3.0T磁共振T1 mapping技术在心肌淀粉样变性和肥厚型心肌病鉴别诊断中的应用

发布时间：2019-02-19 17:22

【摘要】：目的:心肌淀粉样变性和肥厚型心肌病在影像学上均可表现为左室心肌肥厚,临床表现相似,鉴别诊断有一定困难。本研究的目的在于探讨T1 mapping技术及心肌细胞外容积分数(myocardial extracellular volume fraction,ECV)用于心肌淀粉样变性和肥厚型心肌病鉴别诊断的价值。方法:回顾性收集我院2015年1月至2016年]2月收治的经心内膜活检证实的系统性淀粉样变性轻链型(AL)心肌受累患者19名,符合肥厚型心肌病诊断标准的患者15名及正常对照组20名,所有入组成员均进行标准3.0T心脏MRI检查,包括应用改良Look Locker反转恢复(MOLLI)序列进行平扫、增强的T1 mapping成像以及钆对比剂延迟强化(LGE)扫描,使用心脏磁共振专业后处理方法分别测量这三组患者的心功能参数,左室心肌全心平扫T1值(Native_T1)和增强T1值(Post_T1),后两者进一步校正获得ECV值,最终进行统计分析。结果:心肌淀粉样变性组平扫T1值较肥厚型心肌病组显著升高(1457±164msvs1330±45ms,P=0.000),ECV值也较肥厚型心肌病组患者显著升高(0.50±0.09vs 0.29±0.07,P=0.000),结果均有统计学意义。T1值=1366ms时,诊断CA的敏感性84.2%,特异性85.7%,准确性85%。ECV值=0.43时,诊断CA的敏感性85.0%,特异性92.3%,准确性88%。结论:T1 mapping技术在CA和HCM鉴别诊断方面有潜在的应用价值。
[Abstract]:Objective: Myocardial amyloidosis and hypertrophic cardiomyopathy can be seen as left ventricular myocardial hypertrophy on imaging, the clinical manifestations are similar, and it is difficult to differentiate the diagnosis of myocardial amyloidosis and hypertrophic cardiomyopathy. The purpose of this study was to investigate the value of T1 mapping technique and extracellular volume fraction (myocardial extracellular volume fraction,ECV) in the differential diagnosis of myocardial amyloidosis and hypertrophic cardiomyopathy. Methods: from January 2015 to February 2016, 19 patients with systemic amyloidosis light chain (AL) who were diagnosed by endocardial biopsy were retrospectively collected. 15 patients with hypertrophic cardiomyopathy and 20 normal controls were examined with standard 3.0T cardiac MRI, including plain scan with modified Look Locker reverse recovery (MOLLI) sequence. Enhanced T1 mapping imaging and delayed enhanced (LGE) scan with gadolinium contrast agent were used to measure cardiac function parameters in these three groups using cardiac magnetic resonance professional post-processing. The left ventricular myocardium was further corrected for T _ 1 value (Native_T1) and enhanced T _ 1 value (Post_T1), and the ECV value was obtained, and the final statistical analysis was carried out. Results: the T 1 value of myocardial amyloidosis group was significantly higher than that of hypertrophic cardiomyopathy group (1457 卤164msvs1330 卤45 Ms P0. 000), ECV and 0. 50 卤0.09vs 0. 29 卤0. 07 0.09vs P 0. 000). When T1 = 1366ms, the sensitivity of CA was 84.2, the specificity was 85.7, the accuracy of 85%.ECV was 0.43, the sensitivity of CA was 85.00.The specificity was 92.3g, and the accuracy was 880.The results were as follows: (1) when T1 = 1366ms, the sensitivity was 84.2, the specificity was 85.7, and the accuracy was 0.43. Conclusion: T1 mapping technique has potential value in differential diagnosis of CA and HCM.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.2;R445.2

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