体素内不相干运动技术评估高血压患者心肌微循环的初步研究
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摘要
目的尝试使用体素内不相干运动(IVIM)弥散加权成像评估高血压患者的心肌微循环情况,并与正常志愿者进行对照。方法纳入2015年5月至2018年9月在我院完成心脏磁共振电影和IVIM成像检查的正常志愿者30例和高血压患者18例。于左心室中间部短轴层面采用8个b值(20、50、80、100、120、200、300、500 s/mm2)完成IVIM扫描。在左心室短轴层面上获得左心室的结构和功能参数;利用双指数模型测量IVIM各参数快速表观扩散系数(ADCfast)、慢速表观扩散系数、快速扩散成分所占比例。统计分析正常志愿者与高血压患者之间各参数值的差异。结果高血压患者左心室射血分数、心输出量、心肌质量均高于正常志愿者[(68.39±7.51)%vs(63.20±5.22)%、(6.84±2.03)L vs(5.41±1.08)L、(122.54±33.63)g vs(85.97±25.42)g],差异均有统计学意义(t=-2.75、-2.64、-4.15,P均<0.05],而左心室的舒张末期容积、收缩末期容积、每搏输出量、心指数在两组之间差异均无统计学意义(P均>0.05)。高血压患者的ADCfast为0.12(0.03～0.17)mm2/s,低于正常志愿者的0.14(0.10～0.21)mm2/s,差异有统计学意义(Z=-2.83,P<0.01)。结论 IVIM技术有助于评估高血压患者的心肌微循环情况。
Objective To assess the myocardial microcirculation of patients with hypertension using intravoxel incoherent motion(IVIM) diffusion-weighted imaging, and to analyze the differences compared with normal volunteers.Methods Thirty normal volunteers and 18 hypertensive patients, who underwent cardiac magnetic resonance cine and IVIM scans in our hospital from May 2015 to Sep. 2018, were enrolled. The IVIM scan was performed on middle view of left ventricular short-axis with 8 b values(20, 50, 80, 100, 120, 200, 300 and 500 s/mm2). The structural and functional parameters were measured on left ventricular short-axis, and the IVIM parameters(fast apparent diffusion coef?cient [ADCfast], slow apparent diffusion coef?cient, fraction of ADCfast) were measured using biexponential model. The differences of all parameters were analyzed between the normal volunteers and hypertensive patients. Results The left ventricular ejection fraction, cardiac output and myocardial mass of the hypertensive patients were higher than those of the normal volunteers([68.39±7.51]% vs [63.20±5.22]%,[6.84±2.03] L vs [5.41±1.08] L, and [122.54±33.63] g vs [85.97±25.42] g), and the differences were significant(t=-2.75,-2.64 and-4.15; all P<0.05). There were no significant differences in the left ventricular end-diastolic volume,end-systolic volume, stroke volume or cardiac index between the hypertensive patients and normal volunteers(all P>0.05). The ADCfast of the hypertensive patients was significantly lower than that of the normal volunteers(0.12 [0.03-0.17] mm2/s vs 0.14[0.10-0.21] mm2/s, Z=-2.83, P<0.01). Conclusion The application of IVIM can contribute to evaluating myocardial microcirculation of the hypertensive patients.
Objective To assess the myocardial microcirculation of patients with hypertension using intravoxel incoherent motion(IVIM) diffusion-weighted imaging, and to analyze the differences compared with normal volunteers.Methods Thirty normal volunteers and 18 hypertensive patients, who underwent cardiac magnetic resonance cine and IVIM scans in our hospital from May 2015 to Sep. 2018, were enrolled. The IVIM scan was performed on middle view of left ventricular short-axis with 8 b values(20, 50, 80, 100, 120, 200, 300 and 500 s/mm2). The structural and functional parameters were measured on left ventricular short-axis, and the IVIM parameters(fast apparent diffusion coef?cient [ADCfast], slow apparent diffusion coef?cient, fraction of ADCfast) were measured using biexponential model. The differences of all parameters were analyzed between the normal volunteers and hypertensive patients. Results The left ventricular ejection fraction, cardiac output and myocardial mass of the hypertensive patients were higher than those of the normal volunteers([68.39±7.51]% vs [63.20±5.22]%,[6.84±2.03] L vs [5.41±1.08] L, and [122.54±33.63] g vs [85.97±25.42] g), and the differences were significant(t=-2.75,-2.64 and-4.15; all P<0.05). There were no significant differences in the left ventricular end-diastolic volume,end-systolic volume, stroke volume or cardiac index between the hypertensive patients and normal volunteers(all P>0.05). The ADCfast of the hypertensive patients was significantly lower than that of the normal volunteers(0.12 [0.03-0.17] mm2/s vs 0.14[0.10-0.21] mm2/s, Z=-2.83, P<0.01). Conclusion The application of IVIM can contribute to evaluating myocardial microcirculation of the hypertensive patients.
引文
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[5]LIU C,LIANG C,LIU Z,ZHANG S,HUANG B.Intravoxel incoherent motion(IVIM)in evaluation of breast lesions:comparison with conventional DWI[J/OL].Eur J Radiol,2013,82:e782-e789.doi:10.1016/j.ejrad.2013.08.006.
