利用3.0-T心脏磁共振成像检测出血性心肌梗死：对空间表现、时间依赖性及最佳采集方法的见解
Detecting Hemorrhagic Myocardial Infarction With 3.0-T CMR: Insights Into Spatial Manifestation, Time-Dependence, and Optimal Acquisitions.
作者信息
Chen Yinyin, Jin Hang, Guan Xingming, Yang Hsin-Jung, Zhang Xinheng, Chen Zhenhui, Chan Shing Fai, Singh Dhirendra, Jambunathan Nithya, Youssef Khalid, Vora Keyur P, Gruionu Gabriel, Dharmakumar Sanjana K, Schmeisser Glen, Tang Richard, Zeng Mengsu, Dharmakumar Rohan
机构信息
Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Medical Imaging, Shanghai Medical School, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.
Department of Radiology and Imaging Sciences and Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA.
出版信息
JACC Cardiovasc Imaging. 2025 Apr;18(4):436-447. doi: 10.1016/j.jcmg.2024.10.006. Epub 2025 Jan 8.
BACKGROUND
Hemorrhagic myocardial infarction (hMI) can rapidly diminish the benefits of reperfusion therapy and direct the heart toward chronic heart failure. T2∗ cardiac magnetic resonance (CMR) is the reference standard for detecting hMI. However, the lack of clarity around the earliest time point for detection, time-dependent changes in hemorrhage volume, and the optimal methods for detection can limit the development of strategies to manage hMI.
OBJECTIVES
The authors investigated CMR signal characteristics of hMI through time-lapse multiparametric mapping using a clinically relevant animal model and evaluated the translatability in ST-segment elevation MI patients when possible.
METHODS
Canines (N = 20) underwent 3.0-T CMR at baseline and various time points over the first week of reperfused MI. Time-dependent relationships between T1, T2, and T2∗ mapping of hMI, non-hMI, and remote territories were determined. Reperfused ST-segment elevation MI patients (N = 50) were studied to establish clinically feasibility.
RESULTS
Although hMI was evident <1 hour after reperfusion on histopathology, it was not reliably detected with T1, T2, or T2∗ CMR. However, 24 hours to 7 days postreperfusion, hMI was detectable on T2∗ (27.0 ± 2.4 ms [baseline] vs 11.7 ± 2.8 ms [hMI]; P < 0.001), with stable volume and transmurality. In T2 maps, hMI was most visible 5 to 7 days postreperfusion with an area under the curve of 0.98 (sensitivity and specificity ≥0.95) relative to T2∗. However, this was not the case with T1 (sensitivity <0.8, across all time points).
CONCLUSIONS
HMI cannot be reliably detected with T1, T2, or T2∗ on 3.0-T CMR immediately after reperfusion. However, T2∗ CMR can be used to diagnose hMI between 24 hours and 7 days postreperfusion. T2 maps at 3.0-T are a strong alternative to T2∗ maps for diagnosing hMI, provided CMR is performed 5 to 7 days postreperfusion. However, diagnosing hMI with T1 is significantly more challenging at 3.0-T compared with both T2∗ and T2.
背景
出血性心肌梗死（hMI）可迅速降低再灌注治疗的益处，并使心脏走向慢性心力衰竭。T2∗心脏磁共振成像（CMR）是检测hMI的参考标准。然而，检测的最早时间点尚不明确、出血体积的时间依赖性变化以及最佳检测方法等问题可能会限制hMI管理策略的发展。
目的
作者使用临床相关动物模型，通过延时多参数成像研究hMI的CMR信号特征，并在可能的情况下评估其在ST段抬高型心肌梗死患者中的可转化性。
方法
20只犬在再灌注心肌梗死的第一周内，于基线及不同时间点接受3.0-T CMR检查。确定hMI、非hMI及远隔区域的T1、T2和T2∗成像的时间依赖性关系。对50例再灌注ST段抬高型心肌梗死患者进行研究，以确定其临床可行性。
结果
尽管再灌注后<1小时，组织病理学上hMI就已明显，但T1、T2或T2∗ CMR均无法可靠检测到。然而，再灌注后24小时至7天，T2∗成像可检测到hMI（基线时为27.0±2.4 ms，hMI为11.7±2.8 ms；P<0.001），且体积和透壁性稳定。在T2成像中，再灌注后5至7天hMI最为明显，相对于T2∗，曲线下面积为0.98（敏感性和特异性≥0.95）。然而，T1成像并非如此（所有时间点的敏感性<0.8）。
结论
再灌注后立即使用3.0-T CMR的T1、T2或T2∗无法可靠检测hMI。然而，T2∗ CMR可用于诊断再灌注后24小时至7天的hMI。如果CMR在再灌注后5至7天进行，3.0-T的T2成像对于诊断hMI是T2∗成像的有力替代方法。然而，与T2∗和T2相比，在3.0-T下用T1诊断hMI的难度要大得多。
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