rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2023-2982KIRZLArpcardio-2982Research ArticleORIGINAL STUDIESОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯPotential for intramyocardial fibrosis detection based on estimation of extracellular volume using dual-energy computed tomographyВозможности определения интрамиокардиального фиброза на основе расчета объема внеклеточного пространства с помощью двухэнергетической компьютерной томографииhttps://orcid.org/0000-0002-1266-4926МершинаЕ. А.MershinaE. A.

Мершина Елена Александровна, к.м.н., доцент кафедры лучевой диагностики и лучевой терапии, заведующая отделением рентгенодиагностики с кабинетами МРТ и КТ Медицинского научно-образовательного центра

Москва

eLibrary SPIN: 6897-9641

Mershina Elena A., PhD, Associate Professor of Radiology Department, Head of the Department of Radiological Diagnostics

Moscow

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elena_mershina@mail.ruhttps://orcid.org/0000-0002-0894-1994ФилатоваД. А.FilatovaD. A.

Филатова Дарья Андреевна, аспирант кафедры лучевой диагностики и терапии факультета фундаментальной медицины, врач-рентгенолог отделения рентгенодиагностики с кабинетами МРТ и К Медицинского научно-образовательного центра

Москва

eLibrary SPIN: 2665-5973

 

Filatova Daria A., Postgraduate student of the Radiology Department, Faculty of Fundamental Medicine; radiologist of the Department of Radiological Diagnostics

Moscow

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dariafilatova.msu@mail.ruhttps://orcid.org/0000-0002-8402-7643ЛисицкаяМ. В.LisitskayaM. V.

Лисицкая Мария Валерьевна , к.м.н., врач-рентгенолог отдела рентгенодиагностики с кабинетами МРТ и КТ Медицинского научно-образовательного центра

Москва

eLibrary SPIN 2301-8480

Lisitskaya Maria V., PhD, radiologist of the Department of Radiological Diagnostics

Moscow

eLibrary SPIN 2301-8480

lissenok@inbox.ruhttps://orcid.org/0000-0003-3629-0591РыжковаЕ. В.RyzhkovaE. V.

Рыжкова Евгения Викторовна, ассистент кафедры лучевой диагностики факультета фундаментальной медицины ФГБОУ ВО «МГУ им. М.В. Ломоносова»; младший научный сотрудник отделения клинической кардиологии ФГБУ «НМИЦ терапии и профилактической медицины» Минздрава России

Москва

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Ryzhkova Evgenia V., Assistant of Radiology Department, Faculty of Fundamental Medicine, Lomonosov Moscow State University; Junior Researcher, Department of Clinical Cardiology, National Medical Research Centre for Therapy and Preventive Medicine

Moscow

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evgeniya.ryzhkova89@gmail.comhttps://orcid.org/0000-0002-9024-5364МясниковР. П.MyasnikovR. P.

Мясников Роман Петрович, к.м.н., старший научный сотрудник отдела клинической кардиологии ФГБУ «НМИЦ терапии и профилактической медицины» Минздрава России

Москва

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Myasnikov Roman P., Senior Researcher of the Department of Clinical Cardiology of National Medical Research Centre for Therapy and Preventive Medicine

Moscow

eLibrary SPIN 1433-6712

andorom@yandex.ruhttps://orcid.org/0000-0002-5649-2193СиницынВ. Е.SinitsynV. E.

