| 摘要: |
| 目的探讨应用3.0 T心脏磁共振（CMR）体素内不相干运动（IVIM）技术评估肥厚型心肌病（HCM）患者微血管功能障碍的价值。方法纳入2016年4月至2017年10月在兰州大学第一医院行CMR检查的26例HCM患者及12名健康对照，所有纳入对象均接受短轴心脏电影及IVIM扫描，HCM患者还接受钆造影剂延迟增强（LGE）扫描。应用MITK-Diffusion后处理软件测量各心肌节段快速扩散成分所占比例（f）、快速表观扩散系数（ADCfast）、慢速表观扩散系数（ADCslow），于短轴电影图像上测量舒张末期心室壁厚度（EDTH）。依据左心室壁肥厚程度及有无LGE将HCM患者进行分组，分别比较HCM患者与健康对照之间、HCM患者中非肥厚节段与肥厚节段之间和有无LGE心肌节段之间，以及肥厚节段组中不同肥厚程度亚组之间f值、ADCfast、ADCslow的差异。采用Spearman相关分析探究各节段IVIM参数f值、ADCfast、ADCslow与EDTH的相关性。结果 HCM患者ADCslow及ADCfast均低于健康对照[ADCslow分别为0.003（0.002，0.005）、0.004（0.002，0.007）mm2/s，ADCfast分别为0.046（0.025，0.074）、0.069（0.052，0.086）mm2/s]，差异均有统计学意义（Z=－2.434、－7.268，P均<0.05），而f值在HCM患者和健康对照之间差异无统计学意义（P>0.05）。HCM患者非肥厚节段组及肥厚节段组的ADCfast分别为0.051（0.029，0.077）、0.027（0.019，0.052）mm2/s，均低于健康对照，差异均有统计学意义（Z=－5.505、－8.144，P均<0.01）。肥厚节段组f值及ADCfast均低于非肥厚节段组[0.444（0.080，0.834） vs 0.735（0.302，0.877）、0.027（0.019，0.052）mm2/svs 0.051（0.029，0.077）mm2/s]，差异均有统计学意义（Z=－3.527、－4.722，P均<0.01）。轻度、中度、重度、极重度肥厚节段亚组之间仅ADCfast的差异有统计学意义[分别为0.035（0.021，0.061）、0.023（0.015，0.038）、0.018（0.013，0.025）、0.012（0.005，0.055）mm2/s，H=9.769，P=0.021]，但两两比较差异均无统计学意义（P均>0.05）。HCM患者有LGE心肌节段的f值及ADCfast均低于无LGE心肌节段（Z=－2.704、－2.143，P=0.007、0.032）。Spearman相关分析结果示EDTH与f值及ADCfast均呈负相关（r=－0.195、－0.282，P均<0.01）。结论 CMR IVIM技术可无创、定量地反映HCM患者心脏微血管功能障碍。微血管功能障碍的严重程度与心肌肥厚程度有关，非肥厚及无LGE心肌节段亦存在微血管功能障碍。 |
| 关键词: 体素内不相干运动 磁共振成像 肥厚型心肌病 微血管功能障碍 心肌缺血 |
| DOI：10.16781/j.0258-879x.2019.03.0277 |
| 投稿时间：2018-11-01修订日期：2019-02-22 |
| 基金项目:甘肃省青年科技基金（18JR3RA364），兰州大学第一医院院内基金（ldyyyn2015-06）. |
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| 3.0 T cardiac magnetic resonance intravoxel incoherent motion in evaluating microvascular dysfunction of hypertrophic cardiomyopathy patients |
| WEI Ke-xiang1,CHEN Zi-xian1,HE Xiu-chao1,ZHANG Li1,NAN Jiang1,ZHUANG Xin1,XUE Jing-mei1,LEI Jun-qiang1,GUO Shun-lin1*,WANG Shao-yu2 |
(1. Department of Radiology, the First Hospital of Lanzhou University, Lanzhou 730000, Gansu, China;
2. Siemens Healthineers, Shanghai 201318, China
*Corresponding author) |
| Abstract: |
| Objective To explore the value of 3.0 T cardiac magnetic resonance (CMR) intravoxel incoherent motion (IVIM) for evaluating microvascular dysfunction in hypertrophic cardiomyopathy (HCM) patients. Methods Twenty-six HCM patients and 12 healthy controls, who received CMR examination in the First Hospital of Lanzhou University from Apr. 2016 to Oct. 2017, were enrolled. All volunteers underwent short-axis cardiac cine and IVIM scans, and HCM patients underwent late gadolinium enhancement (LGE) scan. The fraction of fast apparent diffusion coefficient (f), fast apparent diffusion coefficient (ADCfast) and slow apparent diffusion coefficient (ADCslow) were measured using MITK-Diffusion post-processing software. End-diastolic thickness (EDTH) was measured on short-axis cine image. HCM patients were grouped according to the severity of the left ventricular hypertrophy and whether having LGE or not. The differences of f value, ADCfast and ADCslow were compared between HCM patients and healthy controls, non-hypertrophic segments and hypertrophic segments of HCM patients, LGE segments and non-LGE segments of HCM patients, and different hypertrophic subgroups in hypertrophic segment group. Spearman correlation analysis was performed to explore the correlation between IVIM parameters (f value, ADCfast and ADCslow) and EDTH in each segment. Results The ADCslow and ADCfast of the HCM patients were lower than those of the healthy controls (ADCslow:0.003[0.002, 0.005] mm2/s vs 0.004[0.002, 0.007] mm2/s, ADCfast:0.046[0.025, 0.074] mm2/s vs 0.069[0.052, 0.086] mm2/s), and the differences were significant (Z=-2.434 and -7.268, both P<0.05). There was no significant difference in the f value between the HCM patients and healthy controls (P>0.05). The ADCfast values of the non-hypertrophic segment group and the hypertrophic segment group in the HCM patients were 0.051 (0.029, 0.077) mm2/s and 0.027 (0.019, 0.052) mm2/s, respectively, which were both significantly lower than that of the healthy controls (Z=-5.505 and -8.144, both P<0.01). The f value and ADCfast of the hypertrophic segment were significantly lower than those of the non-hypertrophic segment (0.444[0.080, 0.834] vs 0.735[0.302, 0.877] and 0.027[0.019, 0.052] mm2/s vs 0.051[0.029, 0.077] mm2/s, Z=-3.527 and -4.722, both P<0.01). There was significant difference in ADCfast between the mild, moderate, severe and extremely severe hypertrophic segment subgroups (0.035[0.021, 0.061] mm2/s, 0.023[0.015, 0.038] mm2/s, 0.018[0.013, 0.025] mm2/s and 0.012[0.005, 0.055] mm2/s, respectively; H=9.769, P=0.021); however, pairwise comparison showed no significant differences (all P>0.05). The f value and ADCfast of the segmental myocardia with LGE were significantly lower than those without LGE (Z=-2.704 and -2.143, P=0.007 and 0.032). Spearman correlation analysis showed that EDTH was significantly negatively correlated with f value and ADCfast (r=-0.195 and -0.282, both P<0.01). Conclusion CMR IVIM technology can non-invasively and quantitatively reflect cardiac microvascular dysfunction in HCM patients. The severity of microvascular dysfunction is related to the severity of myocardial hypertrophy. Microvascular dysfunction is also present in non-hypertrophic and non-LGE myocardia. |
| Key words: intravoxel incoherent motion magnetic resonance imaging hypertrophic cardiomyopathy microvascular dysfunction myocardial ischemia |
