MOCO-PSIR在扩张型心肌病心肌纤维化瘢痕评价中的应用价值

  目的  研究运动校正相位敏感反转恢复序列(MOCO-PSIR)在扩张型心肌病(DCM)致心力衰竭患者心肌纤维化瘢痕评价中的应用价值。  方法  前瞻性纳入2017年6月至2018年11月进行心脏磁共振(CMR)增强扫描的患者60例，其中临床诊断为DCM的患者38例，正常对照组22例；所有患者均同时采用segmented-PSIR(seg-PSIR)、single-shot-PSIR、MOCO-PSIR 3种延迟强化(LGE)评价序列，对比分析3组图像质量的主观评分(4级)和正常及异常心肌的图像信噪比(SNR，客观评价)；并记录3种扫描技术的延迟强化检出节段数(即是否存在心肌瘢痕组织)和图像采集时间。  结果  图像质量主观评分:在DCM患者中，评分由高到低为MOCO-PSIR>single-shot-PSIR>seg-PSIR(P < 0.05)；在正常对照者中，3种不同序列间评分差异无统计学意义。客观评价:在DCM患者和正常对照者中，SNR由高到低均为seg-PSIR>MOCO-PSIR>single-shot-PSIR(P < 0.05)。在DCM患者的646个节段评价中，seg-PSIR无法评价的节段占比最高(25.5%)，MOCO-PSIR占比最低(1.4%)，3组序列间比较差异有统计学意义(P < 0.001)；在正常对照者374个节段评价中，3组序列无法评价的节段占比比较差异无统计学意义。3组序列采集左室全程时间分别为:seg-PSIR(5.6±1.7) min；single-shot-PSIR(0.4±0.2) min；MOCO-PSIR(4.5±1.1) min，三者间比较差异有统计学意义(P < 0.001)。  结论  MOCO-PSIR-LGE在DCM致心力衰竭患者心肌纤维化瘢痕评价方面具有较大的临床意义，其图像质量和延迟强化检出率高于常规的延迟强化扫描序列。

Application Value of Motion-correction Phase Sensitive Inversion Recovery (MOCO-PSIR) to Evaluate Myocardial Fibrosis in Patients with Heart Failure Caused by Dilated Cardiomyopathy

  Objective  To study the application value of motion-correction phase sensitive inversion recovery (MOCO-PSIR) to evaluate myocardial fibrosis in the patients with heart failure caused by dilated cardiomyopathy (DCM).  Methods  A prospective study included 60 patients who underwent cardiac MRI enhanced scan from June 2017 to November 2018, including 38 patients who were clinically diagnosed with DCM and 22 patients in the normal control group. All patients were scanned with three late gadolinium enhancement (LGE) sequences: segmented-PSIR, single-shot-PSIR, MOCO-PSIR at the same time. The subjective quality score (level 4) and image signal-to-noise ratio (objective evaluation) of normal and abnormal myocardium were analyzed and compared in three scanning technique groups. The detection rate of myocardial fibrosis and image acquisition time of the three scanning techniques were recorded.  Results  In the normal control group (sinus rhythm), subjective score showed no statistical significance. Subjective scoring results in the patients with DCM: MOCO-PSIR>single-shot-PSIR> segmented-PSIR (P < 0.05). SNR results PSIR-LGE images in DCM patients as well as control group: segmented-PSIR>MOCO-PSIR> single-shot-PSIR (P < 0.05). In the whole 646 segments analysis of DCM patients, the ratio unable to judge in segmented-PSIR was up to 25.5%, but only 1.4% in MOCO-PSIR. Significant difference was found in the three groups. While in the 374 segments of control group, no statistical difference was found in comparison of incapability to judge. Acquisition time covered left ventricular: (5.6±1.7) min in segmented-PSIR, (0.4±0.2) min in single-shot-PSIR and (4.5±1.1) min in MOCO-PSIR. Pairwise comparison of acquisition time among three scanning techniques was statistically significant (P < 0.001).  Conclusion  MOCO-PSIR-LGE has better clinical significance than conventional delayed enhanced scan sequences in the diagnosis of myocardial fibrosis in the patients with heart failure caused by dilated cardiomyopathy.