MRI-Extracellular Volume Fraction Versus Histological Amyloid Load in Cardiac Amyloidosis: The Importance of T2 Mapping.

IF 6.5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Cardiovascular Imaging Pub Date : 2025-05-01 Epub Date: 2025-03-21 DOI:10.1161/CIRCIMAGING.124.017427

Masafumi Kidoh, Seitaro Oda, Seiji Takashio, Mami Morioka, Naoto Kuyama, Tetsuya Oguni, Takeshi Nakaura, Yasunori Nagayama, Yasuhiro Izumiya, Kenichi Tsujita, Toshinori Hirai

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引用次数: 0

Abstract

Background: Magnetic resonance imaging (MRI)-derived myocardial extracellular volume fraction (ECV) is elevated in the presence of fibrosis, amyloid deposition, inflammation, and edema. In patients with cardiac amyloidosis and prolonged T2 due to concomitant inflammation or edema, MRI-ECV may not correctly reflect histological amyloid load. The authors sought to determine whether MRI-ECV can accurately reflect histological amyloid load in 2 groups of patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM), with and without T2 prolongation.

Methods: This retrospective study included consecutive patients with ATTRwt-CM who underwent endomyocardial biopsy and cardiac MRI from March 2017 to October 2021 for initial evaluation of ATTRwt-CM. We measured MRI-ECV and T2, and evaluated correlation between MRI-ECV and amyloid load from endomyocardial biopsy by means of Pearson correlation analysis.

Results: Of 44 patients (mean age, 75±6 years [SD]; 40 men), 24 showed T2 prolongation (T2≥50 milliseconds). All specimens obtained by endomyocardial biopsy were suitable for analysis. The interval between endomyocardial biopsy and cardiac MRI examination was a median of 3 days (interquartile range, 2-4). In the absence of T2 prolongation due to increased water content, MRI-ECV and amyloid load showed a moderately significant correlation (Spearman ρ=0.50, P=0.03). However, in the presence of T2 prolongation, there was no significant correlation between MRI-ECV and amyloid load (Spearman ρ=-0.05, P=0.83).

Conclusions: In patients with ATTRwt-CM and prolonged T2, MRI-ECV did not accurately reflect histological amyloid load. Our findings underscore the need for a multiparametric imaging approach, combining both ECV and T2 mapping, to better characterize myocardial tissue in patients with ATTRwt-CM, and further prospective research in larger and more diverse cohorts is needed to validate our results.

查看原文本刊更多论文

心肌淀粉样变性的mri细胞外体积分数与组织学淀粉样蛋白负荷：T2定位的重要性。

背景：mri衍生的心肌细胞外体积分数（ECV）在存在纤维化、淀粉样蛋白沉积、炎症和水肿时升高。对于心脏淀粉样变性患者，由于伴随炎症或水肿而延长T2， MRI-ECV可能不能正确反映组织学淀粉样蛋白负荷。作者试图确定两组野生型转甲状腺素淀粉样心肌病（ATTRwt-CM）患者的MRI-ECV是否能准确反映组织学淀粉样蛋白负荷，无论T2延长与否。方法：本回顾性研究纳入了2017年3月至2021年10月连续接受心内膜心肌活检和心脏MRI的attrt - cm患者，以初步评估attrt - cm。我们测量了MRI-ECV和T2，并通过Pearson相关分析评估了MRI-ECV与心内膜活检中淀粉样蛋白负荷之间的相关性。结果：44例患者（平均年龄75±6岁）；40例男性)，24例T2延长（T2≥50毫秒）。心内膜活检所得标本均适合分析。心内膜活检和心脏MRI检查之间的间隔中位数为3天（四分位数间距为2-4）。在没有由于含水量增加而导致T2延长的情况下，MRI-ECV和淀粉样蛋白负荷显示中度显著相关（Spearman ρ=0.50， P=0.03）。然而，在T2延长的情况下，MRI-ECV与淀粉样蛋白负荷无显著相关性（Spearman ρ=-0.05， P=0.83）。结论：在attrt - cm和T2延长的患者中，MRI-ECV不能准确反映组织学淀粉样蛋白负荷。我们的研究结果强调需要多参数成像方法，结合ECV和T2制图，以更好地表征attrt - cm患者的心肌组织，并且需要在更大、更多样化的队列中进行进一步的前瞻性研究来验证我们的结果。

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

Circulation: Cardiovascular Imaging 医学-核医学

CiteScore

6.30

自引率

2.70%

发文量

225

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Imaging, an American Heart Association journal, publishes high-quality, patient-centric articles focusing on observational studies, clinical trials, and advances in applied (translational) research. The journal features innovative, multimodality approaches to the diagnosis and risk stratification of cardiovascular disease. Modalities covered include echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging and spectroscopy, magnetic resonance angiography, cardiac positron emission tomography, noninvasive assessment of vascular and endothelial function, radionuclide imaging, molecular imaging, and others. Article types considered by Circulation: Cardiovascular Imaging include Original Research, Research Letters, Advances in Cardiovascular Imaging, Clinical Implications of Molecular Imaging Research, How to Use Imaging, Translating Novel Imaging Technologies into Clinical Applications, and Cardiovascular Images.