MOCO-PSIR在扩张型心肌病心肌纤维化瘢痕评价中的应用价值
|
摘要
目的研究运动校正相位敏感反转恢复序列(MOCO-PSIR)在扩张型心肌病(DCM)致心力衰竭患者心肌纤维化瘢痕评价中的应用价值。方法前瞻性纳入2017年6月至2018年11月进行心脏磁共振(CMR)增强扫描的患者60例,其中临床诊断为DCM的患者38例,正常对照组22例;所有患者均同时采用segmented-PSIR(seg-PSIR)、single-shot-PSIR、MOCO-PSIR 3种延迟强化(LGE)评价序列,对比分析3组图像质量的主观评分(4级)和正常及异常心肌的图像信噪比(SNR,客观评价);并记录3种扫描技术的延迟强化检出节段数(即是否存在心肌瘢痕组织)和图像采集时间。结果图像质量主观评分:在DCM患者中,评分由高到低为MOCO-PSIR>single-shot-PSIR>seg-PSIR(P<0.05);在正常对照者中,3种不同序列间评分差异无统计学意义。客观评价:在DCM患者和正常对照者中,SNR由高到低均为seg-PSIR>MOCO-PSIR>single-shot-PSIR(P<0.05)。在DCM患者的646个节段评价中,seg-PSIR无法评价的节段占比最高(25.5%),MOCO-PSIR占比最低(1.4%),3组序列间比较差异有统计学意义(P<0.001);在正常对照者374个节段评价中,3组序列无法评价的节段占比比较差异无统计学意义。3组序列采集左室全程时间分别为:seg-PSIR(5.6±1.7) min;single-shot-PSIR(0.4±0.2) min;MOCO-PSIR(4.5±1.1) min,三者间比较差异有统计学意义(P<0.001)。结论 MOCO-PSIR-LGE在DCM致心力衰竭患者心肌纤维化瘢痕评价方面具有较大的临床意义,其图像质量和延迟强化检出率高于常规的延迟强化扫描序列。
Objective To study the application value of motion-correction phase sensitive inversion recovery(MOCO-PSIR) to evaluate myocardial fibrosis in the patients with heart failure caused by dilated cardiomyopathy(DCM). Methods A prospective study included 60 patients who underwent cardiac MRI enhanced scan from June 2017 to November 2018, including 38 patients who were clinically diagnosed with DCM and 22 patients in the normal control group. All patients were scanned with three late gadolinium enhancement(LGE) sequences: segmented-PSIR, single-shot-PSIR, MOCO-PSIR at the same time. The subjective quality score(level 4) and image signal-to-noise ratio(objective evaluation) of normal and abnormal myocardium were analyzed and compared in three scanning technique groups. The detection rate of myocardial fibrosis and image acquisition time of the three scanning techniques were recorded. Results In the normal control group(sinus rhythm), subjective score showed no statistical significance. Subjective scoring results in the patients with DCM: MOCO-PSIR>single-shot-PSIR> segmented-PSIR(P<0.05). SNR results PSIR-LGE images in DCM patients as well as control group: segmented-PSIR>MOCO-PSIR> single-shot-PSIR(P<0.05). In the whole 646 segments analysis of DCM patients, the ratio unable to judge in segmented-PSIR was up to 25.5%,but only 1.4% in MOCO-PSIR. Significant difference was found in the three groups. While in the 374 segments of control group, no statistical difference was found in comparison of incapability to judge. Acquisition time covered left ventricular:(5.6±1.7) min in segmented-PSIR, (0.4±0.2) min in single-shot-PSIR and(4.5±1.1) min in MOCO-PSIR. Pairwise comparison of acquisition time among three scanning techniques was statistically significant(P<0.001). Conclusion MOCO-PSIR-LGE has better clinical significance than conventional delayed enhanced scan sequences in the diagnosis of myocardial fibrosis in the patients with heart failure caused by dilated cardiomyopathy.
