心脏磁共振在理论研究及临床应用中的新进展
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摘要
心脏磁共振(cardiac magnetic resonance,CMR)是近年来广泛运用于研究与临床工作的无创影像检查手段,在心血管疾病诊断、疗效评估及预后判断等方面具有特殊价值。近年来,随着磁共振技术的革新与优化,弥补了以往CMR成像中的局限,在判断心肌细胞活性、心肌局部及整体功能以及心肌纹理特征等方面取得明显进展。本专题通过对磁共振心肌功能评价、磁共振心肌组织特征以及磁共振心肌纹理特征分析等问题进行评述,引导更精准的临床患者疾病评估,并推动心脏临床与基础研究。
Cardiac magnetic resonance(CMR) is a non-invasive imaging technology, which has been used widely in clinical and basic researches on cardiovascular disease in recent years. With the innovation and optimization of CMR technologies, significant progress has been developed in the evaluation of myocardial viability, the function of regions and global myocardium, and the myocardial texture characteristics. Therefore, with the discussion on the progress of CMR to draw more and more attention in clinics, we hope to improve the application of CMR not only in the basic research but also in the diagnosis and precise evaluation aspects of cardiovascular disease.
Cardiac magnetic resonance(CMR) is a non-invasive imaging technology, which has been used widely in clinical and basic researches on cardiovascular disease in recent years. With the innovation and optimization of CMR technologies, significant progress has been developed in the evaluation of myocardial viability, the function of regions and global myocardium, and the myocardial texture characteristics. Therefore, with the discussion on the progress of CMR to draw more and more attention in clinics, we hope to improve the application of CMR not only in the basic research but also in the diagnosis and precise evaluation aspects of cardiovascular disease.
引文
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[14] 朱静,朱桐,张钰,等.心脏磁共振组织追踪2D与3D应变评估实验性自身免疫性心肌炎模型大鼠的诊断价值及可重复性研究.四川大学学报(医学版),2019,50(4):471-477.
[15] 王磊,朱静,朱桐,等.7T心脏磁共振二维组织追踪技术评价树鼩心功能的应用研究 .四川大学学报(医学版),2019,50(4):478-482.
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[21] BENITO EM,CABANELAS N,NUNEZ-GARCIA M,et al.Preferential regional distribution of atrial fibrosis in posterior wall around left inferior pulmonary vein as identified by late gadolinium enhancement cardiac magnetic resonance in patients with atrial fibrillation.Europace,2018,20(12):1959-1965.
[22] 程巍,王思梦,何帅,等.MOCO-PSIR在扩张型心肌病心肌纤维化瘢痕评价中的应用价值 .四川大学学报(医学版),2019,50(4):483-488.
[23] OSHINSKI JN,YANG Z,JONES JR,et al.Imaging time after Gd-DTPA injection is critical in using delayed enhancement to determine infarct size accurately with magnetic resonance imaging.Circulation,2001,104(23):2838-2842.
[24] DALL’ARMELLINA E,KARIA N,LINDSAY AC,et al.Dynamic changes of edema and late gadolinium enhancement after acute myocardial infarction and their relationship to functional recovery and salvage index.Circ Cardiovasc Imaging,2011,4(3):228-236.
[25] KIDAMBI A,MOTWANI M,UDDIN A,et al.Myocardial extracellular volume estimation by CMR predicts functional recovery following acute MI.JACC Cardiovasc Imaging,2017,10(9):989-999.
[26] 夏睿,朱桐,张钰,等.心肌梗死再灌注早期磁共振心肌应变的初步研究.四川大学学报(医学版),2019,50(4):489-493.
[27] SERAPHIM A,KNOTT KD,AUGUSTO J,et al.Quantitative cardiac MRI.J Magn Reson Imaging,2019[2019-03-18].https://doi.org/10.1002/jmri.26789.
