CMR组织追踪技术在心肌淀粉样变性与其他左心室心肌肥厚疾病中的鉴别诊断价值

The Value of CMR Tissue Tracking in Differential Diagnosis Between Cardiac Amyloidosisand Otherleft Ventricular Hypertrophy Diseases

目的 评估心脏磁共振组织追踪(CMR-TT)技术在心肌淀粉样变性(CA)与其他左心室心肌肥厚(LVH)疾病中的鉴别诊断价值。方法 连续性搜集接受CMR检查的LVH患者125例,其中CA 34例、肥厚型心肌病(HCM) 47例、高血压性心脏病(HHD)44例。所有患者采用3.0 TMR采集心脏电影图像。使用CMR-TT技术测量双侧心室的整体应变。采用受试者工作特征(ROC)曲线评估应变参数单独及联合后的鉴别诊断效能。结果 CA组左心室整体纵向应变(LGLS)、右心室整体径向应变(RGRS)、右心室整体环向应变(RGCS)均小于HCM组(P<0.05),CA组双侧心室应变参数均小于HHD组(P<0.05)。ROC曲线分析中,RGRS在CA和HCM组中诊断效能最好,AUC为0.753;LGLS在CA和HHD组中诊断效能最好,AUC为0.809。应变参数联合后诊断效能均有提升,双侧心室应变全部联合后在CA-HCM和CA-HHD中诊断效能均最好,AUC值分别为0.935和0.847。结论 通过CMR-TT技术测量的双心室应变参数在鉴别CA与HCM和HHD中存在一定价值。

Objective To evaluate the differential diagnosis value of Cardiovascular magnetic resonance imaging tissue tracking technique(CMR-TT)in myocardial amyloidosis(CA)and other left ventricular hypertrophy diseases(LVH).Methods A total of 125 patients with left ventricular hypertrophy who underwent CMR examination were continuously collected,including 34 CA,47 HCM and 44 HHD cases.Standard cine images of the heart were acquired in all patients using 3.0T MR.Bilateral ventricles global strain was measured by using CMR-TT.Receiver operating characteristic(ROC)curves were used to evaluate the diagnostic efficacy of strain parameters alone and in combination.Results The LGLS,RGRS,and RGCS in CA group were lower than those of HCM group(P<0.05),and the bilateral ventricular strain parameters in the CA group were lower than those of HHD group(P<0.05).In the ROC curve analysis,RGRS had the best diagnostic performance in the CA-HCM group,with AUC 0.753;LGLS had the best diagnostic efficacy in the CA-HHD group,with AUC 0.809.The combination of strain parameters has improved the diagnostic efficacy.The combination of bilateral ventricular strain has the best diagnostic efficacy in CA-HCM group and CA-HHD group,with AUC 0.935 and 0.847.Conclusion The biventricular strain parameters measured by CMR-TT technique have certain value in differentiating CA from HCM and HHD.