[6]WINFIELD J M,ORTON M R,COLLINS D J,INDT E,ATTYGALLE A,HAZELL S,et al.Separation of type and grade in cervical tumours using non-monoexponential models of diffusion-weighted MRI[J].Eur Radiol,2017,27:627-636.
[7]DELATTRE B M,VIALLON M,WEI H,ZHU Y M,FEIWEIER T,PAI V M,et al.In vivo cardiac diffusionweighted magnetic resonance imaging quantification of normal perfusion and diffusion coefficients with intravoxel incoherent motion imaging[J].Invest Radiol,2012,47:662-670.
[8]李志伟,袁思殊,黄璐,马晓玲,夏黎明.心肌磁共振多b值DWI的初步探讨[J].放射学实践,2013,3:337-340.
[9]刘明熙,张挽时,张子衡,孟利民,龚万沣,刘洁,等.多个低b值DWI技术在心脏成像中的初步研究[J].中国医疗设备,2016,31:42-47.
[10]MOU A,ZHANG C,LI M,JIN F,SONG Q,LIU A,et al.Evaluation of myocardial microcirculation using intravoxel incoherent motion imaging[J].J Magn Reson Imaging,2017,46:1818-1828.
[11]MAVROGENI S,KATSI V,VARTELA V,NOUTSIASM,MARKOUSIS-MAVROGENIS G,KOLOVOU G,et al.The emerging role of Cardiovascular Magnetic Resonance in the evaluation of hypertensive heart disease[J].BMC Cardiovasc Disord,2017,17:4-10.
[12]MOULIN K,CROISILLE P,FEIWEIER T,DELATTREB M,WEI H,ROBERT B,et al.In vivo free-breathing DTI and IVIM of the whole human heart using a realtime slice-followed SE-EPI navigator-based sequence:a reproducibility study in healthy volunteers[J].Magn Reson Med,2016,76:70-82.
[13]CALLOT V,BENNETT E,DECKING U K,BALABANR S,WEN H.In vivo study of microcirculation in canine myocardium using the IVIM method[J].Magn Reson Med,2003,50:531-540.
[2]MORENO M U,EIROS R,GAVIRA J J,GALLEGOC,GONZáLEZ A,RAVASSAS,et al.The hypertensive myocardium:from microscopic lesions to clinical complications and outcomes[J].Med Clin North Am,2017,101:43-52.
[3]L E B I H A N D,B R E T O N E,L A L L E M A N D D,GRENIER P,CABANIS E,LAVAL-JEANTET M.MRimaging of intravoxel incoherent motions:application to diffusion and perfusion in neurologic disorders[J].Radiology,1986,161:401-407.
[4]LUO M,ZHANG L,JIANG X H,ZHANG W D.Intravoxel incoherent motion diffusion-weighted imaging:evaluation of the differentiation of solid hepatic lesions[J].Transl Oncol,2017,10:831-838.
[5]LIU C,LIANG C,LIU Z,ZHANG S,HUANG B.Intravoxel incoherent motion(IVIM)in evaluation of breast lesions:comparison with conventional DWI[J/OL].Eur J Radiol,2013,82:e782-e789.doi:10.1016/j.ejrad.2013.08.006.
[6]WINFIELD J M,ORTON M R,COLLINS D J,INDT E,ATTYGALLE A,HAZELL S,et al.Separation of type and grade in cervical tumours using non-monoexponential models of diffusion-weighted MRI[J].Eur Radiol,2017,27:627-636.
[7]DELATTRE B M,VIALLON M,WEI H,ZHU Y M,FEIWEIER T,PAI V M,et al.In vivo cardiac diffusionweighted magnetic resonance imaging quantification of normal perfusion and diffusion coefficients with intravoxel incoherent motion imaging[J].Invest Radiol,2012,47:662-670.
[8]李志伟,袁思殊,黄璐,马晓玲,夏黎明.心肌磁共振多b值DWI的初步探讨[J].放射学实践,2013,3:337-340.
[9]刘明熙,张挽时,张子衡,孟利民,龚万沣,刘洁,等.多个低b值DWI技术在心脏成像中的初步研究[J].中国医疗设备,2016,31:42-47.
[10]MOU A,ZHANG C,LI M,JIN F,SONG Q,LIU A,et al.Evaluation of myocardial microcirculation using intravoxel incoherent motion imaging[J].J Magn Reson Imaging,2017,46:1818-1828.
[11]MAVROGENI S,KATSI V,VARTELA V,NOUTSIASM,MARKOUSIS-MAVROGENIS G,KOLOVOU G,et al.The emerging role of Cardiovascular Magnetic Resonance in the evaluation of hypertensive heart disease[J].BMC Cardiovasc Disord,2017,17:4-10.
[12]MOULIN K,CROISILLE P,FEIWEIER T,DELATTREB M,WEI H,ROBERT B,et al.In vivo free-breathing DTI and IVIM of the whole human heart using a realtime slice-followed SE-EPI navigator-based sequence:a reproducibility study in healthy volunteers[J].Magn Reson Med,2016,76:70-82.
[13]CALLOT V,BENNETT E,DECKING U K,BALABANR S,WEN H.In vivo study of microcirculation in canine myocardium using the IVIM method[J].Magn Reson Med,2003,50:531-540.