Martuszewski Adrian, Paluszkiewicz Patrycja, Poręba Rafał, Gać Paweł
Department of Environmental Health, Occupational Medicine and Epidemiology, Wroclaw Medical University, Mikulicza-Radeckiego 7, 50-345 Wrocław, Poland.
Department of Neurology, Specialist Hospital in Walbrzych, 58-309 Wałbrzych, Poland.
J Clin Med. 2025 Mar 18;14(6):2066. doi: 10.3390/jcm14062066.
: Extracellular volume (ECV) of the myocardium, a biomarker of interstitial space and fibrosis, plays a critical role in cardiac disease diagnosis and prognosis. Although cardiac magnetic resonance imaging (MRI) is the gold standard for ECV assessment, computed tomography (CT) offers a viable alternative, particularly in patients with contraindications to MRI. This study aimed to assess whether CT-derived ECV is systematically elevated in cardiac diseases associated with myocardial fibrosis. : A systematic search of PubMed and Web of Science up to January 2023 identified 364 studies, including 16 from registers and 4 from manual searches. After exclusions, 73 studies were included in the systematic review. Of these, 15 provided quantitative data on group sizes, mean ECV values, standard deviations, and imaging modalities (CTA, DECT, LIE-DECT) and were analyzed in the meta-analysis. Standardized mean differences (SMD) were calculated using formulas. Statistical analyses employed random-effects models (R version 4.4.2). : The pooled analysis showed that ECV was significantly higher in pathological groups compared to controls (SMD 1.60; 95% CI: 1.23-1.96; I = 84.6%). Elevated ECV correlated with worse clinical outcomes, including higher mortality in heart failure and advanced myocardial fibrosis in amyloidosis and cardiomyopathies. Subgroup analyses demonstrated that advanced CT techniques (DECT, LIE-DECT) and CTA provided comparable diagnostic accuracy. : CT-derived ECV is a reliable, non-invasive marker of myocardial fibrosis, offering diagnostic and prognostic value similar to MRI. Standardizing CT protocols and conducting multicenter studies are essential to validate its broader clinical application.
心肌细胞外容积（ECV）是间质空间和纤维化的生物标志物，在心脏病的诊断和预后中起着关键作用。尽管心脏磁共振成像（MRI）是评估ECV的金标准，但计算机断层扫描（CT）提供了一种可行的替代方法，特别是对于有MRI禁忌证的患者。本研究旨在评估在与心肌纤维化相关的心脏病中，CT衍生的ECV是否系统性升高。：截至2023年1月，对PubMed和Web of Science进行系统检索，共识别出364项研究，包括来自注册库的16项和手工检索的4项。排除后，73项研究纳入系统评价。其中15项提供了关于样本量、平均ECV值、标准差和成像方式（CTA、DECT、LIE-DECT）的定量数据，并在荟萃分析中进行了分析。使用公式计算标准化平均差（SMD）。统计分析采用随机效应模型（R版本4.4.2）。：汇总分析显示，与对照组相比，病理组的ECV显著更高（SMD 1.60；95%CI：1.23-1.96；I² = 84.6%）。升高的ECV与更差的临床结局相关，包括心力衰竭中更高的死亡率以及淀粉样变性和心肌病中的晚期心肌纤维化。亚组分析表明，先进的CT技术（DECT、LIE-DECT）和CTA提供了可比的诊断准确性。：CT衍生的ECV是心肌纤维化的可靠、非侵入性标志物，提供与MRI相似的诊断和预后价值。标准化CT方案并开展多中心研究对于验证其更广泛的临床应用至关重要。
