随着左心室覆盖范围的增加,CMR 定量灌注图的诊断可信度也随之增加。

IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiovascular Magnetic Resonance Pub Date : 2024-06-01 Epub Date: 2024-02-03 DOI:10.1016/j.jocmr.2024.101007
Henrik Engblom, Ellen Ostenfeld, Marcus Carlsson, Julius Åkesson, Anthony H Aletras, Hui Xue, Peter Kellman, Håkan Arheden
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引用次数: 0

摘要

背景:定量 CMR 首过灌注图传统上是在每个心跳中通过 3 个短轴切面(基底、中部和心尖)获取的(3SAX/1RR)。因此,包括心尖在内的大部分左心室心肌未被覆盖。本研究的目的是:1)研究每隔一个RR间期采样3个短轴切面(2RR)获得的灌注图是否能产生与1RR相当的心肌灌注(MP)定量测量结果;2)评估每隔一个RR间期(2RR)额外采集3个灌注切面(即总共6个)是否能增加诊断可信度:方法:287 名疑似缺血性心脏病患者根据临床指征在 1.5T 磁共振扫描仪上进行了应激和静息 MP 检查。对 83 名患者进行了检查,采集了 3 幅 1RR 取样的短轴灌注图(3SAX/1RR),并重建了 2RR 灌注图。此外,103 名患者使用 2RR 取样(3SAX+3LAX/2RR)获得了 3 幅短轴和 3 幅长轴(2、3 和 4 腔视图)灌注图,101 名患者使用 2RR 取样(6SAX/2RR)获得了 6 幅短轴灌注图。根据李克特量表(确定缺血[2 分]、可能缺血[1 分]、不确定[0 分]、可能无缺血[1 分]、确定无缺血[2 分])对排除应激诱导缺血的诊断可信度进行评分:3SAX/1RR和3SAX/2RR之间在总体心肌灌注(ml/min/g)方面有很强的相关性(R=0.99)。当灌注切面数从 3 个增加到 6 个时,诊断可信度得分明显增加(1.24±0.68 vs 1.54±0.64,p < 0.001),3SAX+3LAX/2RR 的诊断可信度得分也有类似增加(1.29±0.68 vs 1.55±0.65,p 结论:采用 2RR 数据采样的定量灌注绘图可获得与 1RR 采样相当的灌注值,从而可在同一灌注扫描中获得更多视图。如果在传统的 3 个短轴切面的基础上增加 3 个长轴或短轴切面,应激诱导缺血的诊断可信度就会增加。因此,CMR 定量灌注的未来发展和临床应用应在目前使用 3 个短轴切面的标准基础上,增加左心室的覆盖范围。
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Diagnostic confidence with quantitative cardiovascular magnetic resonance perfusion mapping increases with increased coverage of the left ventricle.

Background: Quantitative cardiovascular magnetic resonance (CMR) first pass perfusion maps are conventionally acquired with 3 short-axis (SAX) views (basal, mid, and apical) in every heartbeat (3SAX/1RR). Thus, a significant part of the left ventricle (LV) myocardium, including the apex, is not covered. The aims of this study were 1) to investigate if perfusion maps acquired with 3 short-axis views sampled every other RR-interval (2RR) yield comparable quantitative measures of myocardial perfusion (MP) as 1RR and 2) to assess if acquiring 3 additional perfusion views (i.e., total of 6) every other RR-interval (2RR) increases diagnostic confidence.

Methods: In 287 patients with suspected ischemic heart disease stress and rest MP were performed on clinical indication on a 1.5T MR scanner. Eighty-three patients were examined by acquiring 3 short-axis perfusion maps with 1RR sampling (3SAX/1RR); for which also 2RR maps were reconstructed. Additionally, in 103 patients 3 short-axis and 3 long-axis (LAX; 2-, 3, and 4-chamber view) perfusion maps were acquired using 2RR sampling (3SAX + 3LAX/2RR) and in 101 patients 6 short-axis perfusion maps using 2RR sampling (6SAX/2RR) were acquired. The diagnostic confidence for ruling in or out stress-induced ischemia was scored according to a Likert scale (certain ischemia [2 points], probably ischemia [1 point], uncertain [0 points], probably no ischemia [1 point], certain no ischemia [2 points]).

Results: There was a strong correlation (R = 0.99) between 3SAX/1RR and 3SAX/2RR for global MP (mL/min/g). The diagnostic confidence score increased significantly when the number of perfusion views was increased from 3 to 6 (1.24 ± 0.68 vs 1.54 ± 0.64, p < 0.001 with similar increase for 3SAX+3LAX/2RR (1.29 ± 0.68 vs 1.55 ± 0.65, p < 0.001) and for 6SAX/2RR (1.19 ± 0.69 vs 1.53 ± 0.63, p < 0.001).

Conclusion: Quantitative perfusion mapping with 2RR sampling of data yields comparable perfusion values as 1RR sampling, allowing for the acquisition of additional views within the same perfusion scan. The diagnostic confidence for stress-induced ischemia increases when adding 3 additional views, short- or long axes, to the conventional 3 short-axis views. Thus, future development and clinical implementation of quantitative CMR perfusion should aim at increasing the LV coverage from the current standard using 3 short-axis views.

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来源期刊
CiteScore
10.90
自引率
12.50%
发文量
61
审稿时长
6-12 weeks
期刊介绍: Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.
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