延迟回声增强成像定量心肌梗死面积。
Delayed Echo Enhancement Imaging to Quantify Myocardial Infarct Size.
机构信息
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China; Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China; Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
出版信息
J Am Soc Echocardiogr. 2021 Aug;34(8):898-909. doi: 10.1016/j.echo.2021.02.019. Epub 2021 Mar 9.
BACKGROUND
Perfluoropropane droplets formulated from commercial microbubbles exhibit different acoustic characteristics than their parent microbubbles, most likely from enhanced endothelial permeability. This enhanced permeability may permit delayed echo-enhancement imaging (DEEI) similar to delayed enhancement magnetic resonance imaging (DE-MRI). We hypothesized this would allow detection and quantification of myocardial scar.
METHODS
In 15 pigs undergoing 90 minutes of left anterior descending ischemia by either balloon (n = 13) or thrombotic occlusion (n = 2), DE-MRI was performed at 2-24 days postocclusion. Delayed echo-enhancement imaging was performed at 2-4 minutes following an intravenous injection of 1 mL of 50% Definity (Lantheus Medical) compressed into 180 nm droplets; DEEI was attempted in all pigs with single-pulse harmonic imaging at 1.7 transmit/3.4 MHz receive. Myocardial defects observed with DEEI were quantified (percentage of infarct area) and compared with DE-MRI as well as postmortem staining. In six pigs, multipulse low-mechanical index (MI) fundamental nonlinear imaging (FNLI) with intermittent high-MI impulses was performed to determine whether droplet activation within the infarct zone was achievable with a longer pulse duration.
RESULTS
The range of infarct size area by DE-MRI ranged from 0% to 46% of total left ventricular area. Single-pulse harmonic imaging detected a contrast defect that correlated closely with infarct area by DE-MRI (r = 0.81, P = .0001). The FNLI high-MI impulses resulted in droplet activation in both the infarct and normal zones. Harmonic subtraction of the FNLI images resulted in infarct zone enhancement that also correlated closely with infarct size (r = 0.83; P = .04). Droplets were observed on postmortem transmission electron microscopy within myocytes of the infarct and remote normal zone.
CONCLUSION
Intravenously Definity nanodroplets can be utilized to detect and quantify infarct zone at the bedside using DEEI techniques.
背景
由商业微泡配制的全氟丙烷液滴表现出与母微泡不同的声学特性，这很可能是由于内皮通透性增强所致。这种增强的通透性可能允许延迟回声增强成像（DEEI）类似于延迟增强磁共振成像（DE-MRI）。我们假设这将允许检测和量化心肌瘢痕。
方法
在通过球囊（n=13）或血栓闭塞（n=2）进行左前降支缺血 90 分钟的 15 头猪中，在闭塞后 2-24 天进行 DE-MRI。在静脉注射 1mL 50%的 Definity（Lantheus Medical）压入 180nm 液滴后 2-4 分钟进行延迟回声增强成像; 使用单脉冲谐波成像在所有猪中尝试 DEEI，发射/接收频率为 1.7 传输/3.4MHz。通过 DEEI 观察到的心肌缺陷进行量化（梗死面积的百分比），并与 DE-MRI 以及死后染色进行比较。在 6 头猪中，进行了多脉冲低机械指数（MI）基本非线性成像（FNLI），并间歇性地施加高 MI 脉冲，以确定是否可以通过较长的脉冲持续时间在梗死区内实现液滴激活。
结果
DE-MRI 测量的梗死面积范围从总左心室面积的 0%到 46%。单脉冲谐波成像检测到的对比缺陷与 DE-MRI 测量的梗死面积密切相关（r=0.81，P=0.0001）。FNLI 高 MI 脉冲导致在梗死区和正常区都发生液滴激活。FNLI 图像的谐波减法导致梗死区增强，与梗死面积也密切相关（r=0.83; P=0.04）。在梗死和远侧正常区的心肌细胞内，通过透射电子显微镜观察到液滴。
结论
静脉内 Definity 纳米液滴可用于使用 DEEI 技术在床边检测和量化梗死区。
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