[28] MOON JC,MESSROGHLI DR,KELLMAN P,et al.Myocardial T1 mapping and extracellular volume quantification:a Society for Cardiovascular Magnetic Resonance (SCMR) and CMR Working Group of the European Society of Cardiology consensus statement.J Cardiovasc Magn Reson,2013,15:92[2019-03-18].https://doi.org/10.1186/1532-429x-15-92.
[29] MAESTRINI V,TREIBEL TA,WHITE SK,et al.T1 mapping for characterization of intracellular and extracellular myocardial diseases in heart failure.Curr Cardiovasc Imaging Rep,2014(7):9287[2019-03-18].https://doi.org/10.1007/s12410-014-9287-8.
[30] VAN OORSCHOT JW,EL AIDI H,JANSEN OF LORKEERS SJ,et al.Endogenous assessment of chronic myocardial infarction with T(1rho)-mapping in patients.J Cardiovasc Magn Reson,2014,16:104[2019-03-18].https://doi.org/10.1186/s12968-014-0104-y.
[31] WANG C,ZHENG J,SUN J,et al.Endogenous contrast T1rho cardiac magnetic resonance for myocardial fibrosis in hypertrophic cardiomyopathy patients.J Cardiol,2015,66(6):520-526.
[32] ZHANG Y,ZENG W,CHEN W,et al.MR extracellular volume mapping and non-contrast T1rho mapping allow early detection of myocardial fibrosis in diabetic monkeys.Eur Radiol,2019,29(6):3006-3016.
[33] TESSA C,DEL MEGLIO J,LILLI A,et al.T1 and T2 mapping in the identification of acute myocardial injury in patients with NSTEMI.Radiol Med,2018,123(12):926-934.
[34] NASSENSTEIN K,NENSA F,SCHLOSSER T,et al.Cardiac MRI:T2-mapping versus T2-weighted dark-blood TSE imaging for myocardial edema visualization in acute myocardial infarction.Rofo,2014,186(2):166-172.
[35] BULLUCK H,WHITE SK,ROSMINI S,et al.T1 mapping and T2 mapping at 3T for quantifying the area-at-risk in reperfused STEMI patients.J Cardiovasc Magn Reson,2015,17:73 [2019-03-18].https://doi.org/10.1186/s12968-015-0173-6.
[36] BAESSLER B,LUECKE C,LURZ J,et al.Cardiac MRI texture analysis of T1 and T2 maps in patients with infarctlike acute myocarditis.Radiology,2018,289(2):357-365.
[37] THAVENDIRANATHAN P,WALLS M,GIRI S,et al.Improved detection of myocardial involvement in acute inflammatory cardiomyopathies using T2 mapping.Circ Cardiovasc Imaging,2012,5(1):102-110.
[38] KRITTAYAPHONG R,ZHANG S,SAIVIROONPORN P,et al.Assessment of cardiac iron overload in Thalassemia with MRI on 3.0-T:high-field T1,T2,and T2* quantitative parametric mapping in comparison to T2* on 1.5-T.JACC Cardiovasc Imaging,2019,12(4):752-754.
[39] BARRERA CA,OTERO HJ,HARTUNG HD,et al.Protocol optimization for cardiac and liver iron content assessment using MRI:what sequence should I use?Clin Imaging,2019,56:52-57[2019-03-18].https://doi.org/10.1016/j.clinimag.2019.02.012.
[40] CHEN W,ZHANG B,XIA R,et al.T2 mapping at 7T MRI can quantitatively assess intramyocardial hemorrhage in rats with acute reperfused myocardial infarction in vivo.J Magn Reson Imaging,2016,44(1):194-203.
[41] LIAO PA,LIN G,TSAI SY,et al.Myocardial triglyceride content at 3 T cardiovascular magnetic resonance and left ventricular systolic function:a cross-sectional study in patients hospitalized with acute heart failure.J Cardiovasc Magn Reson,2016,18:9[2019-03-18].https://doi.org/10.1186/s12968-016-0228-3.
[42] KOROSOGLOU G,HUMPERT PM,AHRENS J,et al.Left ventricular diastolic function in type 2 diabetes mellitus is associated with myocardial triglyceride content but not with impaired myocardial perfusion reserve.J Magn Reson Imaging,2012,35(4):804-811.
