracy for detecting MI with native-T1 maps at 3T was high, logistic regression analysis showed that MI location was a prominent confounder.
CONCLUSIONS
Native-T1 mapping can be used to image chronic MI with high degree of accuracy, and as such, it is a viable alternative for scar imaging in patients with chronic MI who are contraindicated for LGE. Technical advancements may be needed to overcome the imaging confounders that currently limit native-T1 mapping from reaching equivalent detection levels as LGE.
背景
临床前研究和初步患者研究表明，在 3T 场强下，使用钆剂对比剂的心脏磁共振原生 T1 图谱可检测和特征化陈旧性梗死。本研究旨在多中心环境下评估该方法对陈旧性心肌梗死（MI）的诊断能力。
方法
在 3 家不同的医疗中心招募了 105 例有陈旧性 MI 的患者，对其进行 3T 心脏磁共振的原生 T1 映射和晚期钆增强（LGE）扫描。从原生 T1 图谱和 LGE 中确定梗死部位、大小和透壁程度。与 LGE 相比，评估了其对 MI 位置检测的敏感性、特异性、受试者工作特征曲线和观察者内、观察者间的可重复性。
结果
在所有受试者中，MI 区域的 T1 值为 1621±110ms，远隔区域为 1225±75ms。基于原生 T1 图谱检测 MI 位置的敏感性、特异性和曲线下面积（AUC）分别为 88%、92%和 0.93。原生 T1 图谱在测量梗死面积（原生 T1 图谱：12.1±7.5%；LGE：11.8±7.2%，=0.82）方面没有差异，与 LGE 结果一致（=0.92，偏差为 0.09±2.6%）。相应的观察者内和观察者间评估也高度相关（观察者内：=0.90，偏差为 0.18±2.4%；观察者间：=0.91，偏差为 0.28±2.1%）。原生 T1 图谱在测量 MI 的透壁程度方面也没有差异（原生 T1 图谱：49.1±15.8%；LGE：47.2±19.0%，=0.56），并与 LGE 具有一致性（=0.71；偏差为 1.32±10.2%）。相应的观察者内和观察者间评估也一致（观察者内：=0.81，偏差为 0.1±9.4%；观察者间：=0.91，偏差为 0.28±2.1%）。虽然使用 3T 场强下的原生 T1 图谱检测 MI 的整体准确性较高，但逻辑回归分析表明 MI 部位是一个显著的混杂因素。
结论
原生 T1 映射可用于高度准确地成像陈旧性 MI，因此，对于因禁忌 LGE 而不能接受 LGE 成像的陈旧性 MI 患者，它是一种可行的瘢痕成像替代方法。可能需要技术进步来克服目前限制原生 T1 映射达到与 LGE 相当的检测水平的成像混杂因素。
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