MRI与正电子发射计算机体层、单光子发射计算机体层显像检测活性心肌的对比研究  

Multimodality MRI in determination of myocardial viability:comparison with positron emission tomography and single photon emission computed tomography

作　　者：朱海云[1] 田建明[1] 王莉[1] 曾浩[1] 黄胜东[2] 徐训宇[2] 陆健[3] 

机构地区：[1]第二军医大学附属长海医院放射科,上海200433 [2]第二军医大学附属长海医院胸心外科,上海200433 [3]第二军医大学统计教研室,上海200433

出　　处：《中华放射学杂志》2005年第6期593-598,共6页Chinese Journal of Radiology

基　　金：国家自然科学基金资助项目(30270419)

摘　　要：目的评估各种影像学方法检测心肌活性的价值。方法建立慢性心肌缺血模型猪10只,按照美国心脏病协会推荐的方法将左心室分为16节段,分别于制作模型前和后1～2个月进行MR多技术联合应用扫描及正电子发射计算机体层显像(PET)、201铊单光子发射计算机体层显像(201TlSPECT)检查,判断心肌缺血区和坏死区的大小,并与病理结果对照,了解各种方法的敏感性、特异性。结果7只动物顺利完成所有检查,共计112个节段。静息时MR电影扫描共有10个(8.93%)节段运动丧失,4个(3.57%)节段运动轻度减弱,2个(1.78%)节段运动明显减弱;负荷后MR电影扫描共有10个(8.93%)节段运动丧失;心肌灌注扫描见34个(30.36%)节段缺血,心肌活性扫描见12个(10.71%)节段坏死;PET检查见17个(15.18%)节段为梗死心肌;SPECT检查见9个(8.04%)节段为梗死心肌;氯化三苯基四氮唑(TTC)染色见14个(12.50%)节段为无红染的苍白色梗死区。PET检出的坏死节段多于MR心肌活性扫描(χ2=5,P=0.0253,Kappa=0.8028)和电影扫描(χ2=7,P=0.0082,Kappa=0.7079),并有统计学意义;亦多于TTC染色显示的坏死节段,但无统计学意义(χ2=3,P=0.0833,Kappa=0.8879);SPECT检出的坏死节段较TTC染色显示的节段少,并有统计学意义(χ2=5,P=0.0253,Kappa=0.7590);MR电影检出的坏死节段较TTC染色显示的节段稍少,并有统计学意义(χ2=4,P=0.0455,Kappa=0.8100);MR心肌活性扫描检出的坏死节段和TTC染色显示的坏死节段相比无统计学意义(χ2=2,P=0.1573,Kappa=0.9130)。以TTC染色结果为金标准,MR电影、MR心肌活性扫描、PET和SPECT检出无活性心肌的敏感性、特异性分别为71.43%、100.00%;85.71%、100.00%;100.00%、96.94%;64.29%、100.00%。结论MR心脏检查可结合形态、功能及灌注多种方法检测活性心肌,清晰显示心肌梗死的位置、程度,并可对左室室壁运动进行直观显示,且价格相对PET便宜;PET检查高估心肌坏死范围,且不能判断心Objective To evaluate the diagnostic value for myocardial viability by using various imaging methods. Methods Chronic myocardial ischemia animal model in 10 pigs were established and underwent multi-modality MR imaging, PET(positron emission tomography)and ~ 201 Tl SPECT(single photon emission computed tomography)before and after 1 to 2 month modeling respectively. The size of myocardial ischemia and necrosis was judged and compared with pathological findings to assess the sensitivity and specificity of various methods. Results 7 pigs completed all examination successfully. At rest-cine MRI, 10(8.93%) segments were akinetic, 4(3.57%) segments were mild hypokinetic and 2(1.78%) segments were severely hypokinetic. During dobutamine infusion, 10(8.93%) segments were akinetic. Perfusion was abnormal in 34(30.36%) segments. Delayed hyperenhancement was observed in 12(10.71%) segments. PET showed 17(15.18%) segments of myocardial necrosis. SPECT showed 9(8.04%) segments of myocardial necrosis. Triphenyl tetrazolium chloride(TTC) determined 14(12.50%) segments of pale necrosis. Necrosis segments determined by PET significantly higher than contrast-enhanced MR imaging (χ~2= 5,P=0.0253,Kappa=0.8028) and cine MRI (χ~2=7,P=0.0082, Kappa=0.7079), it was also higher than TTC(χ~2=3,P=0.0833, Kappa=0.8879), but had no significant statistic difference. Necrosis segments determined by SPECT was significantly lower than TTC(χ~2=5,P=0.0253, Kappa=0.7590). Necrosis segments determined by cine MR was significantly lower than TTC(χ~2=4,P=0.0455, Kappa=0.8100). Necrosis segments determined by contrast-enhanced MRI had no significant statistic difference with TTC(χ~2=2,P=0.1573, Kappa=0.9130). Using TTC as the gold standard, the sensitivity and specificity of cine MRI, contrast-enhanced MRI, PET and SPECT in the determination of unviable myocardium were 71.43%,100.00%;85.71%,100.00%;100.00%, 96.94% and 64.29%, 100%, respectively. Conclusion Cardiac MRI can provide information of morphology, function and perfusion for determining v

关 键 词：正电子发射 MRI 对比研究 显像检测 单光子发射计算机体层显像 TTC染色 慢性心肌缺血模型 氯化三苯基四氮唑 美国心脏病协会 SPECT检查 心肌活性 PET检查 节段运动 MR电影 心肌坏死范围 病理结果 梗死心肌 CT检出 心肌梗死 

分 类 号：R445[医药卫生—影像医学与核医学]