2020 JTI (Black blood LGE sequence in Ischemic Cardiomyopathy)

Purpose: The aim of this study was to assess the reliability of a 2D dark-blood phase-sensitive late gadolinium enhancement sequence (2D-DBPSLGE) compared with 2D phase-sensitive inversion recovery late gadolinium enhancement sequence (2D-BBPSLGE) in patients with ischemic cardiomyopathy (ICM). Materials and Methods: A total of 73 patients with a clinical history of ICM were prospectively enrolled. The following endpoints were evaluated: (a) comparison of image quality between 2D-BBPSLGE and 2D-DBPSLGE for differentiation between blood pool-late gadolinium enhancement (LGE), remote myocardium-LGE, and blood poolremote myocardium; (b) diagnostic accuracy of 2D-DBPSLGE compared with gold standard 2D-BBPSLGE for the evaluation of infarcted segments; (c) diagnostic accuracy of 2D-DBPSLGE for the evaluation of microvascular obstruction (MVO); (d) comparison of transmurality index between 2D-BBPSLGE and 2D-DBPSLGE; (e) comparison of papillary muscle hyperenhancement between 2D-BBPSLGE and 2DDBPSLGE; inter-reader agreement for depiction of hyperenhanced segments in both LGE sequences. Data were analyzed using paired t test, Wilcoxon test, and McNemar test, and η2 coefficient and intercorrelation coefficient (ICC). Results: Image quality was superior for 2D-DBPSLGE for differentiation of blood pool-LGE (P<0.001). 2D-DBPSLGE, compared with 2D-BBPSLGE, showed a sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 96.93%, 99.89%, 99.71%, 98.78, and 99.04%, respectively. Concerning MVO detection, 2D-DBPSLGE showed a sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 66.67%, 100.00%, 100.00%, 80.95%, and 86.21%, respectively. 2DDBPSLGE underestimated the transmurality (P=0.007) and identified papillary muscle hyperenhancement (P<0.001). Both LGE sequences showed comparable interobserver agreement for the evaluation of infarcted areas (2D-BBPSLGE: ICC 0.99;2D-DBPSLGE: ICC 0.99). Conclusions: Compared with 2D-BBPSLGE, 2D-DBPSLGE sequences provide better differentiation between LGE and blood-pool, while underestimating LGE trasmurality and the presence of MVO.

研究目的：本研究旨在对比2D黑血相位敏感钆延迟增强序列（2D-DBPSLGE）与2D血池相位敏感钆延迟增强序列（2D-BBPSLGE）在缺血性心肌病（ICM）患者中的应用可靠性。

材料与方法：前瞻性纳入73例具有缺血性心肌病临床病史的患者。本研究评估以下研究终点：（a）对比2D-BBPSLGE与2D-DBPSLGE在区分血池-钆延迟增强（LGE）、远端心肌-LGE以及血池-远端心肌信号时的图像质量；（b）以金标准2D-BBPSLGE为参照，评估2D-DBPSLGE检测梗死节段的诊断准确性；（c）评估2D-DBPSLGE检测微血管阻塞（MVO）的诊断准确性；（d）对比2D-BBPSLGE与2D-DBPSLGE的透壁指数；（e）对比2D-BBPSLGE与2D-DBPSLGE的乳头肌强化表现；同时评估两种LGE序列在显示强化梗死节段时的阅片者间一致性。数据分析采用配对t检验、威尔科克森检验、麦克尼马尔检验，以及η²系数和组内相关系数（ICC）。

结果：在区分血池-LGE时，2D-DBPSLGE的图像质量显著更优（P<0.001）。相较于2D-BBPSLGE，2D-DBPSLGE的灵敏度、特异度、阳性预测值、阴性预测值及诊断准确率分别为96.93%、99.89%、99.71%、98.78%及99.04%。在微血管阻塞检测方面，2D-DBPSLGE的灵敏度、特异度、阳性预测值、阴性预测值及诊断准确率分别为66.67%、100.00%、100.00%、80.95%及86.21%。2D-DBPSLGE会低估LGE的透壁程度（P=0.007），且检出的乳头肌强化例数更少（P<0.001）。两种LGE序列在评估梗死面积时的观察者间一致性均优异（2D-BBPSLGE：ICC 0.99；2D-DBPSLGE：ICC 0.99）。

结论：相较于2D-BBPSLGE，2D-DBPSLGE序列可更好地区分LGE与血池信号，但会低估LGE透壁程度，且对微血管阻塞的检出能力有限。