摘要
目的:探讨多参数心脏磁共振在全面评估系统性红斑狼疮(SLE)患者心脏损害的临床应用价值。方法:回顾性分析37例临床确诊的SLE患者(患者组)与21例健康对照者(对照组)。对两组均行多参数CMR检查,包括心脏电影、黑血T_(2)WI、增强前T_(1)/T_(2)-mapping、延迟成像(LGE)以及增强后T_(1)-mapping成像。结果:SLE患者组年龄44±14岁,男性6例(16%)。超声心动图心脏异常患者27例(73%),心电图异常24例(65%)。CMR表现异常31例,其中9例(24%)出现心肌水肿;17例(46%)共81个(30%)心肌节段出现LGE,主要表现为心外膜下及心肌中层的条形、斑片状病灶,主要分布在基底段下间壁(19%)、中间段下间壁(14%),其次是基底段前间壁、下壁和下侧壁(均为11%),较少累及心尖段。27例(73%)出现心包增厚、心包积液和/或心包强化。与健康对照组相比,SLE患者左心室容积及功能参数均未见显著性差异(所有P>0.05),而心肌组织定量参数差异显著,SLE患者增强前T_(1)值、T_(2)值及细胞外容积分数(ECV)显著高于健康对照组(所有P值≤0.001),而增强后T_(1)值显著低于健康对照组(P=0.045)。结论:多参数CMR可以从形态、结构、功能及组织特征对SLE心脏损害进行系统性、全面一站式评估,并能在SLE患者心肌损害发生形态学和/或功能学异常之前更早更敏感地检测到组织学异常,具有重要的临床实践指导价值。
Objective:To investigate the clinical application value of multiparameter cardiovascular magnetic resonance(CMR)in the comprehensive assessment of cardiac impairment in patients with systemic lupus erythematosus(SLE).Methods:A retrospective analysis was conducted on 37 patients clinically confirmed SLE patients(patient group)and 21 healthy controls(control group).All subjects underwent multiparameter CMR examination,including cardiac cine imaging,black-blood T_(2)-weighted imaging(T_(2)WI),native T_(1) and T_(2)-mapping,late gadolinium enhancement(LGE)imaging,and post-contrast T_(1)-mapping.Results:The SLE patient group had a mean age of 44±14 years,including 6 males(16%).Echocardiographic abnormalities were present in 27 patients(73%),and electrocardiographic(ECG)abnormalities were found in 24 patients(65%).Abnormal CMR findings were observed in 31 patients.Among them,9 patients(24%)exhibited myocardial edema.LGE was detected in 17 patients(46%),involving a total of 81 myocardial segments(30%).The lesions mainly presented as strip-shaped or patchy foci.The LGE lesions typically presented as linear or patchy patterns located predominantly in the subepicardium or mid-myocardium.These lesions were most frequently distributed in the basal inferoseptal segments(19%)and mid inferoseptal segments(14%),followed by the basal anteroseptal,inferior,and inferolateral segments(all 11%).The apical segments were rarely involved.Pericardial abnormalities,including thickening,effusion,and/or enhancement,were observed in 27 patients(73%).Compared with the healthy control group,SLE patients showed no significant differences in left ventricular volumetric and functional parameters(all P>0.05).However,significant differences were found in quantitative tissue characterization parameters.SLE patients had significantly higher native T_(1) values,T_(2) values,and extracellular volume(ECV)than the healthy controls(all P≤0.001),while post-contrast T_(1) values were significantly lower than those of the healthy controls(P=0.045).Conclusion:Multiparameter CMR enables a systematic,comprehensive,and one-stop assessment of cardiac involvement in SLE,encompassing morphology,structure,function,and tissue characteristics.Importantly,it can detect histological abnormalities earlier and more sensitively,even before the onset of overt morphological or functional changes in the myocardium of SLE patients,underscoring its significant clinical utility.
作者
韩瑞
蒋鸿
彭勇
刘兴华
朱华敏
邹亮
HAN Rui;JIANG Hong;PENG Yong(Wuhan No.1 Hospital,Wuhan 430022,China)
出处
《放射学实践》
北大核心
2025年第11期1428-1434,共7页
Radiologic Practice
基金
湖北省科学自然基金项目(2025AFC105)。
关键词
系统性红斑狼疮
心脏磁共振
组织特征
心脏损害
Systemic lupus erythematosus
Cardiac magnetic resonance
Tissue characterization
Cardiac involvement
作者简介
韩瑞(1984-),男,安徽亳州人,硕士,副主任医师,主要从事心脏大血管及胸部影像学诊断工作;通讯作者:韩瑞,E-mail:hanrui31@163.com。