[43] CHEN BH,SHI RY,AN DA,et al.BOLD cardiac MRI for differentiating reversible and irreversible myocardial damage in ST segment elevation myocardial infarction.Eur Radiol,2019,29(2):951-962.
[44] NAGAO M,YAMASAKI Y,KAWANAMI S,et al.Quantification of myocardial oxygenation in heart failure using blood-oxygen-level-dependent T2* magnetic resonance imaging:comparison with cardiopulmonary exercise test.Magn Reson Imaging,2017,39:138-143[2019-03-18].https://doi.org/10.1016/j.mri.2017.02.005.
[45] ZHANG H,GROPLER RJ,LI D,et al.Assessment of myocardial oxygen extraction fraction and perfusion reserve with BOLD imaging in a canine model with coronary artery stenosis.J Magn Reson Imaging,2007,26(1):72-79.
[46] MCCOMMIS KS,ZHANG H,GOLDSTEIN TA,et al.Myocardial blood volume is associated with myocardial oxygen consumption:an experimental study with cardiac magnetic resonance in a canine model.JACC Cardiovasc Imaging,2009,2(11):1313-1320.
[47] ALVES JR,DE QUEIROZ RAB,BAR M,et al.Simulation of the perfusion of contrast agent used in cardiac magnetic resonance:a step toward non-invasive cardiac perfusion quantification.Front Physiol,2019,10:177[2019-03-18].https://doi.org/10.3389/fphys.2019.00177.
[48] ZORACH B,SHAW PW,BOURQUE J,et al.Quantitative cardiovascular magnetic resonance perfusion imaging identifies reduced flow reserve in microvascular coronary artery disease.J Cardiovasc Magn Reson,2018,20(1):14 [2019-03-18].https://doi.org/10.1186/s12968-018-0435-1.
[49] BAESSLER B,MANNIL M,MAINTZ D,et al.Texture analysis and machine learning of non-contrast T1-weighted MR images in patients with hypertrophic cardiomyopathy-preliminary results.Eur J Radiol,2018,102:61-67[2019-03-18].https://doi.org/10.1016/j.ejrad.2018.03.013.
[50] SHAO XN,SUN YJ,XIAO KT,et al.Texture analysis of magnetic resonance T1 mapping with dilated cardiomyopathy:a machine learning approach.Medicine (Baltimore),2018,97(37):e12246 [2019-03-18].https://doi.org/10.1097/md.0000000000012246.
[51] 吴韬,孙怀强,刘秀民,等.健康志愿者心肌磁共振纹理特征初探 .四川大学学报(医学版),2019,50(4):494-499.
[2] PEREA RJ,ORTIZ-PEREZ JT,SOLE M,et al.T1 mapping:characterisation of myocardial interstitial space.Insights Imaging,2015,6(2):189-202.
[3] GANDHI MS,KAMALOV G,SHAHBAZ AU,et al.Cellular and molecular pathways to myocardial necrosis and replacement fibrosis.Heart Fail Rev,2011,16(1):23-34.
[4] KIM RJ,FIENO DS,PARRISH TB,et al.Relationship of MRI delayed contrast enhancement to irreversible injury,infarct age,and contractile function.Circulation,1999,100(19):1992-2002.
[5] PETERZAN MA,RIDER OJ,ANDERSON LJ.The role of cardiovascular magnetic resonance imaging in heart failure.Card Fail Rev,2016,2(2):115-122.
[6] AZARISMAN SM,CARBONE A,SHIRAZI M,et al.Characterisation of myocardial injury via T1 mapping in early reperfused myocardial infarction and its relationship with global and regional diastolic dysfunction.Heart Lung Circ,2016,25(11):1094-1106.
