CAJ | 학술논문

目的探讨纵向弛豫时间定量(T1mapping)成像对肥厚型心肌病(HCM)纤维化的诊断价值.方法按诊断标准入选48例HCM患者和18名健康志愿者,分别行常规延迟强化(LGE)检查与T1 mapping成像,按HCM LGE有无及程度,分为LGE远处正常区、LGE边缘区、LGE区(分为晕状LGE与典型斑片状LGE),分别测量2组心肌对比剂增强后T1值的变化率并进行卡方检验、两两对比及ROC曲线分析.结果健康志愿者T1值变化率与HCM远离LGE区差异无统计学意义(3.98 ±3.19和3.36 ±2.77,=0.98,p＞0.05),与LGE周边区(13.51±5.67)、晕状区(17.70±5.57)、斑片区(36.62±8.03)比较差异有统计学意义(t值分别为15.28、17.13和47.48,P值均＜0.01)；远处正常区(3.36 ±2.77)与LGE周边区、晕状区及斑片区比较差异均有统计学意义(t值分别为19.64、20.76和56.64,P值均＜0.01)；LGE周边区与LGE晕状区和斑片区比较差异均有统计学意义(t值分别为6.12和39.90,P值均＜0.01)；LGE晕状区与斑片区比较差异有统计学意义(t=25.63,P＜0.01).ROC曲线提示T1 mapping成像较传统LGE成像有更大的曲线下面积(0.974±0.050和0.751±0.180).结论 HCM纤维化常见,且受累心肌的纤维化程度不一,T1 mapping成像能对HCM患者心肌纤维化的严重程度进行评价,能够发现处于纤维化早期的病变.
목적 탐토종향이예시간정량(T1mapping)성상대비후형심기병(HCM)섬유화적진단개치.방법 안진단표준입선48례HCM환자화18명건강지원자,분별행상규연지강화(LGE)검사여T1 mapping성상,안HCM LGE유무급정도,분위LGE원처정상구、LGE변연구、LGE구(분위훈상LGE여전형반편상LGE),분별측량2조심기대비제증강후T1치적변화솔병진행잡방검험、량량대비급ROC곡선분석.결과 건강지원자T1치변화솔여HCM원리LGE구차이무통계학의의(3.98 ±3.19화3.36 ±2.77,=0.98,p＞0.05),여LGE주변구(13.51±5.67)、훈상구(17.70±5.57)、반편구(36.62±8.03)비교차이유통계학의의(t치분별위15.28、17.13화47.48,P치균＜0.01)；원처정상구(3.36 ±2.77)여LGE주변구、훈상구급반편구비교차이균유통계학의의(t치분별위19.64、20.76화56.64,P치균＜0.01)；LGE주변구여LGE훈상구화반편구비교차이균유통계학의의(t치분별위6.12화39.90,P치균＜0.01)；LGE훈상구여반편구비교차이유통계학의의(t=25.63,P＜0.01).ROC곡선제시T1 mapping성상교전통LGE성상유경대적곡선하면적(0.974±0.050화0.751±0.180).결론 HCM섬유화상견,차수루심기적섬유화정도불일,T1 mapping성상능대HCM환자심기섬유화적엄중정도진행평개,능구발현처우섬유화조기적병변.
Objective To investigate the diagnostic values of T1 mapping imaging for evaluating myocardial fibrosis in patients with hypertrophic cardiomyopathy (HCM).Methods Forty-eight subjects with HCM and 18 healthy volunteers underwent conventional late gadolinium enhancement (LGE) MR imaging and T1 mapping imaging.According to the characteristics of LGE,the myocardium in HCM was divided into remote area of LGE,peri-LGE,LGE (halo-like LGE and typical patchy LGE).The changing rates of contrast-enhanced T1 value of these regions were measured and compared with normal volunteers'myocardium.The Chi-square test,pairwise comparison and ROC curve were used for statistical analysis.Results The changing rate of T1 value (CRT) in healthy volunteers was no significant difference from that in the remote area of LGE (3.98 ±3.19 vs.3.36 ±2.77,t =0.98,P ＞0.05).There were significant differences in CRT between healthy volunteers' myocardium and the peri-LGE (13.51 ± 5.67),halo-likeLGE (17.70±5.57) and typical patchy LGE(36.62 ±8.03,t =15.28,17.13 and 47.48,respectively,all P ＜ 0.01),between remote area-LGE and peri-LGE,halo-like LGE and typical patchy LGE (t =19.64,20.76 and 56.64,respectively,all P ＜ 0.01),between peri-LGE and halo-like LGE and typical patchy LGE(t =6.12 and 39.90,respectively,both P ＜ 0.01),between halo-like LGE and typical patchy LGE(t =25.63,P ＜0.01).ROC curves indicated that T1 mapping imaging has a greater area under the curve than that of traditional LGE imaging (0.974 ±0.050 vs.0.751 ±0.180).Conclusion T1 mapping imaging can be a useful method to evaluate the severity of the fibrosis,especially at the early stage.