Centro Cardiologico Monzino, IRCCS.
Department of Surgical Sciences, Radiology Institute, University of Turin, Turin.
J Thorac Imaging. 2020 Sep;35(5):326-333. doi: 10.1097/RTI.0000000000000448.
The aim of this study was to assess the reliability of a 2D dark-blood phase-sensitive late gadolinium enhancement sequence (2D-DBPSLGE) compared with 2D phase-sensitive inversion recovery late gadolinium enhancement sequence (2D-BBPSLGE) in patients with ischemic cardiomyopathy (ICM).
A total of 73 patients with a clinical history of ICM were prospectively enrolled. The following endpoints were evaluated: (a) comparison of image quality between 2D-BBPSLGE and 2D-DBPSLGE for differentiation between blood pool-late gadolinium enhancement (LGE), remote myocardium-LGE, and blood pool-remote myocardium; (b) diagnostic accuracy of 2D-DBPSLGE compared with gold standard 2D-BBPSLGE for the evaluation of infarcted segments; (c) diagnostic accuracy of 2D-DBPSLGE for the evaluation of microvascular obstruction (MVO); (d) comparison of transmurality index between 2D-BBPSLGE and 2D-DBPSLGE; (e) comparison of papillary muscle hyperenhancement between 2D-BBPSLGE and 2D-DBPSLGE; inter-reader agreement for depiction of hyperenhanced segments in both LGE sequences. Data were analyzed using paired t test, Wilcoxon test, and McNemar test, and η coefficient and intercorrelation coefficient (ICC).
Image quality was superior for 2D-DBPSLGE for differentiation of blood pool-LGE (P<0.001). 2D-DBPSLGE, compared with 2D-BBPSLGE, showed a sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 96.93%, 99.89%, 99.71%, 98.78, and 99.04%, respectively. Concerning MVO detection, 2D-DBPSLGE showed a sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 66.67%, 100.00%, 100.00%, 80.95%, and 86.21%, respectively. 2D-DBPSLGE underestimated the transmurality (P=0.007) and identified papillary muscle hyperenhancement (P<0.001). Both LGE sequences showed comparable interobserver agreement for the evaluation of infarcted areas (2D-BBPSLGE: ICC 0.99;2D-DBPSLGE: ICC 0.99).
Compared with 2D-BBPSLGE, 2D-DBPSLGE sequences provide better differentiation between LGE and blood-pool, while underestimating LGE trasmurality and the presence of MVO.
本研究旨在评估二维黑血相位敏感晚期钆增强（2D-DBPSLGE）序列与二维相位敏感反转恢复晚期钆增强（2D-BBPSLGE）序列在缺血性心肌病（ICM）患者中的可靠性。
前瞻性纳入 73 例有 ICM 临床病史的患者。评估以下终点：（a）比较 2D-BBPSLGE 和 2D-DBPSLGE 对区分血池-晚期钆增强（LGE）、远隔心肌-LGE 和血池-远隔心肌的图像质量；（b）2D-DBPSLGE 评估梗死节段的诊断准确性与金标准 2D-BBPSLGE 的比较；（c）2D-DBPSLGE 评估微血管阻塞（MVO）的诊断准确性；（d）2D-BBPSLGE 和 2D-DBPSLGE 之间透壁指数的比较；（e）2D-BBPSLGE 和 2D-DBPSLGE 之间乳头肌强化的比较；两种 LGE 序列中强化节段的描绘的观察者间一致性。使用配对 t 检验、Wilcoxon 检验和 McNemar 检验以及 η 系数和互相关系数（ICC）分析数据。
2D-DBPSLGE 对区分血池-LGE 的图像质量优于 2D-BBPSLGE（P<0.001）。与 2D-BBPSLGE 相比，2D-DBPSLGE 的灵敏度、特异性、阳性预测值、阴性预测值和诊断准确性分别为 96.93%、99.89%、99.71%、98.78%和 99.04%。在 MVO 检测方面，2D-DBPSLGE 的灵敏度、特异性、阳性预测值、阴性预测值和诊断准确性分别为 66.67%、100.00%、100.00%、80.95%和 86.21%。2D-DBPSLGE 低估了透壁性（P=0.007）并识别出乳头肌强化（P<0.001）。两种 LGE 序列在评估梗死区域方面均具有相似的观察者间一致性（2D-BBPSLGE：ICC 0.99；2D-DBPSLGE：ICC 0.99）。
与 2D-BBPSLGE 相比，2D-DBPSLGE 序列提供了更好的 LGE 与血池之间的区分，同时低估了 LGE 的透壁性和 MVO 的存在。