Objective To study the application value of motion-correction phase sensitive inversion recovery(MOCO-PSIR) to evaluate myocardial fibrosis in the patients with heart failure caused by dilated cardiomyopathy(DCM). Methods A prospective study included 60 patients who underwent cardiac MRI enhanced scan from June 2017 to November 2018, including 38 patients who were clinically diagnosed with DCM and 22 patients in the normal control group. All patients were scanned with three late gadolinium enhancement(LGE) sequences: segmented-PSIR, single-shot-PSIR, MOCO-PSIR at the same time. The subjective quality score(level 4) and image signal-to-noise ratio(objective evaluation) of normal and abnormal myocardium were analyzed and compared in three scanning technique groups. The detection rate of myocardial fibrosis and image acquisition time of the three scanning techniques were recorded. Results In the normal control group(sinus rhythm), subjective score showed no statistical significance. Subjective scoring results in the patients with DCM: MOCO-PSIR>single-shot-PSIR> segmented-PSIR(P<0.05). SNR results PSIR-LGE images in DCM patients as well as control group: segmented-PSIR>MOCO-PSIR> single-shot-PSIR(P<0.05). In the whole 646 segments analysis of DCM patients, the ratio unable to judge in segmented-PSIR was up to 25.5%,but only 1.4% in MOCO-PSIR. Significant difference was found in the three groups. While in the 374 segments of control group, no statistical difference was found in comparison of incapability to judge. Acquisition time covered left ventricular:(5.6±1.7) min in segmented-PSIR, (0.4±0.2) min in single-shot-PSIR and(4.5±1.1) min in MOCO-PSIR. Pairwise comparison of acquisition time among three scanning techniques was statistically significant(P<0.001). Conclusion MOCO-PSIR-LGE has better clinical significance than conventional delayed enhanced scan sequences in the diagnosis of myocardial fibrosis in the patients with heart failure caused by dilated cardiomyopathy.
引文
[1] SALERNO M,KRAMER CM.Prognosis in hypertrophic cardiomyopathy with contrast-enhanced cardiac magnetic resonance:the future looks bright.J Am Coll Cardiol,2010,56(11):888-889.
[2] HUBER A,HAYES C,SPANNAGL B,et al.Phase-sensitive inversion recovery single-shot balanced steady-state free precession for detection of myocardial infarction during a single breath hold.Acad Radiol,2007,14(12):1500-1508.
[3] HUNOLD P,SCHLOSSER T,VOGT FM,et al.Myocardial late enhancement in contrast-enhanced cardiac MRI:distinction between infarction scar and non-infarction-related disease.AJR Am J Roentgenol,2005,184(5):1420-1426.
[4] KELLMAN P,ARAI AE,MCVEIGH ER,et al.Phase-sensitive inversion recovery for detecting myocardial infarction using gadolinium-delayed hyperenhancement.Magn Reson Med,2002,47(2):372-383.
[5] PIEHLER KM,WONG TC,PUNTIL KS,et al.Free-breathing,motion-corrected late gadolinium enhancement is robust and extends risk stratification to vulnerable patients.Circ Cardiovasc Imaging,2013,6(3):423-432.
[6] KLEM I,SHAH DJ,WHITE RD,et al.Prognostic value of routine cardiac magnetic resonance assessment of left ventricular ejection fraction and myocardial damage:aninternational,multicenter study.Circ Cardiovasc Imaging,2011,4(6):610-619.
[7] MUEHLBERG F,ARNHOLD K,FRITSCHI S,et al.Comparison of fast multi-slice and standard segmented techniques for detection of late gadolinium enhancement in ischemic and non-ischemic cardiomyopathy-a prospective clinical cardiovascular magnetic resonance trial.J Cardiovasc Magn Reson,2018,20(1):13.
[8] OLIVIERI L,CROSS R,O’BRIEN KJ,et al.Free-breathing motion-corrected late gadolinium enhancement imaging improves image quality in children.Pediatr Radiol,2016,46(7):983-990.
[9] KELLMAN P,LARSON AC,HSU LY,et al.Motion-corrected free-breathing delayed enhancement imaging of myocardial infarction.Magn Reson Med,2005,53(1):194-200.
[10] XUE H,GREISER A,ZUEHLSDORFF S,et al.Phase-sensitive inversion recovery for myocardial T1 mapping with motion correction and parametric fitting.Magn Reson Med,2013,69(5):1408-1420.
[11] GABRIELLA C,ILARIA L,YANG Y,et al.Motion-corrected free-breathing LGE delivers high quality imaging and reduces scan time by half:an independent validation study.Int J Cardiovasc Imaging,2019 [2019-05-23].https://link.springer.com/article/10.1007%2Fs10554-019-01620-x.doi:10.1007/s10554-019-01620-x.
