基于可变形配准算法的心肌形变分析对肥厚型心肌病的诊断及预后预测的价值探讨

doi:10.16150/j.1671-2870.2019.03.007

摘要/Abstract

摘要：

目的： 探讨基于可变形图像配准（deformableregistration algorithms,DRA）算法的心肌形变分析在肥厚型心肌病（hypertrophic cardiomyopathy,HCM）中的诊断及预后预测价值。方法： 回顾性收集本院确诊的HCM患者23例,另招募23名年龄性别匹配的健康志愿者（对照组）,均行心脏MRI扫描。HCM组按有无心肌延迟强化（late gadoli-nium enhancement,LGE）分为LGE（+）组和LGE（-）组。采用基于DRA算法的TrufiStrain软件进行心肌形变分析,测量整体径向应变峰值（global peak radial strain, GPRS）、整体环向应变峰值（global peak circumferential strain, GPCS）和整体纵向应变峰值（global peak longitudinal strain, GPLS）以及心尖部、中部和基底部的径向应变峰值（peak radial strain, PRS）、环向应变峰值（peak circumferential strain, PCS）和纵向应变峰值（peak longitudinal strain,PLS）,探讨心肌形变参数在HCM中的诊断效能及其与心室壁厚度、LGE间的关系。结果： 除心尖部PCS外,HCM组的GPRS、GPCS、GPLS及基底部和中部PRS、PCS、PLS,以及心尖部的PRS、PLS均明显低于对照组（P<0.05）,而HCM组的整体及各部分3个方向（环向、纵向、径向）的应变率比值均明显小于对照组（P<0.05）,且LGE（-）组及对照组各部分的PRS、PCS、PLS及3个方向的舒张早期和晚期应变率比值[径向应变率比值（ratio of radial strain rate during early and late diastole,REL）,环向应变率比值（ratio of circumferential strain rate during early and late diastole,CEL）和纵向应变率比值（ratio of longitudinal strain rate during early and late diastole,LEL）]均大于LGE（+）组（P<0.05）。GPRS、GPCS、GPLS、REL、CEL、LEL均与左心室心肌最大厚度明显相关（P<0.05）。GPRS、GPCS、GPLS、REL、CEL及LEL诊断HCM的曲线下面积分别为0.686、0.905、0.921、0.972、0.974及0.917,GPRS、GPCS、GPLS、REL、CEL及LEL预测HCM患者是否有LGE的曲线下面积均大于0.871。结论： 基于DRA的心肌形变分析在诊断HCM、预测HCM患者发生LGE中具有重要价值,且与心肌厚度密切相关。

关键词: 可变形图像配准, 心肌应变成像, 肥厚型心肌病, 心肌延迟强化

Abstract:

Objective: To explore the value of myocardial strain analysis based on deformable registration algorithm (DRA) in the diagnosis of hypertrophic cardiomyopathy (HCM) and its relationship with prognostic risk factors. Methods: Twenty- three patients who were diagnosed as HCM in our hospital with (50.70±14.80) years old were collected retrospectively.In addition, 23 volunteers who matched the age and sex were also recruited. All volunteers underwent a cardiac MRI (CMR) scan consistent with the patients with HCM. According to the presence or absence of late gadolinium enhancement (LGE), the HCM group was divided into non-enhanced [LGE(-)] subgroup andenhanced [LGE(+)] subgroup.Images of patients with HCM and volunteers were analyzed using the DRA-based myocardial deformation post-processing software named TrufiStrain. The measurement parameters includedglobal peak radial strain (GPRS), global peak circumferential strain (GPCS), global peak longitudinal strain (GPLS), and peak radial, circumferential and longitudinal strain(PRS, PCS, and PLS) of different parts of the left ventricle (the apex, the middle of left ventricle, and the base). Student-t test or Mann-Whitney, Pearson correlation analysis, ROC curve were used to statistically analyze the diagnostic efficacy of myocardial deformation parameters in HCM and its relationship with left ventricular wall thickness and LGE. Results: Other than apical PCS, all GPRS, GPCS, GPLS, basal and medial PRS, PCS, PLS, and apical PRS, PLS in patients with HCM were significantly lower than those in healthy volunteers (P<0.05). The global, apical, basal and medial radial, circumferential and longitudinal strain and strain rate of the patients with HCM were significantly smaller than those of the control group (P<0.05). The basal and medial PRS, PCS, PLS of both the control group and the LGE(-) subgroup were significantly higher than those in LGE (+) subgroup (P<0.05). The ratio of radialstrain rate during early and late diastole (REL）, circumferentialstrain rate during early and late diastole (CEL) and longitudinal strain rate during early and late diastole (LEL) of patients in LGE (+) subgroup were smaller than those in LGE(-) subgroup and the control group (P<0.05). GPRS, GPCS, GPLS, REL, CEL and LEL were all significantly correlated with the maximum thickness of left ventricular myocardium (P<0.05). ROC curve analysis showed that areas under the curve of GPRS, GPCS, GPLS, REL, CEL and LEL for the diagnosis of HCM were 0.686, 0.905, 0.921, 0.972, 0.974 and 0.917, respectively. The areas under the curve of GPRS, GPCS, GPLS, REL, CEL and LEL for predicting LGE in patients with HCM were greater than 0.871. Conclusions: DRA-based myocardial deformation analysis is of great value in diagnosing HCM and predicting LGE in HCM patients and is closely correlated to myocardial thickness.

