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肥厚型心肌病心肌纤维化磁共振评价临床研究进展

Clincial Research Progress in Using Magnetic Resonance Imaging to Assess Myocardial Fibrosis in Hypertrophic Cardiomyopathy

  • 摘要: 肥厚型心肌病(hypertrophic cardiomyopathy, HCM)是导致青少年和运动员发生心源性猝死最常见的原发性心肌病。我国现有HCM患者超过100万,位居全球首位,且患病人数呈逐年上升趋势。心肌纤维化是HCM最重要的病理学改变,也是患者发生恶性室性心律失常、心室重构及心衰的首要原因。目前心脏MRI是无创检测心肌纤维化的“金标准”,包括钆对比剂延迟增强序列、T1 mapping序列等显示出良好的应用前景,不仅为阐释HCM组织学特征提供了切实可行的影像学手段,还有助于对患者远期预后进行评价。本文从钆对比剂延迟增强成像、T1 mapping组织特征成像、T1ρ mapping组织特征成像、基于MRI的影像组学与机器学习模型4个方面,就近年来HCM心肌纤维化MRI研究进展作一综述。

     

    Abstract: Hypertrophic cardiomyopathy (HCM) is the most common type of primary cardiomyopathy that causes sudden cardiac death in adolescents and athletes. With over 1 million HCM patients, China has the largest population of HCM patients in the world, and the total number of cases is increasing year on year. Myocardial fibrosis is the most important histopathological characterization in HCM and is regarded as the primary cause of malignant ventricular arrhythmia, cardiac remodeling, and heart failure. At present, cardiac magnetic resonance imaging (MRI) serves as the gold-standard imaging modality for noninvasive evaluation of myocardial fibrosis. Several techniques, such as late gadolinium enhancement and T1 mapping, are showing considerable promise for potential applications. These techniques have emerged as viable imaging approaches to the elucidation of HCM tissue characterization. They are also helpful in predicting the long-term prognosis of patients. Herein, we summarized recent advances in using cardiac MRI to assess myocardial fibrosis in HCM from four perspectives, including late gadolinium enhancement, T1 mapping, T1ρ mapping, and MRI-based radiomics and machine learning models.

     

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