心脏淀粉样变磁共振特征分析

MRI characteristics of cardiac amyloidosis

目的观察心脏淀粉样变的心脏磁共振的影像学特征,探讨其对心脏淀粉样变的诊断价值。方法回顾性分析22例心脏淀粉样变患者的心脏磁共振影像学资料。结果 22例患者左室射血分数为(38.8±13.0)%,其中17例降低,左心室舒张末期容积指数[(62.2±15.1)mL/m^(2)]和左心室收缩末期容积指数[(37.8±15.5)mL/m^(2)]均降低,伴有瓣膜反流19例;左心室壁增厚21例(同时伴右心室壁增厚2例),左心室质量[(201.7±76.6)g]升高;22例患者钆延迟强化(late gadolinium enhancement, LGE)均呈典型弥漫性心内膜或透壁性强化,纵向弛豫时间定量成像显示初始T1值[(1 444.6±80.9)ms]增大,增强后T1值[(435.6±62.0)ms]降低,细胞外容积[(57.94±7.5)%]升高;出现心包积液21例,少量胸腔积液11例。结论心脏淀粉样变的心脏磁共振表现具有特征性,LGE表现为典型弥漫性心内膜或透壁性强化,纵向弛豫时间定量成像显示心肌T1时间延长,细胞外容积增高;LGE与T1定量成像联合可提高诊断准确性。

Objective To observe the imaging features of cardiac MRI of cardiac amyloidosis and to evaluate its value to the diagnosis of cardiac amyloidosis. Methods The cardiac MRI imaging data of 22 patients with cardiac amyloidosis were retrospectively analyzed. Results In 22 patients, left ventricular ejection fraction [(38.8±13.0)%] decreased in 17 patients. The left ventricular end-diastolic volume index and left ventricular end-systolic volume index decreased to(62.2±15.1) and(37.8±15.5) mL/m^(2).Nineteen patients were complicated with valve regurgitation.Left ventricular wall thickening developed in 21 patients, in which 2 patients were complicated with right ventricular wall thickening.The left ventricular mass increased to(201.7±76.6) g.Late gadolinium enhancement showed typical diffuse endocardial or transmural enhancement in all patients.Longitudinal relaxation time of myocardium showed the initial T_(1) value increased to(1 444.6±80.9) ms, the enhanced T_(1) value decreased to(435.6±62.0) ms, and the extracellular volume value increased to(57.94±7.5)%.Pericardial effusion occurred in 21 patients and a few pleural effusion occurred in 11. Conclusions Cardiac MRI findings of cardiac amyloidosis have characteristics.Late gadolinium enhancement shows typical diffuse endocardial or transmural enhancement.Longitudinal relaxation time of myocardium shows T_(1) mapping prolongs and extracellular volume increases.Late gadolinium enhancement combined with T_(1) mapping can improve the diagnostic accuracy.