Key words: Deformableregistration algorithms, Myocardialstrainimaging, Hypertrophic Cardiomyopathy, Late Gadolinium Enhancement

中图分类号:

R445.4

朱兰, 顾圣佳, 陈炽华, 曹琪琪, 周皛月, 严福华, 闵佶华. 基于可变形配准算法的心肌形变分析对肥厚型心肌病的诊断及预后预测的价值探讨[J]. 诊断学理论与实践, 2019, 18(03): 278-285.

ZHU Lan, GU Shengjia, CHEN Chihua, CAO Qiqi, ZHOU Xiaoyue, YAN Fuhua, MIN Jihua. The value of myocardial deformation analysis based on deformable registration algorithm in the diagnosis and prediction of prognosis of hypertrophic cardiomyopathy[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(03): 278-285.

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分组	对照组	HCM组	P值
男性（n）	18（78.26%）	18（78.26%）	/
年龄（岁）	50.26±8.66	50.70±14.18	0.901
身高（cm）	167.65±4.42	166.57±7.15	0.539
体重（kg）	65.83±65.57	72.17±15.00	0.067
心率（次/分）	65.78±7.66	65.61±8.94	0.944
BSA（m²）	1.71±0.09	1.79±0.22	0.141
EDV（mL）	109.53±20.58	131.08±25.93	0.003
EDVI（mL/m²）	63.92±11.26	73.81±14.02	0.011
ESV（mL）	45.59±13.81	55.55±14.86	0.023
ESVI（mL/m²）	26.60±7.82	31.31±8.66	0.049
EDM（g）	82.08±17.62	195.57±87.64	<0.001
EDMI（g/m²）	47.73±8.88	109.74±17.54	<0.001
ESM（g）	82.63±18.73	194.78±16.89	<0.001
ESMI（g/m²）	48.02±9.40	109.15±16.38	<0.001
SV（mL）	63.94±9.09	75.53±16.17	0.004
LVEF（%）	59.06±6.25	58.00±7.86	0.614

部位	组别	径向应变		环向应变		纵向应变
部位	组别	峰值（%）	率比值	峰值（%）	率比值	峰值（%）	率比值
整体	对照组	29.08±5.87	3.42±0.67	-15.43±1.43	2.67±1.45	-12.92±1.85	2.28±0.55
	HCM组	23.77±10.14	1.73±0.55	-11.15±3.55	1.45±0.90	-8.16±4.34	1.18±0.54
	P值	0.037	<0.001	<0.001	<0.001	<0.001	<0.001
基底部	对照组	38.33±9.02	3.34±0.69	-17.15±2.53	2.78±0.76	-22.90±3.34	2.16±0.68
	HCM组	23.81±11.42	1.66±0.99	-11.88±3.60	1.67±1.36	-15.34±5.85	1.41±0.79
	P值	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001
中部	对照组	38.25±8.08	3.73±1.04	-16.64±2.37	3.51±1.18	-20.41±3.31	3.05±1.28
	HCM组	24.29±10.90	1.65±0.90	-11.70±4.86	1.65±1.39	-14.28±6.39	1.43±0.76
	P值	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001
心尖部	对照组	37.97±7.74	3.61±1.04	-17.45±2.49	3.15±1.25	-20.48±3.90	2.54±1.10
	HCM组	27.34±10.37	1.95±1.15	-15.11±6.93	1.98±1.44	-16.35±6.82	1.78±1.06
	P值	<0.001	<0.001	0.139	0.005	0.016	0.02

