Role of endogenous T1ρ and its dispersion imaging in differential diagnosis of cardiac amyloidosis.

IF 4.2 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Magnetic Resonance Pub Date : 2024-08-08 DOI:10.1016/j.jocmr.2024.101080

Keyan Wang, Yong Zhang, Wenbo Zhang, Hongrui Jin, Jing An, Jingliang Cheng, Jie Zheng

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引用次数: 0

Abstract

Background: Cardiovascular magnetic resonance (CMR) has demonstrated excellent performance in the diagnosis of cardiac amyloidosis (CA). However, misdiagnosis occasionally occurs because the morphological and functional features of CA are non-specific. This study was performed to determine the value of non-contrast CMR T1ρ in the diagnosis of CA.

Methods: This prospective study included 45 patients with CA, 30 patients with hypertrophic cardiomyopathy (HCM), and 10 healthy controls (HCs). All participants underwent cine (whole heart), T1ρ mapping, pre- and post-contrast T1 mapping imaging (three slices), and late gadolinium enhancement using a 3T whole-body magnetic resonance imaging system. All participants underwent T1ρ at two spin-locking frequencies: 0 and 298 Hz. Extracellular volume (ECV) maps were obtained using pre- and post-contrast T1 maps. The myocardial T1ρ dispersion map, termed myocardial dispersion index (MDI), was also calculated. All parameters were measured in the left ventricular myocardial wall. Participants in the HC group were scanned twice on different days to assess the reproducibility of T1ρ measurements.

Results: Excellent reproducibility was observed upon evaluation of the coefficient of variation between two scans (T1ρ [298 Hz]: 3.1%; T1ρ [0 Hz], 2.5%). The ECV (HC: 27.4 ± 2.8% vs HCM: 32.6 ± 5.8% vs CA: 46 ± 8.9%; p < 0.0001), T1ρ [0 Hz] (HC: 35.8 ± 1.7 ms vs HCM: 40.0 ± 4.5 ms vs CA: 51.4 ± 4.4 ms; p < 0.0001) and T1ρ [298 Hz] (HC: 41.9 ± 1.6 ms vs HCM: 48.8 ± 6.2 ms vs CA: 54.4 ± 5.2 ms; p < 0.0001) progressively increased from the HC group to the HCM group, and then the CA group. The MDI progressively decreased from the HCM group to the HC group, and then the CA group (HCM: 8.8 ± 2.8 ms vs HC: 6.1 ± 0.9 ms vs CA: 3.4 ± 2.1 ms; p < 0.0001). For differential diagnosis, the combination of MDI and T1ρ [298 Hz] showed the greatest sensitivity (98.3%) and specificity (95.5%) between CA and HCM, compared with the native T1 and ECV.

Conclusion: The T1ρ and MDI approaches can be used as non-contrast CMR imaging biomarkers to improve the differential diagnosis of patients with CA.

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内源性 T1ρ 及其弥散成像在心脏淀粉样变性鉴别诊断中的作用。

背景：心血管磁共振（CMR）在诊断心脏淀粉样变性（CA）方面表现出色。然而，由于心脏淀粉样变性的形态和功能特征不具有特异性，因此偶尔会出现误诊。本研究旨在确定非对比CMR T1ρ在诊断CA中的价值：这项前瞻性研究包括 45 名 CA 患者、30 名肥厚型心肌病 (HCM) 患者和 10 名健康对照组 (HC)。所有参与者均使用 3T 全身核磁共振成像系统接受了 cine（全心）、T1ρ 映射、对比前和对比后 T1 映射成像（三张切片）以及后期钆增强检查。所有参与者都在两种自旋锁定频率下进行了 T1ρ成像：0Hz 和 298Hz。利用对比前和对比后的 T1 图获得了 ECV 图。同时还计算了心肌 T1ρ 弥散图，即心肌弥散指数（MDI）。所有参数都是在左心室心肌壁上测量的。为了评估 T1ρ 测量的可重复性，HC 组的参与者在不同的日子里接受了两次扫描：结果：通过评估两次扫描之间的变异系数（T1ρ [298Hz]：3.1%；T1ρ [0Hz]：2.5%），可观察到极佳的重现性。ECV（HC：27.4 ± 2.8% vs. HCM：32.6 ± 5.8% vs. CA：46 ± 8.9%；p < 0.0001）、T1ρ [0Hz]（HC：35.8 ± 1.7 ms vs. HCM：40.0 ± 4.5 ms vs. CA：51.4 ± 4.4 ms；p < 0.0001）和 T1ρ [298Hz] （HC：41.9 ± 1.6 ms vs. HCM：48.8 ± 6.2 ms vs. CA：54.4 ± 5.2 ms；p < 0.0001）从 HC 组逐渐增加到 HCM 组，然后是 CA 组。从 HCM 组到 HC 组，再到 CA 组，MDI 逐渐降低（HCM：8.8 ± 2.8 ms vs. HC：6.1 ± 0.9 ms vs. CA：3.4 ± 2.1 ms；p < 0.0001）。在鉴别诊断方面，与本地 T1 和 ECV 相比，MDI 和 T1ρ [298Hz] 的组合在 CA 和 HCM 之间显示出最高的灵敏度（98.3%）和特异性（95.5%）：T1ρ和MDI方法可用作非对比CMR成像生物标志物，以改善CA患者的鉴别诊断。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiovascular Magnetic Resonance 医学-核医学

CiteScore

10.90

自引率

12.50%

发文量

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.