Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Korean J Radiol. 2024 Jun;25(6):540-549. doi: 10.3348/kjr.2023.1271.
This study investigated the feasibility and prognostic relevance of threshold-based quantification of myocardial delayed enhancement (MDE) on CT in patients with nonischemic dilated cardiomyopathy (NIDCM).
Forty-three patients with NIDCM (59.3 ± 17.1 years; 21 male) were included in the study and underwent cardiac CT and MRI. MDE was quantified manually and with a threshold-based quantification method using cutoffs of 2, 3, and 4 standard deviations (SDs) on three sets of CT images (100 kVp, 120 kVp, and 70 keV). Interobserver agreement in MDE quantification was assessed using the intraclass correlation coefficient (ICC). Agreement between CT and MRI was evaluated using the Bland-Altman method and the concordance correlation coefficient (CCC). Patients were followed up for the subsequent occurrence of the primary composite outcome, including cardiac death, heart transplantation, heart failure hospitalization, or appropriate use of an implantable cardioverter-defibrillator. The Kaplan-Meier method was used to estimate event-free survival according to MDE levels.
Late gadolinium enhancement (LGE) was observed in 29 patients (67%, 29/43), and the mean LGE found with the 5-SD threshold was 4.1% ± 3.6%. The 4-SD threshold on 70-keV CT showed excellent interobserver agreement (ICC = 0.810) and the highest concordance with MRI (CCC = 0.803). This method also yielded the smallest bias with the narrowest range of 95% limits of agreement compared to MRI (bias, -0.119%; 95% limits of agreement, -4.216% to 3.978%). During a median follow-up of 1625 days (interquartile range, 712-1430 days), 10 patients (23%, 10/43) experienced the primary composite outcome. Event-free survival significantly differed between risk subgroups divided by the optimal MDE cutoff of 4.3% (log-rank = 0.005).
The 4-SD threshold on 70-keV monochromatic CT yielded results comparable to those of MRI for quantifying MDE as a marker of myocardial fibrosis, which showed prognostic value in patients with NIDCM.
本研究旨在探讨基于阈值的心肌延迟强化（MDE）定量在非缺血性扩张型心肌病（NIDCM）患者中的 CT 可行性和预后相关性。
本研究纳入 43 例 NIDCM 患者（59.3±17.1 岁，21 名男性），并进行心脏 CT 和 MRI 检查。MDE 采用手动和基于阈值的定量方法进行定量，阈值分别为 2、3 和 4 个标准差（SD），并在三组 CT 图像（100 kVp、120 kVp 和 70 keV）上进行测量。采用组内相关系数（ICC）评估 MDE 定量的观察者间一致性。采用 Bland-Altman 法和一致性相关系数（CCC）评估 CT 和 MRI 之间的一致性。对患者进行随访，以评估主要复合终点（包括心源性死亡、心脏移植、心力衰竭住院或植入式心脏复律除颤器的适当使用）的发生情况。根据 MDE 水平，采用 Kaplan-Meier 法估计无事件生存率。
29 例患者（67%，29/43）出现延迟钆增强（LGE），5-SD 阈值下的平均 LGE 为 4.1%±3.6%。70 keV CT 上的 4-SD 阈值显示出极好的观察者间一致性（ICC=0.810），与 MRI 的一致性最高（CCC=0.803）。与 MRI 相比，该方法还具有最小的偏倚和最窄的 95%一致性界限范围（偏倚，-0.119%；95%一致性界限，-4.216%至 3.978%）。在中位数为 1625 天（四分位距，712-1430 天）的随访期间，10 例患者（23%，10/43）发生了主要复合终点。根据最佳 MDE 截断值 4.3%，将患者分为风险亚组后，无事件生存率有显著差异（对数秩检验=0.005）。
70 keV 单能 CT 上的 4-SD 阈值可用于定量 MDE，作为心肌纤维化的标志物，与 MRI 相比结果相当，在 NIDCM 患者中具有预后价值。
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