Detection of Myocardial Fibrosis in Systemic Sclerosis by Contrast-Enhanced Magnetic Resonance Imaging

 

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Zusammenfassung

Ziel: Ziel der vorliegenden Studie war es, die Prävalenz sowie das Muster einer späten myokardialen Kontrastmittelanreicherung (Late Gadolinium Enhancement; LGE) als In-vivo-Korrelat einer myokardialen Fibrose bei kardial asymptomatischen Patienten mit systemischer Sklerodermie zu untersuchen. Material und Methoden: Eine kardiale MRT wurde erfolgreich in 34 Patienten (30 Frauen, 14 Männer, mittleres Alter 54 ± 14 Jahre) mit gesicherter systemischer Sklerodermie sowie in einem nach Alter, Geschlecht und kardiovaskulären Risikofaktoren gematchten Kontrollkollektiv durchgeführt. Alle Untersuchungen wurden an einem 1,5T-MR-Scanner (Avanto, Siemens Medical Solutions, Erlangen, Deutschland) durchgeführt. Zehn bis 15 min nach intravenöser Injektion von 0,2 mmol Gd-DTPA pro Kg Körpergewicht wurde eine 2-D-Inversion-Recovery präparierte gespoilte Gradientenechosequenz (TR 8,0 ms, TE 4,0 ms, TI 180 – 240 ms, FA 20°, Schichtdicke 8 mm, Auflösung 1,2 × 1,2 mm²) in Standardkurz- und Langachsenschichten aufgenommen, um ein myokardiales LGE zu detektieren. Ergebnisse: Fleckige unscharf begrenzte sowie scharf begrenzte Kontrastmittelanreicherungen fanden sich in 5 von 34 (15 %) Sklerodermie-Patienten vorwiegend intramural unter Aussparung des subendo- und subepikardialen Myokards in den basalen Schichten des linken Ventrikels. Eine fokale Kontrastmittelanreicherung wurde in einer Kontrolle (3 %, p > 0,05) im apikalen Septum beobachtet. Insgesamt wurden Kontrastmittelanreicherungen in 15 Segmenten der Sklerodermie-Patienten und nur in 1 Segment der Kontrollen beobachtet (p < 0,005). Schlussfolgerung: Unsere Studie zeigt eine signifikant höhere Anzahl an Segmenten mit pathologischer Kontrastmittelanreicherung bei Patienten mit systemischer Sklerodermie im Vergleich zu unserem Kontrollkollektiv und belegt damit die Fähigkeit der kontrastverstärkten kardialen MRT, das entscheidende Kennzeichen einer kardialen Beteiligung bei systemischer Sklerodermie – die myokardiale Fibrose – in vivo nachzuweisen.

Abstract

Purpose: Our study aimed to assess the prevalence and pattern of late gadolinium enhancement (LGE) as an in vivo correlate of myocardial fibrosis in cardiac asymptomatic patients with systemic sclerosis (SSc). Materials and Methods: Cardiac magnetic resonance imaging was successfully performed in 34 patients (30 female, 4 male, mean age of 54 ± 14 years) with proven SSc and in controls with matching age, sex and cardiovascular risk factors. All examinations were performed on a 1.5 T MR system (Avanto, Siemens, Germany). 2D inversion recovery spoiled gradient echo images (TR 8.0 msec, TE 4.0 msec, TI 180 – 240 msec, FA 20°, slice thickness 8 mm, in-plane resolution 1.2 × 1.2 mm²) were acquired 10 to 15 min after injection of 0.2 mmol Gd-DTPA per kg body weight to detect myocardial LGE. Results: Poorly defined, patchy as well as well-defined focal areas of LGE were detected predominantly in the mid-myocardial layer of the basal left ventricular segments in 5 of 34 (15 %) SSc patients. A focal area of LGE was observed within the apical septum in one control (3 %, p > 0.05). LGE was observed in a total of 15 segments of the SSc patients and in 1 segment of the controls (p < 0.005). Conclusion: Our results revealed a significantly higher number of LGE positive segments in patients with SSc compared to matched controls, and demonstrate the ability of contrast-enhanced MRI to detect myocardial fibrosis, the hallmark of scleroderma heart disease, in-vivo.

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2 ¹ McNemar test.

5 ² Student-t test.

6 ³ χ²-test.

Dr. Kai Naßenstein

Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Essen

Hufelandstraße 55

45122 Essen

Phone: ++ 49/2 01/7 23 23 11

Fax: ++ 49/2 01/7 23 15 48

Email: Kai.Nassenstein@uni-due.de