基于应变曲线分析的优化触发延迟的体素内不相干运动 MRI 图像改善用于评估运动性热疾病的心肌微血管功能障碍。
Image Improved Intravoxel Incoherent Motion MRI With Optimized Trigger Delays Based on Strain Curve Analysis to Evaluate Myocardial Microvascular Dysfunction of Exertional Heat Illness.
机构信息
Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.
出版信息
J Magn Reson Imaging. 2023 Dec;58(6):1785-1796. doi: 10.1002/jmri.28684. Epub 2023 Mar 21.
BACKGROUND
Intravoxel incoherent motion (IVIM) MRI has not been widely used and its role in evaluating exertional heat illness (EHI)-related myocardial involvement remains unknown.
PURPOSE
To investigate the feasibility of strain curve-derived trigger delay (TD) IVIM-MRI and its role in assessing myocardial diffusion and microvascular perfusion of EHI patients.
STUDY TYPE
Prospective.
SUBJECTS
A total of 42 male EHI patients (median age: 21 years) and 22 age- and sex-matched healthy controls (HC).
FIELD STRENGTH/SEQUENCE: A 3-T, diffusion-weighted spin-echo echo-planar-imaging sequence.
ASSESSMENT
IVIM-MRI was acquired by conventional TD method (group A) or strain curve-based TD method (group B) in random order. IVIM image quality was evaluated on a 3-point Likert scale (1, nondiagnostic; 2, moderate; 3, good). Technical success was defined as image quality score = 3. IVIM-MRI-derived parameters (pseudo diffusion in the capillaries [D*], perfusion fraction [f], and slow apparent diffusion coefficient [D]) were compared between EHI and HC.
STATISTICAL TESTS
Student's t-tests, chi-square tests, one-way analysis of variance, receiver operating characteristic (ROC) curve analysis, Pearson's correlation coefficient (r). The statistical significance level was set at P < 0.05.
RESULTS
IVIM-MRI image quality score (median [interquartile range]: 3 [2, 3] vs. 2 [1-3]) and technical success rate (61.9%[13/21] vs. 28.6%[6/21]) were significantly improved in group B. EHI patients showed significantly decreased D* (118.1 ± 23.3 × 10 mm /sec vs. 142.7 ± 42.6 × 10 mm /sec) and f values (0.42 ± 0.12 vs. 0.51 ± 0.11) and significantly higher D values (3.0 ± 0.9 × 10 mm /sec vs. 2.5 ± 0.6 × 10 mm /sec) compared to HC. Relative to D and D*, f showed the most robust efficacy for detecting EHI-related myocardial injury with the highest area under the ROC curve (0.906: 95% confidence interval, 0.799, 0.967) and sensitivity of 88.5% and specificity of 85.6%.
CONCLUSION
The strain curve-based TD method significantly improved image quality and technical success rate of IVIM-MRI, and f value may be an effective biomarker to assess myocardial microcirculation abnormalities of EHI patients.
EVIDENCE LEVEL
TECHNICAL EFFICACY
Stage 3.
背景
体素内不相干运动（IVIM）MRI 尚未得到广泛应用，其在评估与运动相关的热应激病（EHI）相关心肌受累中的作用尚不清楚。
目的
探讨应变曲线衍生触发延迟（TD）IVIM-MRI 的可行性及其在评估 EHI 患者心肌扩散和微血管灌注中的作用。
研究类型
前瞻性。
受试者
共 42 名男性 EHI 患者（中位数年龄：21 岁）和 22 名年龄和性别匹配的健康对照（HC）。
场强/序列：3.0T，扩散加权自旋回波回波平面成像序列。
评估
通过常规 TD 方法（A 组）或应变曲线为基础的 TD 方法（B 组）以随机顺序进行 IVIM-MRI。采用 3 分李克特量表评估 IVIM 图像质量（1，无法诊断；2，中等；3，良好）。技术成功定义为图像质量评分=3。比较 EHI 和 HC 之间的 IVIM-MRI 衍生参数（毛细血管中的假扩散[D*]、灌注分数[f]和缓慢表观扩散系数[D]）。
统计学检验
学生 t 检验、卡方检验、单因素方差分析、受试者工作特征（ROC）曲线分析、皮尔逊相关系数（r）。统计显著性水平设为 P<0.05。
结果
B 组 IVIM-MRI 图像质量评分（中位数[四分位距]：3[2，3]比 2[1，3]）和技术成功率（61.9%[13/21]比 28.6%[6/21]）显著提高。EHI 患者的 D*（118.1±23.3×10mm/s 比 142.7±42.6×10mm/s）和 f 值（0.42±0.12 比 0.51±0.11）显著降低，D 值（3.0±0.9×10mm/s 比 2.5±0.6×10mm/s）显著升高，与 HC 相比。与 D 和 D*相比，f 显示出检测 EHI 相关心肌损伤的最高功效，ROC 曲线下面积最高（0.906：95%置信区间，0.799，0.967），灵敏度为 88.5%，特异性为 85.6%。
结论
应变曲线为基础的 TD 方法显著提高了 IVIM-MRI 的图像质量和技术成功率，f 值可能是评估 EHI 患者心肌微循环异常的有效生物标志物。
证据水平
2。
技术效果
3 级。
Zotero 插件