部位		LGE分组	例数（n）	径向应变（%）	P值	环向应变（%）		纵向应变（%）	P值
基底部	HCM组	+	16	18.44±8.37	<0.001^a)	-10.09±2.03	<0.001^a)	-13.61±4.17	<0.001^a)
		-	7	36.07±7.15	<0.001^b)	-15.98±3.00	<0.001^b)	-20.02±3.83	<0.001^b)
	对照组		23	38.33±9.02	0.538^c)	-17.15±2.53	0.310^c)	-22.90±3.34	0.080^c)
	P值			<0.001		<0.001		<0.001
中部	HCM组	+	16	18.86±5.99	<0.001^b)	-9.40±3.21	<0.001^a)	-13.26±5.66	0.003^a)
		-	7	36.70±9.35	<0.001^b)	-16.94±3.83	<0.001^b)	-19.35±3.13	<0.001^b)
	对照组		23	38.25±8.08	0.633^c)	-16.64±2.37	0.839^c)	-20.41±3.31	0.566^c)
	P值			0.002		<0.001		<0.001
心尖部	HCM组	+	10	17.5±5.22	<0.001^b)	-9.79±2.47	<0.001^a)	-10.41±3.57	<0.001^a)
		-	13	34.91±5.84	<0.001^b)	-19.2±6.45	<0.001^b)	-20.92±4.87	<0.001^b)
	对照组		23	37.97±7.74	0.118^c)	-16.28±5.28	0.215^c)	-20.48±3.90	0.772^c)
	P值			<0.001		<0.001		<0.001

部位	分组	LGE	例数	径向比值	P值	环向比值	P值	纵向比值	P值
基底部	HCM	+	16	1.13±0.47	<0.001^a)	0.90±0.49	<0.001^a)	0.98±0.36	<0.001^a)
		-	7	2.87±0.79	<0.001^b)	3.40±1.05	<0.001^b)	2.41±0.55	<0.001^b)
	对照组		23	3.73±1.04	0.155^c)	2.78±0.76	0.049^c)	2.16±0.68	0.317^c)
	P值			0.001		<0.001		<0.001
中部	HCM	+	16	1.17±0.49	<0.001^a)	0.96±0.58	<0.001^a)	1.03±0.39	0.004^a)
		-	7	2.75±0.56	<0.001^b)	3.23±1.44	<0.001^b)	2.36±0.54	<0.001^b)
	对照组		23	3.45±1.13	0.007^c)	3.51±1.18	0.896^c)	3.05±1.28	0.103^c)
	P值			<0.001		<0.001		<0.001
心尖部	HCM	+	10	1.13±0.36	<0.001^a)	2.59±1.15	<0.001^a)	3.61±1.04	<0.001^a)
		-	13	2.59±1.15	<0.001^b)	2.38±1.83	<0.001^b)	3.15±1.25	<0.001^b)
	对照组		23	3.61±1.04	0.008^c)	3.15±1.25	0.426^c)	2.54±1.10	0.817^c)
	P值			<0.001		<0.001		<0.001

部位	LGE	例数	心肌最大厚度（mm）	P值
基底部	LGE (+)	16	15.21±4.02	0.012
	LGE (-)	7	21.48±5.36
中部	LGE (+)	16	17.83±3.27	0.336
	LGE (-)	7	16.07±5.26
心尖部	LGE (+)	10	12.37±4.39	0.007
	LGE (-)	13	17.58±3.90