[7] LIU X,YANG ZG,GAO Y,et al.Left ventricular subclinical myocardial dysfunction in uncomplicated type 2 diabetes mellitus is associated with impaired myocardial perfusion:a contrast-enhanced cardiovascular magnetic resonance study.Cardiovasc Diabetol,2018,17(1):139[2019-03-18].https://doi.org/10.1186/s12933-018-0782-0.
[8] VO HQ,MARWICK TH,NEGISHI K.MRI-derived myocardial strain measures in normal subjects.JACC Cardiovasc Imaging,2018,11(2 Pt 1):196-205.
[9] KOOS R,ALTIOK E,DOETSCH J,et al.Layer-specific strain-encoded MRI for the evaluation of left ventricular function and infarct transmurality in patients with chronic coronary artery disease.Int J Cardiol,2013,166(1):85-89.
[10] HINOJAR R,FERNANDEZ-GOLFIN C,GONZALEZ-GOMEZ A,et al.Prognostic implications of global myocardial mechanics in hypertrophic cardiomyopathy by cardiovascular magnetic resonance feature tracking.Relations to left ventricular hypertrophy and fibrosis.Int J Cardiol,2017,249:467-472[2019-03-18].https://doi.org/10.1016/j.ijcard.2017.07.087.
[11] CHIMURA M,ONISHI T,TSUKISHIRO Y,et al.Longitudinal strain combined with delayed-enhancement magnetic resonance improves risk stratification in patients with dilated cardiomyopathy.Heart,2017,103(9):679-686.
[12] KIDO T,NAGAO M,KIDO T,et al.Stress/rest circumferential strain in non-ischemia,ischemia,and infarction——quantification by 3 Tesla tagged magnetic resonance imaging.Circ J,2013,77(5):1235-1241.
[13] 王哲涛,王春华,陈榆舒,等.MRI组织追踪技术在心脏淀粉样变性中的应用 .四川大学学报(医学版),2019,50(4):466-470.
[14] 朱静,朱桐,张钰,等.心脏磁共振组织追踪2D与3D应变评估实验性自身免疫性心肌炎模型大鼠的诊断价值及可重复性研究.四川大学学报(医学版),2019,50(4):471-477.
[15] 王磊,朱静,朱桐,等.7T心脏磁共振二维组织追踪技术评价树鼩心功能的应用研究 .四川大学学报(医学版),2019,50(4):478-482.
[16] DI MARCO A,ANGUERA I,SCHMITT M,et al.Late gadolinium enhancement and the risk for ventricular arrhythmias or sudden death in dilated cardiomyopathy:systematic review and meta-analysis.JACC Heart Fail,2017,5(1):28-38.
[17] WENG Z,YAO J,CHAN RH,et al.Prognostic value of LGE-CMR in HCM:a meta-analysis.JACC Cardiovasc Imaging,2016,9(12):1392-1402.
[18] KIM RJ,CHEN EL,LIMA JA,et al.Myocardial Gd-DTPA kinetics determine MRI contrast enhancement and reflect the extent and severity of myocardial injury after acute reperfused infarction.Circulation,1996,94(12):3318-3326.
[19] PATEL H,MAZUR W,WILLIAMS KA,et al.Myocardial viability-state of the art:is it still relevant and how to best assess it with imaging?Trends Cardiovasc Med,2018,28(1):24-37.
[20] HUNOLD P,SCHLOSSER T,VOGT FM,et al.Myocardial late enhancement in contrast-enhanced cardiac MRI:distinction between infarction scar and non-infarction-related disease.AJR Am J Roentgenol,2005,184(5):1420-1426.
[21] BENITO EM,CABANELAS N,NUNEZ-GARCIA M,et al.Preferential regional distribution of atrial fibrosis in posterior wall around left inferior pulmonary vein as identified by late gadolinium enhancement cardiac magnetic resonance in patients with atrial fibrillation.Europace,2018,20(12):1959-1965.
[22] 程巍,王思梦,何帅,等.MOCO-PSIR在扩张型心肌病心肌纤维化瘢痕评价中的应用价值 .四川大学学报(医学版),2019,50(4):483-488.