[12] 程巍,陈玉成,孙家瑜,等.3.0T磁共振single shot PSIR与segmented PSIR序列在心肌梗死评价中的对比研究.四川大学学报(医学版),2015,46(3):463-466.
[13] 樊红霞,尹刚,杨新令,等.运动相位纠正技术与节段法相位技术在磁共振心肌延迟增强中的对比研究.中国循环杂志,2017,32(9):908-912.
[14] CRUZ G,JAUBERT O,SCHNEIDER T,et al.Rigid motion-corrected magnetic resonance fingerprinting.Magn Reson Med,2019,81(2):947-961.
[15] XU Z,YE H,LYU M,et al.Rigid motion correction for magnetic resonance fingerprinting with sliding-window reconstruction and image registration.Magn Reson Imaging,2019,57:303-312[2019-05-23].https://doi.org/10.1016/j.mri.2018.11.001.
[2] HUBER A,HAYES C,SPANNAGL B,et al.Phase-sensitive inversion recovery single-shot balanced steady-state free precession for detection of myocardial infarction during a single breath hold.Acad Radiol,2007,14(12):1500-1508.
[3] HUNOLD P,SCHLOSSER T,VOGT FM,et al.Myocardial late enhancement in contrast-enhanced cardiac MRI:distinction between infarction scar and non-infarction-related disease.AJR Am J Roentgenol,2005,184(5):1420-1426.
[4] KELLMAN P,ARAI AE,MCVEIGH ER,et al.Phase-sensitive inversion recovery for detecting myocardial infarction using gadolinium-delayed hyperenhancement.Magn Reson Med,2002,47(2):372-383.
[5] PIEHLER KM,WONG TC,PUNTIL KS,et al.Free-breathing,motion-corrected late gadolinium enhancement is robust and extends risk stratification to vulnerable patients.Circ Cardiovasc Imaging,2013,6(3):423-432.
[6] KLEM I,SHAH DJ,WHITE RD,et al.Prognostic value of routine cardiac magnetic resonance assessment of left ventricular ejection fraction and myocardial damage:aninternational,multicenter study.Circ Cardiovasc Imaging,2011,4(6):610-619.
[7] MUEHLBERG F,ARNHOLD K,FRITSCHI S,et al.Comparison of fast multi-slice and standard segmented techniques for detection of late gadolinium enhancement in ischemic and non-ischemic cardiomyopathy-a prospective clinical cardiovascular magnetic resonance trial.J Cardiovasc Magn Reson,2018,20(1):13.
[8] OLIVIERI L,CROSS R,O’BRIEN KJ,et al.Free-breathing motion-corrected late gadolinium enhancement imaging improves image quality in children.Pediatr Radiol,2016,46(7):983-990.
[9] KELLMAN P,LARSON AC,HSU LY,et al.Motion-corrected free-breathing delayed enhancement imaging of myocardial infarction.Magn Reson Med,2005,53(1):194-200.
[10] XUE H,GREISER A,ZUEHLSDORFF S,et al.Phase-sensitive inversion recovery for myocardial T1 mapping with motion correction and parametric fitting.Magn Reson Med,2013,69(5):1408-1420.
[11] GABRIELLA C,ILARIA L,YANG Y,et al.Motion-corrected free-breathing LGE delivers high quality imaging and reduces scan time by half:an independent validation study.Int J Cardiovasc Imaging,2019 [2019-05-23].https://link.springer.com/article/10.1007%2Fs10554-019-01620-x.doi:10.1007/s10554-019-01620-x.
[12] 程巍,陈玉成,孙家瑜,等.3.0T磁共振single shot PSIR与segmented PSIR序列在心肌梗死评价中的对比研究.四川大学学报(医学版),2015,46(3):463-466.
[13] 樊红霞,尹刚,杨新令,等.运动相位纠正技术与节段法相位技术在磁共振心肌延迟增强中的对比研究.中国循环杂志,2017,32(9):908-912.
[14] CRUZ G,JAUBERT O,SCHNEIDER T,et al.Rigid motion-corrected magnetic resonance fingerprinting.Magn Reson Med,2019,81(2):947-961.
[15] XU Z,YE H,LYU M,et al.Rigid motion correction for magnetic resonance fingerprinting with sliding-window reconstruction and image registration.Magn Reson Imaging,2019,57:303-312[2019-05-23].https://doi.org/10.1016/j.mri.2018.11.001.