Синицын Валентин Евгеньевич, д.м.н., профессор, заведующий отделом лучевой диагностики МНОЦ, заведующий кафедрой лучевой диагностики и лучевой терапии факультета фундаментальной медицины

Москва

eLibrary SPIN: 8449-6590

Sinitsyn Valentin E., Head of the Radiology Department 

Moscow

eLibrary SPIN: 8449-6590

vsini@mail.ruМедицинский научно-образовательный центр Московского государственного университета им. М. В. ЛомоносоваРоссияMedical Research and Educational Center, Lomonosov Moscow State UniversityRussian FederationМедицинский научно-образовательный центр Московского государственного университета им. М. В. Ломоносова; Национальный медицинский исследовательский центр терапии и профилактической медициныРоссияMedical Research and Educational Center, Lomonosov Moscow State University; National Medical Research Centre for Therapy and Preventive MedicineRussian Federation202328122023196565571Copyright © Mershina E.A., Filatova D.A., Lisitskaya M.V., Ryzhkova E.V., Myasnikov R.P., Sinitsyn V.E., 20232023Мершина Е.А., Филатова Д.А., Лисицкая М.В., Рыжкова Е.В., Мясников Р.П., Синицын В.Е.Mershina E.A., Filatova D.A., Lisitskaya M.V., Ryzhkova E.V., Myasnikov R.P., Sinitsyn V.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/2982

An increase in left ventricular (LV) extracellular volume (ECV) is an important parameter of LV morphology and is considered synonymous with myocardial fibrosis, as well as a reliable marker of myocardial injury and impaired cardiac function. Accurate methods for detecting and assessing myocardial fibrosis are very important for clinical practice. The current standard for myocardial fibrosis imaging is delayed gadolinium enhanced cardiac magnetic resonance imaging (MRI) or T1 mapping, but these techniques have limitations. They can be avoided by using dual-energy computed tomography (DECT), which makes it possible to identify myocardial fibrosis, including small-focal fibrosis, in two different ways (subtraction technique and iodine density measurement technique). The literature analysis carried out by the authors showed good comparability of MRI and DECT results in determining ECV in patients with various heart diseases of both ischemic and non-ischemic nature, including cardiomyopathies, aortic stenosis, pulmonary hypertension, sarcoidosis, and amyloidosis. In addition, the use of DECT to identify myocardial fibrosis is also possible if cardiac inflammation is suspected. In addition to evaluating the effectiveness of DECT compared with MRI, different scanning protocols were analyzed, since there is currently no consensus on the optimal contrast administration regimen. The issue of radiation exposure in modern DECT scanners is also separately considered. The authors showed that DECT is an important tool for determining ECV, which is of interest for clinical practice.

Увеличение объема внеклеточного пространства (extracellular volume, ECV) миокарда левого желудочка (ЛЖ) является важным показателем морфологии ЛЖ и рассматривается как синоним фиброза миокарда, а также как достоверный маркер повреждения миокарда и нарушения сердечной функции. Точные методы выявления и оценки фиброза миокарда очень важны для клинической практики. В настоящее время стандартом визуализации миокардиального фиброза является магнитно-резонансная томография (МРТ) сердца с контрастированием в режиме отсроченного гадолиниевого усиления или с применением технологии Т1-картирования (что возможно без введения контрастного препарата), однако у этих методик есть ограничения. Избежать их позволяет применение двухэнергетической компьютерной томографии (ДЭКТ), позволяющей идентифицировать миокардиальный фиброз, в том числе мелкоочаговый, двумя различными способами (методика субтракции и методика определения плотности йода). Проведенный авторами анализ литературы показал хорошую сопоставимость результатов МРТ и ДЭКТ в определении ECV у пациентов с различными заболеваниями сердца как ишемической, так и неишемической природы, в том числе кардиомиопатиями, аортальным стенозом, легочной гипертензией, саркоидозом, амилоидозом. Кроме того, применение методики ДЭКТ для определения наличия миокардиального фиброза возможно и при подозрении на воспалительное поражение сердца. Помимо оценки эффективности ДЭКТ по сравнению с МРТ, были проанализированы различные протоколы сканирования, поскольку единого мнения по поводу оптимального режима введения контрастного препарата в настоящее время не существует. Также отдельно рассмотрен вопрос о лучевой нагрузке в современных ДЭКТ-сканерах. Авторами было показано, что ДЭКТ является важным инструментом для определения ECV, что представляет интерес для клинической практики.

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The authors declare that there are no conflicts of interest present.