[23] OSHINSKI JN,YANG Z,JONES JR,et al.Imaging time after Gd-DTPA injection is critical in using delayed enhancement to determine infarct size accurately with magnetic resonance imaging.Circulation,2001,104(23):2838-2842.
[24] DALL’ARMELLINA E,KARIA N,LINDSAY AC,et al.Dynamic changes of edema and late gadolinium enhancement after acute myocardial infarction and their relationship to functional recovery and salvage index.Circ Cardiovasc Imaging,2011,4(3):228-236.
[25] KIDAMBI A,MOTWANI M,UDDIN A,et al.Myocardial extracellular volume estimation by CMR predicts functional recovery following acute MI.JACC Cardiovasc Imaging,2017,10(9):989-999.
[26] 夏睿,朱桐,张钰,等.心肌梗死再灌注早期磁共振心肌应变的初步研究.四川大学学报(医学版),2019,50(4):489-493.
[27] SERAPHIM A,KNOTT KD,AUGUSTO J,et al.Quantitative cardiac MRI.J Magn Reson Imaging,2019[2019-03-18].https://doi.org/10.1002/jmri.26789.
[28] MOON JC,MESSROGHLI DR,KELLMAN P,et al.Myocardial T1 mapping and extracellular volume quantification:a Society for Cardiovascular Magnetic Resonance (SCMR) and CMR Working Group of the European Society of Cardiology consensus statement.J Cardiovasc Magn Reson,2013,15:92[2019-03-18].https://doi.org/10.1186/1532-429x-15-92.
[29] MAESTRINI V,TREIBEL TA,WHITE SK,et al.T1 mapping for characterization of intracellular and extracellular myocardial diseases in heart failure.Curr Cardiovasc Imaging Rep,2014(7):9287[2019-03-18].https://doi.org/10.1007/s12410-014-9287-8.
[30] VAN OORSCHOT JW,EL AIDI H,JANSEN OF LORKEERS SJ,et al.Endogenous assessment of chronic myocardial infarction with T(1rho)-mapping in patients.J Cardiovasc Magn Reson,2014,16:104[2019-03-18].https://doi.org/10.1186/s12968-014-0104-y.
[31] WANG C,ZHENG J,SUN J,et al.Endogenous contrast T1rho cardiac magnetic resonance for myocardial fibrosis in hypertrophic cardiomyopathy patients.J Cardiol,2015,66(6):520-526.
[32] ZHANG Y,ZENG W,CHEN W,et al.MR extracellular volume mapping and non-contrast T1rho mapping allow early detection of myocardial fibrosis in diabetic monkeys.Eur Radiol,2019,29(6):3006-3016.
[33] TESSA C,DEL MEGLIO J,LILLI A,et al.T1 and T2 mapping in the identification of acute myocardial injury in patients with NSTEMI.Radiol Med,2018,123(12):926-934.
[34] NASSENSTEIN K,NENSA F,SCHLOSSER T,et al.Cardiac MRI:T2-mapping versus T2-weighted dark-blood TSE imaging for myocardial edema visualization in acute myocardial infarction.Rofo,2014,186(2):166-172.
[35] BULLUCK H,WHITE SK,ROSMINI S,et al.T1 mapping and T2 mapping at 3T for quantifying the area-at-risk in reperfused STEMI patients.J Cardiovasc Magn Reson,2015,17:73 [2019-03-18].https://doi.org/10.1186/s12968-015-0173-6.
[36] BAESSLER B,LUECKE C,LURZ J,et al.Cardiac MRI texture analysis of T1 and T2 maps in patients with infarctlike acute myocarditis.Radiology,2018,289(2):357-365.
[37] THAVENDIRANATHAN P,WALLS M,GIRI S,et al.Improved detection of myocardial involvement in acute inflammatory cardiomyopathies using T2 mapping.Circ Cardiovasc Imaging,2012,5(1):102-110.
