Cardiological Center Monzino, IRCCS, Milano.
Division of Diagnostic Imaging, Department of Biomedicine and Prevention, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Rome, Italy.
J Thorac Imaging. 2022 Jan 1;37(1):2-16. doi: 10.1097/RTI.0000000000000621.
Ischemic cardiomyopathy (ICM) is one of the most common causes of congestive heart failure. In patients with ICM, tissue characterization with cardiac magnetic resonance imaging (CMR) allows for evaluation of myocardial abnormalities in acute and chronic settings. Myocardial edema, microvascular obstruction (MVO), intracardiac thrombus, intramyocardial hemorrhage, and late gadolinium enhancement of the myocardium are easily depicted using standard CMR sequences. In the acute setting, tissue characterization is mainly focused on assessment of ventricular thrombus and MVO, which are associated with poor prognosis. Conversely, in chronic ICM, it is important to depict late gadolinium enhancement and myocardial ischemia using stress perfusion sequences. Overall, with CMR's ability to accurately characterize myocardial tissue in acute and chronic ICM, it represents a valuable diagnostic and prognostic imaging method for treatment planning. In particular, tissue characterization abnormalities in the acute setting can provide information regarding the patients that may develop major adverse cardiac event and show the presence of ventricular thrombus; in the chronic setting, evaluation of viable myocardium can be fundamental for planning myocardial revascularization. In this review, the main findings on tissue characterization are illustrated in acute and chronic settings using qualitative and quantitative tissue characterization.
缺血性心肌病（ICM）是充血性心力衰竭最常见的原因之一。在 ICM 患者中，心脏磁共振成像（CMR）的组织特征可评估急性和慢性情况下的心肌异常。使用标准 CMR 序列可以轻松描绘心肌水肿、微血管阻塞（MVO）、心内血栓、心肌内出血和心肌晚期钆增强。在急性期，组织特征主要集中在评估室壁血栓和 MVO，这与不良预后相关。相反，在慢性 ICM 中，使用负荷灌注序列描绘晚期钆增强和心肌缺血很重要。总的来说，CMR 能够准确地描述急性和慢性 ICM 中的心肌组织，代表了一种有价值的治疗计划诊断和预后成像方法。特别是，急性期组织特征异常可以提供可能发生重大不良心脏事件的患者信息，并显示室壁血栓的存在；在慢性情况下，评估存活心肌对于计划心肌血运重建至关重要。在本综述中，使用定性和定量组织特征在急性和慢性情况下说明了主要的组织特征发现。
