利用非对比增强 CMR 电影序列检测急性心肌梗死及随访检查中的瘢痕节段应变。
Segmental strain for scar detection in acute myocardial infarcts and in follow-up exams using non-contrast CMR cine sequences.
机构信息
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland.
出版信息
BMC Cardiovasc Disord. 2022 May 18;22(1):226. doi: 10.1186/s12872-022-02664-z.
BACKGROUND
The purpose of the study was to investigate feasibility of infarct detection in segmental strain derived from non-contrast cardiac magnetic resonance (CMR) cine sequences in patients with acute myocardial infarction (AMI) and in follow-up (FU) exams.
METHODS
57 patients with AMI (mean age 61 ± 12 years, CMR 2.8 ± 2 days after infarction) were retrospectively included, FU exams were available in 32 patients (35 ± 14 days after first CMR). 43 patients with normal CMR (54 ± 11 years) served as controls. Dedicated software (Segment CMR, Medviso) was used to calculate global and segmental strain derived from cine sequences. Cine short axis stacks and segmental circumferential strain calculations of every patient and control were presented to two blinded readers in random order, who were advised to identify potentially infarcted segments, blinded to LGE and clinical information.
RESULTS
Impaired global strain was measured in AMI patients compared to controls (global peak circumferential strain [GPCS] p = 0.01; global peak longitudinal strain [GPLS] p = 0.04; global peak radial strain [GPRS] p = 0.01). In both imaging time points, mean segmental peak circumferential strain [SPCS] was impaired in infarcted tissue compared to remote segments (AMI: p = 0.03, FU: p = 0.02). SPCS values in infarcted segments were similar between AMI and FU (p = 0.8). In SPCS calculations, 141 from 189 acutely infarcted segments were accurately detected (74.6%), visual evaluation of correlating cine images detected 43.4% infarcts. In FU, 80% infarcted segments (91/114 segments) were detected in SPCS and 51.8% by visual evaluation of correlating short axis cine images (p = 0.01).
CONCLUSION
Segmental circumferential strain derived from routinely acquired native cine sequences detects nearly 75% of acute infarcts and 80% of infarcts in subacute follow-up CMR, significantly more than visual evaluation of correlating cine images alone. Acute infarcts may display only subtle impairment of wall motion and no obvious wall thinning, thus SPCS calculation might be helpful for scar detection in patients with acute infarcts, when LGE images are not available.
背景
本研究旨在探讨在急性心肌梗死（AMI）患者的对比增强心脏磁共振（CMR）电影序列和随访（FU）检查中，从非对比增强 CM R 电影序列中检测节段性应变的可行性。
方法
回顾性纳入 57 例 AMI 患者（平均年龄 61±12 岁，CMR 检查在梗死后 2.8±2 天进行），其中 32 例患者可进行 FU 检查（FU 检查在首次 CMR 检查后 35±14 天进行）。43 例 CMR 正常的患者（54±11 岁）作为对照组。使用专用软件（Segment CMR，Medviso）计算电影序列的整体和节段应变。将每位患者和对照者的电影短轴堆栈和节段圆周应变计算结果以随机顺序呈现给两位盲法读者，他们被建议识别潜在的梗死节段，盲法于 LGE 和临床信息。
结果
与对照组相比，AMI 患者的整体应变受损（整体峰值圆周应变[GPCS]p=0.01；整体峰值纵向应变[GPLS]p=0.04；整体峰值径向应变[GPRS]p=0.01）。在两个成像时间点，梗死组织的节段峰值圆周应变[SPCS]均低于远隔节段（AMI：p=0.03，FU：p=0.02）。AMI 和 FU 时，梗死节段的 SPCS 值无差异（p=0.8）。在 SPCS 计算中，189 个急性梗死节段中有 141 个（74.6%）准确检测到，相关电影图像的视觉评估检测到 43.4%的梗死。FU 时，SPCS 检测到 80%（91/114 个节段）的梗死节段，相关短轴电影图像的视觉评估检测到 51.8%（p=0.01）。
结论
从常规采集的原始电影序列中提取的节段圆周应变可检测到近 75%的急性梗死和亚急性 FU CMR 中的 80%梗死，明显优于单独评估相关电影图像。急性梗死可能仅显示轻微的壁运动障碍，而无明显的壁变薄，因此在没有 LGE 图像时，SPCS 计算可能有助于急性梗死患者的瘢痕检测。
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