[38] KRITTAYAPHONG R,ZHANG S,SAIVIROONPORN P,et al.Assessment of cardiac iron overload in Thalassemia with MRI on 3.0-T:high-field T1,T2,and T2* quantitative parametric mapping in comparison to T2* on 1.5-T.JACC Cardiovasc Imaging,2019,12(4):752-754.
[39] BARRERA CA,OTERO HJ,HARTUNG HD,et al.Protocol optimization for cardiac and liver iron content assessment using MRI:what sequence should I use?Clin Imaging,2019,56:52-57[2019-03-18].https://doi.org/10.1016/j.clinimag.2019.02.012.
[40] CHEN W,ZHANG B,XIA R,et al.T2 mapping at 7T MRI can quantitatively assess intramyocardial hemorrhage in rats with acute reperfused myocardial infarction in vivo.J Magn Reson Imaging,2016,44(1):194-203.
[41] LIAO PA,LIN G,TSAI SY,et al.Myocardial triglyceride content at 3 T cardiovascular magnetic resonance and left ventricular systolic function:a cross-sectional study in patients hospitalized with acute heart failure.J Cardiovasc Magn Reson,2016,18:9[2019-03-18].https://doi.org/10.1186/s12968-016-0228-3.
[42] KOROSOGLOU G,HUMPERT PM,AHRENS J,et al.Left ventricular diastolic function in type 2 diabetes mellitus is associated with myocardial triglyceride content but not with impaired myocardial perfusion reserve.J Magn Reson Imaging,2012,35(4):804-811.
[43] CHEN BH,SHI RY,AN DA,et al.BOLD cardiac MRI for differentiating reversible and irreversible myocardial damage in ST segment elevation myocardial infarction.Eur Radiol,2019,29(2):951-962.
[44] NAGAO M,YAMASAKI Y,KAWANAMI S,et al.Quantification of myocardial oxygenation in heart failure using blood-oxygen-level-dependent T2* magnetic resonance imaging:comparison with cardiopulmonary exercise test.Magn Reson Imaging,2017,39:138-143[2019-03-18].https://doi.org/10.1016/j.mri.2017.02.005.
[45] ZHANG H,GROPLER RJ,LI D,et al.Assessment of myocardial oxygen extraction fraction and perfusion reserve with BOLD imaging in a canine model with coronary artery stenosis.J Magn Reson Imaging,2007,26(1):72-79.
[46] MCCOMMIS KS,ZHANG H,GOLDSTEIN TA,et al.Myocardial blood volume is associated with myocardial oxygen consumption:an experimental study with cardiac magnetic resonance in a canine model.JACC Cardiovasc Imaging,2009,2(11):1313-1320.
[47] ALVES JR,DE QUEIROZ RAB,BAR M,et al.Simulation of the perfusion of contrast agent used in cardiac magnetic resonance:a step toward non-invasive cardiac perfusion quantification.Front Physiol,2019,10:177[2019-03-18].https://doi.org/10.3389/fphys.2019.00177.
[48] ZORACH B,SHAW PW,BOURQUE J,et al.Quantitative cardiovascular magnetic resonance perfusion imaging identifies reduced flow reserve in microvascular coronary artery disease.J Cardiovasc Magn Reson,2018,20(1):14 [2019-03-18].https://doi.org/10.1186/s12968-018-0435-1.
[49] BAESSLER B,MANNIL M,MAINTZ D,et al.Texture analysis and machine learning of non-contrast T1-weighted MR images in patients with hypertrophic cardiomyopathy-preliminary results.Eur J Radiol,2018,102:61-67[2019-03-18].https://doi.org/10.1016/j.ejrad.2018.03.013.
[50] SHAO XN,SUN YJ,XIAO KT,et al.Texture analysis of magnetic resonance T1 mapping with dilated cardiomyopathy:a machine learning approach.Medicine (Baltimore),2018,97(37):e12246 [2019-03-18].https://doi.org/10.1097/md.0000000000012246.
[51] 吴韬,孙怀强,刘秀民,等.健康志愿者心肌磁共振纹理特征初探 .四川大学学报(医学版),2019,50(4):494-499.
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