Zhao Shi-Hai, Yun Hong, Chen Cai-Zhong, Chen Yin-Yin, Lin Jin-Yi, Zeng Meng-Su, Liu Tian-Shu, Pan Cui-Zhen, Jin Hang
Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China; Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Cardiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Cardiovascular Diseases, Shanghai, China.
Eur J Radiol. 2022 Nov;156:110558. doi: 10.1016/j.ejrad.2022.110558. Epub 2022 Oct 17.
Sparse researches evaluated the quantitative cardiovascular magnetic resonance (CMR) parameters for immune checkpoint inhibitors (ICI)-associated myocarditis. We aimed to apply quantitative CMR mappings and late gadolinium enhancement (LGE) extent for detecting ICI-associated myocarditis.
The retrospective study included patients with ICI-associated myocarditis and CMR examination from August 2018 to August 2021 in our hospital. ICI-associated myocarditis was clinically diagnosed based on the clinical criteria by European Society of Cardiology guidelines. The multiparametric CMR images including T2 mapping and black blood T2-weighted images were used to evaluate myocardial edema. The myocardial edema ratio (ER) ≥ 2.0 was applied for determining myocardial edema on T2-weighted images.
56 patients with ICI-associated myocarditis were included. The global T2 value and native T1 value of patients with ICI-associated myocarditis were significantly higher than the reference ranges in our hospital (p < 0.05). The rate of elevated global T2 value (92%) was significantly higher than those of abnormal native T1 value (73%), ER (52%) and LGE presence (68%) in patients with ICI-associated myocarditis (p < 0.05). The LGE extent and left ventricular ejection fraction of patients with ICI-associated myocarditis were 10.38 ± 9.64% and 56.42 ± 8.54%, respectively. LGE extent inversely correlated with left ventricular ejection fraction (r = -0.38, p = 0.004) but positively correlated with native T1 value (r = 0.28, p < 0.04) and extracellular volume (r = 0.50, p = 0.001).
T2 mapping could detect higher rate of patients with ICI-associated myocarditis than native T1 mapping, ER and LGE presence. LGE extent inversely correlated with left ventricular ejection fraction but positively correlated with native T1 value and extracellular volume in patients with ICI-associated myocarditis.
关于免疫检查点抑制剂（ICI）相关心肌炎的定量心血管磁共振（CMR）参数的研究较少。我们旨在应用定量CMR成像和延迟钆增强（LGE）范围来检测ICI相关心肌炎。
这项回顾性研究纳入了2018年8月至2021年8月在我院接受CMR检查且患有ICI相关心肌炎的患者。ICI相关心肌炎根据欧洲心脏病学会指南的临床标准进行临床诊断。使用包括T2加权成像和黑血T2加权图像在内的多参数CMR图像来评估心肌水肿。在T2加权图像上，心肌水肿比（ER）≥2.0用于确定心肌水肿。
纳入56例ICI相关心肌炎患者。ICI相关心肌炎患者的整体T2值和固有T1值显著高于我院的参考范围（p<0.05）。ICI相关心肌炎患者中整体T2值升高率（92%）显著高于固有T1值异常率（73%）、ER异常率（52%）和LGE出现率（68%）（p<0.05）。ICI相关心肌炎患者的LGE范围和左心室射血分数分别为10.38±9.64%和56.42±8.54%。LGE范围与左心室射血分数呈负相关（r=-0.38，p=0.004），但与固有T1值呈正相关（r=0.28，p<0.04）以及与细胞外容积呈正相关（r=0.50，p=0.001）。
与固有T1成像、ER和LGE出现情况相比，T2加权成像能够检测出更高比例的ICI相关心肌炎患者。在ICI相关心肌炎患者中，LGE范围与左心室射血分数呈负相关，但与固有T1值和细胞外容积呈正相关。
