稳定型胸痛患者中，计算机断层扫描与心血管磁共振成像测量心肌细胞外容积分数的比较
Myocardial extracellular volume fraction by computed tomography vs. cardiovascular magnetic resonance imaging in patients with stable chest pain.
作者信息
Saberwal Bunny, Patel Kush, Klotz Ernst, Herrey Anna, Seraphim Andreas, Vandermolen Sebastian, Thornton George D, Khanji Mohammed Y, Treibel Thomas A, Pugliese Francesca
机构信息
NIHR Barts Biomedical Research Centre, The William Harvey Research Institute, Queen Mary University of London, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.
Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK.
出版信息
Eur Heart J Imaging Methods Pract. 2025 Mar 10;3(1):qyaf019. doi: 10.1093/ehjimp/qyaf019. eCollection 2025 Jan.
AIMS
Computed tomography (CT) is increasingly being recognized as a diagnostic modality across a range of cardiovascular conditions. Myocardial late enhancement imaging has shown value as an imaging biomarker for the identification and prognostication of disease. The objective of this study was to compare extracellular volume fraction by CT (ECVCT) against cardiovascular magnetic resonance (ECVCMR), the latter considered as reference standard for this study.
METHODS AND RESULTS
Consecutive patients with an index history of cardiac chest pain referred for invasive angiography were prospectively recruited. In addition to late gadolinium enhancement (LGE) imaging, patients underwent 1.5 T CMR with T1-mapping [by MOdified Look-Locker Inversion (MOLLI) recovery]. Pre- and post-contrast CT was performed for whole-heart ECVCT quantification. Averaged and segmental ECVCT was compared in patients with and without LGE, as well as between mid-ventricular averaged ECVCT and ECVCMR. Bland-Altman analysis was used to determine limits of agreement and identify differences between ECVCT and ECVCMR. A total of 88 participants (74% male, mean age 59.8 ± 9.1 years) underwent ECVCT and LGE; 49 of these also underwent mid-ventricular ECVCMR. For these, the CMR and CTECV fractions were 27.6 ± 2.4 and 26.8 ± 2.2, respectively. Patients with LGE findings on CMR ( = 24) had a significantly higher ECVCT than those without ( = 64): 27.2 [25.8, 28.7] vs. 26.1 [25.0, 27.7] ( = 0.02). Segments with LGE demonstrated a consistently higher ECV: 30.8 [25.7, 35.9] ( = 0.008) (endocardial LGE) and 30.9 [27.9, 33.1] ( = 0.0001) (transmural LGE) vs. 26.1 [25.0, 27.4].
CONCLUSION
ECVCT obtained from 5 min post-contrast CT protocols shows good agreement with CMR in a stable chest pain cohort. Such a protocol could be seamlessly introduced into a CT workflow for the identification of significant secondary pathologies.
目的
计算机断层扫描（CT）在一系列心血管疾病的诊断中日益受到认可。心肌延迟强化成像已显示出作为疾病识别和预后的成像生物标志物的价值。本研究的目的是将CT测量的细胞外容积分数（ECVCT）与心血管磁共振测量的细胞外容积分数（ECVCMR）进行比较，后者被视为本研究的参考标准。
方法与结果
前瞻性招募有心脏胸痛病史并接受有创血管造影的连续患者。除了钆延迟强化（LGE）成像外，患者还接受了1.5T磁共振成像及T1映射[采用改良Look-Locker反转（MOLLI）恢复法]。进行对比剂注射前和注射后的CT扫描以定量全心脏的ECVCT。比较有和无LGE患者的平均和节段性ECVCT，以及心室中部平均ECVCT和ECVCMR之间的差异。采用Bland-Altman分析确定一致性界限，并识别ECVCT和ECVCMR之间的差异。共有88名参与者（74%为男性，平均年龄59.8±9.1岁）接受了ECVCT和LGE检查；其中49人还接受了心室中部的ECVCMR检查。对于这些患者，磁共振成像和CT测量的ECV分数分别为27.6±2.4和26.8±2.2。磁共振成像有LGE表现的患者（n = 24）的ECVCT显著高于无LGE表现的患者（n = 64）：27.2 [25.8, 28.7] 对比 26.1 [25.0, 27.7]（P = 0.02）。有LGE的节段显示出一致较高的ECV：30.8 [25.7, 35.9]（P = 0.008）（心内膜LGE）和30.9 [27.9, 33.1]（P = 0.0001）（透壁LGE），对比26.1 [25.0, 27.4]。
结论
对比剂注射后5分钟CT扫描方案获得的ECVCT在稳定胸痛队列中与磁共振成像显示出良好的一致性。这样的方案可以无缝引入CT工作流程以识别重要的继发性病变。
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