心脏MR定量成像对系统性红斑狼疮亚临床心肌损害的应用价值

Clinical value of quantitative cardiac magnetic resonance imaging in subclinical myocardial injury of inactive SLE

目的评估T_1-maping及T_2-mapping技术对识别亚临床状态的心肌炎性反应的应用价值,比较非活动期SLE(systemic lupus erythematosus)患者与正常对照组T_1、T_2量化值,分析SLE患者抗核抗体(ANA)与抗DNA抗体(AntiDNA)阳性组T_2值变化。方法筛选24例临床非活动期SLE患者,平均年龄(54±9)岁,其中17例ANA阳性,5例AntiDNA阳性;15例健康对照者,平均年龄(51±5)岁。行常规MRI的CMR稳态自由进动序列,T_2-mapping及Molli序列的T_1-mapping扫描。采用间接免疫荧光法(IIF)和放射免疫法(Farr)检测患者血清中的抗核抗体(ANA)和抗DNA抗体(Anti-DNA)。所得的数据用统计学t检验,分类变量的卡方检验,还进行单因素和多因素线性回归分析及Bland-Altman检验。结果 SLE组的T_2时间高于正常对照组(58.2±5.6)msec,(52.6±4.2)msec,P<0.01)。抗核抗体(ANA)阳性组与阴性组T_2时间(57.81±5.45)msec,(57.08±6.78)msec)无统计学意义(P=0.782)。Anti-DNA抗体阳性组与阴性组T_2时间(58.52±6.9)msec,(58.12±5.8)msec无统计学差异(P=0.966);pre T_1-mapping中SLE组T_1时间长于对照组(980.7±62.2)msec,(957.5±37.9)msec,但无统计学意义(P=0.3)。左心室的大小与功能,SLE与正常对照组无明显统计学意义。结论心脏磁共振T_2-mapping对显示非活动期系统性红斑狼疮早期心肌损害有意义。这种新的可以定量分析,而且高度可重复性的无创性技术也可以应用于早期的心肌炎性改变的检测。ANA、Anti-DNA阳性组与阴性组T_2值变化无统计学意义,亚临床状态SLE心肌炎性改变与血清抗体谱没有明显相关性。

Objective To analyze if the T1-maping and T2-mapping can identify SLE subclinical myocardial edema. We contrastd the SLE and controls T2 value and analyze the relationship between T2 value and ANA/Anti-DNA）. Methods Twenty four consecutive patients（ mean age,54 ± 9） with the diagnosis of SLE and fifteen healthy controls（ mean age,51 ± 5） were enrolled. All CMR imaging for this study was performed on a 1. 5-T MRI（ Siemens Healthcare,Erlangen,Germany） system. Quantitative T2 mappings were acquired using a T2-prepared single-shot SSFP technique. Quantitative T1 mapping was performed with a Modified Look-Locker Inversion-Recovery（ MOLLI） sequence. Using IIF and Farr technique,we detected serum antinuclear antibody（ ANA） and anti-DNA. Statistical analysis was performed with software Origin（ version 8. 0）. For all statistical analysis a pvalue of less than 0. 05 was considered significant. Continuous variables were expressed by mean ± standard deviation. Twotailed paired Student t-test was used for comparisons. Correlation between parameters was determined by ANOVA multivariate linear regression. Results T2 time was significantly higher in inactive SLE（ inactive SLE： 58. 2 ± 5. 6,controls： 52. 6 ± 4. 2 msec）. There were significant differences between SLE and controls（ P 0. 05）. T1 time was similar in inactive SLE and controls（980. 7 ± 62. 2 msec,957. 5 ± 37. 9 msec（ Table 2 and Figure 2） There were no significant differences between SLE and controls（ P 0. 05）. T2 time was similar in positive and negative ANA（ 57. 81 ± 5. 45 msec,57. 08 ± 6. 78 msec）,anti-DNA（58. 52 ± 6. 9 msec,58. 12 ± 5. 8 msec）. There were no significant differences（ P = 0. 78,0. 96）. Conclusion Quantitative T2 mapping reliably identifies SLE subclinical myocardial edema. This offers the potential to quantify diffuse tissue damage that is less obvious on conventional CMR images.