平扫多参数心脏磁共振早期诊断淀粉样变性心肌受累及评价疗效的研究

Amyloidosis is a group of diseases in which amyloid protein is deposited in the extracellular matrix, causing damage and dysfunction of tissues and organs at the deposition site. Patients often have serious illness and high mortality. The heart is one of the most commonly involved organs and has the most important impact on prognosis. Cardiac magnetic resonance can be a one-stop comprehensive assessment of cardiac morphology and movement, myocardial perfusion, and myocardial tissue components. It has become the most reliable imaging test for cardiac amyloidosis diagnosis and prognosis evaluation, but there is still a risk of contrast agents. Problems such as unclear value of efficacy evaluation need to be resolved. This study intends to use the non-contrast magnetic resonance chemical exchange saturation transfer imaging to reveal the characteristics and dynamic changes of amyloidosis myocardial lesions from the perspective of myocardial metabolism. In combination with other non-contrast parameters, to investigate its ability of myocardial involvement early diagnosis and therapeutic effect evaluation. Therefore is expected to replace the traditional contrast agent enhancing parameters, improve the efficiency of examination, reduce the risk of side effects, provide a scientific basis for early intervention and follow-up prognosis, so that more patients can benefit from it.

淀粉样变性是由于淀粉样蛋白沉积在细胞外基质，造成沉积部位组织和器官损伤、功能障碍的一组疾病，患者往往病情重，病死率高。心脏是轻链型淀粉样变性最常累及的器官之一，也是对预后影响最重要的器官。心脏磁共振可以对心脏形态和运动、心肌灌注和组织成分进行“一站式”综合评估，已经成为心脏淀粉样变性诊断和预后评价的最可靠影像学检查手段，但仍存在钆对比剂禁忌、疗效评价价值未明等问题亟待解决。本研究拟利用无对比剂磁共振化学交换饱和转移（Chemical exchange saturation transfer, CEST）成像，从心肌代谢角度来揭示淀粉样变性心肌病变特点及其动态变化，并结合其他平扫参数早期检出淀粉样变性心肌受累，有效地进行疗效评估，从而有望替代传统的钆对比剂增强参数，提高检查效率、降低副反应风险，为早期干预和随访预后提供科学依据，使更多患者得以从中受益。

淀粉样变性是由于淀粉样蛋白沉积在细胞外基质，造成沉积部位组织和器官损伤、功能障碍的一组疾病，患者往往病情重，病死率高。心脏是轻链型淀粉样变性最常累及的器官之一，也是对预后影响最重要的器官。心脏磁共振可以对心脏形态和运动、心肌灌注和组织成分进行“一站式”综合评估，已经成为心脏淀粉样变性诊断和预后评价的最可靠影像学检查手段，但仍存在钆对比剂禁忌、疗效评价价值未明等问题亟待解决。本研究将无对比剂磁共振化学交换饱和转移（Chemical exchange saturation transfer, CEST）成像新技术成功应用于淀粉样变性患者，证实其可用于疾病诊断及严重程度评估，实现转化医学研究。基于总体纵向应变、T2等构建心脏磁共振平扫多参数模型，实现淀粉样变性心肌受累的早期检出、预后评价，并有效地进行疗效评估。本研究有助于解决该领域目前存在的瓶颈问题，有望替代传统的钆对比剂增强参数，提高检查效率、降低副反应风险，为该疾病的早期干预和随访预后提供科学依据，使更多患者得以从中受益。