基于心脏磁共振影像组学及特征追踪技术解析肥厚型心肌病心肌异质性的新视角

陆熠婷; 周燕锋; 凌云 谷; 翼 严; 晓平 谢; 宇 张

doi:10.62177/fcdt.v2i3.1455

作者

陆熠婷南通大学附属江阴医院放射科
周燕锋江阴泰富临港医院放射科
谷凌云南通大学附属江阴医院放射科
严翼南通大学附属江阴医院放射科
谢晓平中国人民解放军63680部队医院放射科
张宇南通大学附属江阴医院放射科

DOI:

https://doi.org/10.62177/fcdt.v2i3.1455

关键词:

心脏磁共振, 影像组学, 特征追踪, 整体纵向应变, 肥厚型心肌病, 心肌异质性

摘要

目的：应用影像组学技术定量分析肥厚型心肌病（Hypertrophic Cardiomyopathy,HCM）患者中钆对比剂延迟强化（late gadolinium contrast enhancement,LGE）阴性且‌舒张末期室壁厚度（End-Diastolic Wall Thickness, EDWT）正常的“远端心肌”（Remote Myocardium）微观纹理特征。通过对比瘢痕区、单纯肥厚区和远端心肌的组学差异，探讨远端心肌微观改变对整体纵向应变（Global Longitudinal Strain,GLS）受损的独立影响，重新评估该区域在HCM病理生理中的地位。材料与方法：回顾性分析2021年1月至2025年11月确诊的120例HCM患者资料。所有患者均行3.0T心脏磁共振（Cardiac Magnetic Resonance,CMR）检查。基于LGE及EDWT‌，在舒张末期电影图像上将左室心肌分割为Zone 1（瘢痕区）、Zone 2（单纯肥厚区）和Zone 3（远端心肌）。使用PyRadiomics提取影像组学特征，通过LASSO回归构建各区域的影像组学评分（Rad-Score），并采用多重线性回归分析各区域评分与GLS的相关性及独立贡献。结果：纹理分析显示心肌微观结构呈显著的梯度分布（P＜0.001）：Zone 3（远端心肌）熵值最高（均值≈1.41），显著高于Zone 1（瘢痕区，均值≈1.15）和Zone 2（单纯肥厚区，均值≈0.83）。Zone 3 Rad-Score与GLS呈显著正相关（r＝0.523, P＜0.001），提示微观纹理紊乱程度与GLS恶化密切相关。多因素回归分析表明，Zone 2（单纯肥厚区，β＝0.30）与Zone 3（远端心肌，β＝0.29）均为GLS受损的独立预测因子，两者贡献度相当；而Zone 1（瘢痕区）在校正后未显示出统计学显著的独立贡献（P＞0.05）。结论：影像组学分析证实HCM患者“外观正常”的远端心肌存在显著的微观结构异常。这种弥漫性的隐匿性病变与显性心肌肥厚共同驱动了整体心功能的恶化，提示临床评估应关注远端心肌的潜在病理改变。

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