摘要
目的以MRI作为参照,探讨基于双能量CT的细胞外容积分数(DECT-ECV)定量评估心肌纤维化的最佳延迟时间。方法前瞻性纳入2022年1至5月在阜外华中心血管病医院就诊疑似或确诊有心肌病变的患者30例,所有患者在1周内完成心脏DECT和MRI检查。根据MRI心肌延迟强化(LGE)表现将心肌节段分为以下3种:缺血性LGE(+)心肌节段、非缺血性LGE(+)心肌节段和LGE(-)心肌节段;根据DECT延迟扫描时间将整体心肌及心脏节段分为3组:A组(延迟3 min)、B组(延迟5 min)和C组(延迟7 min)。分别在整体心肌和心肌节段水平比较CT-ECV与MRI-ECV相关性和一致性。相关性分析采用Pearson检验或Spearman检验,一致性分析采用Bland-Altman检验。结果30例患者共480个心肌节段最终纳入本研究。以整体心肌为研究对象,MRI-ECV为33.12%±4.29%,A、B、C组的CT-ECV分别为35.81%±4.48%、36.02%±4.56%、36.58%±4.69%。A、B、C 3组内DECT-ECV与MRI-ECV相关系数依次为0.878、0.955和0.947(P均<0.001),一致性均较好。以心肌节段为研究对象,缺血性LGE(+)心肌节段MRI-ECV及A、B、C组的CT-ECV分别为34.60%(31.70%,39.40%)、37.50%(34.20%,41.90%)、38.20%(36.20%,40.60%)和39.40%(35.50%,42.40%),A、B、C 3组内DECT-ECV与MRI-ECV相关系数依次为0.559、0.695和0.682(P均<0.001),一致性均较好;非缺血性LGE(+)心肌节段MRI-ECV及A、B、C组的CT-ECV分别为35.10%(32.68%,38.70%)、38.15%(35.13%,41.75%)、39.25%(35.78%,42.20%)和39.60%(35.88%,42.90%),A、B、C 3组内DECT-ECV与MRI-ECV相关系数依次为0.531、0.772和0.744(P均<0.001),一致性均较好;LGE(-)心肌节段MRI-ECV及A、B、C组的CT-ECV分别为28.50%(27.00%,30.10%)、31.10%(28.70%,34.60%)、31.30%(28.40%,33.80%)、31.30%(29.20%,34.80%),A、B、C 3组内DECT-ECV与MRI-ECV相关系数依次为0.273、0.508和0.425(P均<0.001),一致性均较好。结论DECT-ECV可用于定量评价心肌组织学特征,且在5和7 min时均有较好的相关性和一致性。为了更好地普及该技术并提高该技术的应用能力,在临床实践中延迟扫描时间推荐为注射对比剂后5 min。
Objective To investigate the optimal delay time in the quantitative assessment of myocardial fibrosis based on dual-energy CT extracellular volume fraction(DECT-ECV),using MRI as a reference.Methods Thirty patients with confirmed or suspected of cardiomyopathy were prospectively enrolled in this study.All the patients underwent both cardiac DECT and MRI examination within one week.According to the imaging features of late gadolinium enhancement(LGE)on MRI,myocardial segments were classified into 3 types:ischemic LGE segments,non-ischemic LGE segments and negative LGE segments.According to the DECT delay time,the whole and segmental myocardium were divided into 3 groups:delay of 3 min(Group A),delay of 5 min(Group B)and delay of 7 min(Group C).Correlation and agreement between CT-ECV and MRI-ECV were performed on a basis of overall myocardium and segmental myocardium.Pearson or Spearman test was used for correlation analysis and Bland-Altman test was used for consistency analysis.Results Thirty patients with 480 segments were finally included in our study.In the analysis based on overall myocardium,MRI-ECV was 33.12%±4.29%,and CT-ECV were 35.81%±4.48%,36.02%±4.56%,and 36.58%±4.69%in Group A,B,and C,respectively.The agreement between DECT-ECV and MRI-ECV results was good,with the correlation coefficients of 0.878(group A),0.955(Group B)and 0.947(Group C)(all P<0.001).In the analysis based on segmental myocardium,as for the ischemic LGE myocardial segments,MRI-ECV was 34.60%(31.70%,39.40%),and CT-ECV were 37.50(34.20,41.90),38.20%(36.20%,40.60%)and 39.40%(35.50%,42.40%)in Group A,B,and C,respectively.The agreement between DECT-ECV and MRI-ECV results was good,with the correlation coefficients of 0.559,0.695 and 0.682(all P<0.001)for groups A,B and C,and as for non-ischemic LGE myocardial segments,MRI-ECV was 35.10%(32.68%,38.70%),and CT-ECV were 38.15%(35.13%,41.75%),39.25%(35.78%,42.20%)and 39.60%(35.88%,42.90%)in Group A,B,and C.The correlation coefficients of CMR-ECV and DECT-ECV of groups A,B and C were 0.531,0.772 and 0.744(all P<0.001),showing good agreement;as for negative LGE myocardial segments,MRI-ECV and CT-ECV of Group A,Group B,Group C were 28.50%(27.00%,30.10%),31.10%(28.70%,34.60%),31.30%(28.40%,33.80%),31.30%(29.20%,34.80%).The correlation coefficients between MRI-ECV and DECT-ECV of group A,B and C were 0.273,0.508 and 0.425(all P<0.001),which also showed good agreement.Conclusions DECT-ECV can be used for quantitative evaluation of myocardial histological features.DECT-ECV with a 5 min and 7 min delay shows good correlation and agreement with MRI-ECV.In order to make this technology more well-known and improve its application capability,our recommendation for clinical practice is a 5 min delay after contrast administration in clinical practice.
作者
李晨菲
王明月
孙明华
谢瑞刚
吕滨
葛英辉
Li Chenfei;Wang Mingyue;Sun Minghua;Xie Ruigang;Lyu Bin;Ge Yinghui(Department of Radiology,Fuwai Central China Cardiovascular Hospital,Henan Key Laboratory of Cardiology Imaging Medicine,Henan Provincial People′s Hospital Heart Center,Zhengzhou 451464,China;Department of Radiology,Fuwai Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,National Center for Cardiovascular Diseases,Beijing 100037,China)
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2024年第10期1035-1041,共7页
Chinese Journal of Radiology
基金
河南省医学科技攻关省部共建项目(SB201901097)。