Extracellular volume fraction mapping in the myocardium, part 2: initial clinical experience

Journal of Cardiovascular Magnetic Resonance

Research

Martin Ugander¹  Joel R Wilson²  Peter Kellman²  Sujata M Shanbhag²  W Patricia Bandettini²  Andrew E Arai²  Kirk M Druey³  Hui Xue⁴ 

[1] Department of Clinical Physiology, Karolinska Institute and Karolinska, University Hospital, Stockholm, Sweden;National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA;National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA;Siemens Corporate Research, Princeton, NJ, USA;

关键词: Fibrosis;    Edema;    Gadolinium;    Myocardial infarction;    Hypertrophic cardiomyopathy;    Dilated cardiomyopathy;    Myocarditis;    Systemic capillary leak syndrome;   

DOI  :  10.1186/1532-429X-14-64

 received in 2012-05-02, accepted in 2012-09-03,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundDiffuse myocardial fibrosis, and to a lesser extent global myocardial edema, are important processes in heart disease which are difficult to assess or quantify with cardiovascular magnetic resonance (CMR) using conventional late gadolinium enhancement (LGE) or T1-mapping. Measurement of the myocardial extracellular volume fraction (ECV) circumvents factors that confound T1-weighted images or T1-maps. We hypothesized that quantitative assessment of myocardial ECV would be clinically useful for detecting both focal and diffuse myocardial abnormalities in a variety of common and uncommon heart diseases.MethodsA total of 156 subjects were imaged including 62 with normal findings, 33 patients with chronic myocardial infarction (MI), 33 with hypertrophic cardiomyopathy (HCM), 15 with non-ischemic dilated cardiomyopathy (DCM), 7 with acute myocarditis, 4 with cardiac amyloidosis, and 2 with systemic capillary leak syndrome (SCLS). Motion corrected ECV maps were generated automatically from T1-maps acquired pre- and post-contrast calibrated by blood hematocrit. Abnormally-elevated ECV was defined as >2SD from the mean ECV in individuals with normal findings. In HCM the size of regions of LGE was quantified as the region >2 SD from remote.ResultsMean ECV of 62 normal individuals was 25.4 ± 2.5% (m ± SD), normal range 20.4%-30.4%. Mean ECV within the core of chronic myocardial infarctions (without MVO) (N = 33) measured 68.5 ± 8.6% (p < 0.001 vs normal). In HCM, the extent of abnormally elevated ECV correlated to the extent of LGE (r = 0.72, p < 0.001) but had a systematically greater extent by ECV (mean difference 19 ± 7% of slice). Abnormally elevated ECV was identified in 4 of 16 patients with non-ischemic DCM (38.1 ± 1.9% (p < 0.001 vs normal) and LGE in the same slice appeared “normal” in 2 of these 4 patients. Mean ECV values in other disease entities ranged 32-60% for cardiac amyloidosis (N = 4), 40-41% for systemic capillary leak syndrome (N = 2), and 39-56% within abnormal regions affected by myocarditis (N = 7).ConclusionsECV mapping appears promising to complement LGE imaging in cases of more homogenously diffuse disease. The ability to display ECV maps in units that are physiologically intuitive and may be interpreted on an absolute scale offers the potential for detection of diffuse disease and measurement of the extent and severity of abnormal regions.

【 授权许可】

CC BY   
© Kellman et al.; licensee BioMed Central Ltd. 2012