Warnica William, Al-Arnawoot Amna, Stanimirovic Aleksandra, Thavendiranathan Paaladinesh, Wald Rachel M, Pakkal Mini, Karur Gauri Rani, Wintersperger Bernd J, Rac Valeria, Hanneman Kate
From the Department of Medical Imaging (W.W., A.A., P.T., R.M.W., M.P., G.R.K., B.J.W., K.H.) and Division of Cardiology (P.T., R.M.W.), Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, UHN, Toronto, Canada (A.S., V.R.); and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (V.R.).
Radiology. 2022 Nov;305(2):319-326. doi: 10.1148/radiol.220067. Epub 2022 Jul 5.
Background There are limited data on the incremental value of parametric mapping compared with core cardiac MRI protocols for suspected cardiomyopathy in routine clinical practice. Purpose To evaluate the impact of cardiac MRI T1 and T2 mapping in routine clinical practice with respect to diagnostic accuracy, reader diagnostic confidence, and downstream cardiac imaging utilization. Materials and Methods In this retrospective single-center study, consecutive clinical cardiac MRI scans obtained with and without T1 and T2 mapping for evaluation of suspected cardiomyopathy between January 2017 and October 2019 were evaluated. Diagnostic accuracy and reader diagnostic confidence were evaluated in a random subset. Downstream cardiac imaging utilization was analyzed in patients with a minimum of 1 year of clinical follow-up ending before January 2020. Results A total of 1876 patients (mean age, 51 years ± 17 [SD]; 1113 men) were evaluated. Of these, 751 (40%) underwent cardiac MRI with the core protocol and 1125 (60%) with the core protocol plus T1 and T2 mapping. In the mapping group, T1 and T2 were high in 280 (25%) and 47 patients (4%), respectively. In the subset evaluated for diagnostic utility ( = 450), the addition of T1 and T2 maps to the core protocol resulted in an improvement in reader diagnostic confidence in 174 patients (39%). Diagnostic sensitivity was higher with the core protocol plus mapping compared with the core protocol alone for myocarditis (89% [31 of 35 patients] vs 69% [24 of 35]; = .008), Fabry disease (93% [13 of 14 patients] vs 50% [seven of 14]; = .01), and amyloidosis (100% [16 of 16 patients] vs 63% [10 of 16]; = .01). In the subset evaluated for downstream imaging utilization ( = 903), 47% of patients with mapping had at least one subsequent cardiac imaging test compared with 55% of patients without mapping ( = .01). Conclusion In patients with suspected cardiomyopathy, cardiac MRI with T1 and T2 mapping had high diagnostic utility and was associated with lower downstream cardiac imaging utilization. © RSNA, 2022 . See also the editorial by Jerosch-Herold and Coelho-Filho in this issue.
在日常临床实践中，与核心心脏磁共振成像（MRI）方案相比，参数映射对于疑似心肌病的增量价值的数据有限。目的：评估心脏MRI T1和T2映射在日常临床实践中对诊断准确性、阅片者诊断信心以及下游心脏成像利用情况的影响。材料与方法：在这项回顾性单中心研究中，对2017年1月至2019年10月期间为评估疑似心肌病而进行的连续临床心脏MRI扫描进行了评估，这些扫描包括有和没有T1和T2映射的情况。在一个随机子集中评估诊断准确性和阅片者诊断信心。对在2020年1月之前结束的至少有1年临床随访的患者分析下游心脏成像利用情况。结果：共评估了1876例患者（平均年龄51岁±17[标准差]；1113例男性）。其中，751例（40%）接受了核心方案的心脏MRI检查，1125例（60%）接受了核心方案加T1和T2映射的检查。在映射组中，T1和T2升高的分别有280例（25%）和47例（4%）。在评估诊断效用的子集中（n = 450），在核心方案中添加T1和T2映射使174例患者（39%）的阅片者诊断信心得到改善。与单独的核心方案相比，核心方案加映射对于心肌炎的诊断敏感性更高（89%[35例中的31例]对69%[35例中的24例]；P = .008），法布里病（93%[14例中的13例]对50%[14例中的7例]；P = .01），以及淀粉样变性（100%[16例中的16例]对63%[16例中的10例]；P = .01）。在评估下游成像利用情况的子集中（n = 903），接受映射检查的患者中有47%至少进行了一次后续心脏成像检查，而未接受映射检查的患者为55%（P = .01）。结论：在疑似心肌病患者中，采用T1和T2映射的心脏MRI具有较高的诊断效用，且与较低的下游心脏成像利用情况相关。©RSNA，2022 。另见本期Jerosch-Herold和Coelho-Filho的社论。
