Cui Qian, He Qiang, Ge Xihong, Gao Guangfeng, Liu Yang, Yu Jing, Wang Hongle, Shen Wen
The First Central Clinical School, Tianjin Medical University, Tianjin 300192, China.
Department of Radiology, Tianjin First Central Hospital, Tianjin 300192, China.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2023 Dec;35(12):1304-1308. doi: 10.3760/cma.j.cn121430-20230914-00779.
To investigate the value of T2 mapping in the assessment of myocardial changes and prognosis in patients with acute ST segment elevation myocardial infarction (STEMI).
A retrospective study was conducted. A total of 30 patients with acute STEMI admitted to Tianjin First Central Hospital from January 2021 to March 2022 were enrolled as the experimental group. At the same time, 30 age- and sex-matched healthy volunteers and outpatients with non-specific chest pain with no abnormalities in cardiac magnetic resonance (CMR) examination were selected as the control group. CMR was performed within 2 weeks after the diagnosis of STEMI, as the initial reference. A plain CMR review was performed 6 months later (chronic myocardial infarction, CMI). Plain scanning includes film sequence (CINE), T2 weighted short tau inversion recovery (T2-STIR), native-T1 mapping, and T2 mapping. Enhanced scanning includes first-pass perfusion, late gadolinium enhancement (LGE), and post-contrast T1 mapping. Quantitative myocardial parameters were compared between the two groups, before and after STEMI myocardial infarction. The receiver operator characteristic curve (ROC curve) was used to evaluate the diagnostic efficacy of native-T1 before myocardial contrast enhancement and T2 values in differentiating STEMI and CMI after 6 months.
There were no statistically significant differences in age, gender, heart rate and body mass index (BMI) between the two groups, which were comparable. The native-T1 value, T2 value and extracellular volume (ECV) were significantly higher than those in the control group [native-T1 value (ms): 1 434.5±165.3 vs. 1 237.0±102.5, T2 value (ms): 48.3±15.6 vs. 21.8±13.1, ECV: (39.6±13.8)% vs. (22.8±5.0)%, all P < 0.05]. In the experimental group, 12 patients were re-examined by plain CMR scan 6 months later. After 6 months, the high signal intensity on T2-STIR was still visible, but the range was smaller than that in the acute phase, and the native-T1 and T2 values were significantly lower than those in the acute phase [native-T1 value (ms): 1 271.0±26.9 vs. 1 434.5±165.3, T2 value (ms): 34.2±11.2 vs. 48.3±15.6, both P < 0.05]. ROC curve analysis showed that the area under the ROC curve (AUC) of native-T1 and T2 values in differentiating acute STEMI from CMI was 0.71 and 0.80, respectively. When native-T1 cut-off value was 1 316.0 ms, the specificity was 100% and the sensitivity was 53.3%; when T2 cut-off value was 46.7 ms, the specificity was 100% and the sensitivity was 73.8%.
The T2 mapping is a non-invasive method for the diagnosis of myocardial changes in patients with acute STEMI myocardial infarction, and can be used to to evaluate the clinical prognosis of patients.
探讨T2 mapping在评估急性ST段抬高型心肌梗死（STEMI）患者心肌变化及预后中的价值。
进行一项回顾性研究。选取2021年1月至2022年3月入住天津市第一中心医院的30例急性STEMI患者作为实验组。同时，选取30例年龄和性别匹配的健康志愿者以及心脏磁共振（CMR）检查无异常的非特异性胸痛门诊患者作为对照组。在STEMI诊断后2周内进行CMR检查，作为初始参考。6个月后（慢性心肌梗死，CMI）进行CMR平扫复查。平扫包括电影序列（CINE）、T2加权短反转时间反转恢复序列（T2-STIR）、固有T1 mapping和T2 mapping。增强扫描包括首过灌注、延迟钆增强（LGE）和对比剂后T1 mapping。比较两组在STEMI心肌梗死前后的定量心肌参数。采用受试者操作特征曲线（ROC曲线）评估心肌对比增强前固有T1和T2值在鉴别6个月后STEMI和CMI中的诊断效能。
两组在年龄、性别、心率和体重指数（BMI）方面无统计学显著差异，具有可比性。实验组的固有T1值、T2值和细胞外容积（ECV）显著高于对照组[固有T1值（ms）：1434.5±165.3 vs. 1237.0±102.5，T2值（ms）：48.3±15.6 vs. 21.8±13.1，ECV：（39.6±13.8）% vs. （22.8±5.0）%，均P<0.05]。实验组中有12例患者在6个月后进行了CMR平扫复查。6个月后，T2-STIR上的高信号强度仍可见，但范围小于急性期，固有T1和T2值显著低于急性期[固有T1值（ms）：1271.0±26.9 vs. 1434.5±165.3，T2值（ms）：34.2±11.2 vs. 48.3±15.6，均P<0.05]。ROC曲线分析显示，固有T1和T2值在鉴别急性STEMI和CMI时的ROC曲线下面积（AUC）分别为0.71和0.80。当固有T1截断值为1316.0 ms时，特异性为100%，敏感性为53.3%；当T2截断值为46.7 ms时，特异性为100%，敏感性为73.8%。
T2 mapping是诊断急性STEMI心肌梗死患者心肌变化的一种无创方法，可用于评估患者的临床预后。
