磁共振多技术扫描检测活性心肌与病理结果对照实验研究  

Experimental study on myocardial viability by multimodality MRI compared with pathological findings

作　　者：朱海云[1] 王莉[1] 田建明[1] 曾浩[1] 黄盛东[2] 徐驯宇[2] 

机构地区：[1]上海市长海医院放射科,上海200433 [2]上海市长海医院胸心外科,上海200433

出　　处：《生物医学工程与临床》2006年第2期64-67,F0003,共5页Biomedical Engineering and Clinical Medicine

基　　金：国家自然科学基金(编号:30270419)

摘　　要：目的评估磁共振多技术扫描检测心肌存活的价值。方法选择慢性心肌缺血模型猪25只,分别于制作模型前、后1～2个月行磁共振多技术联合应用扫描(形态、电影扫描、心肌灌注和心肌活性扫描),判断心肌缺血区和坏死区的大小,并与病理结果对照了解其准确性。结果共有20只猪顺利完成检查,有3只形态扫描见左心室侧壁变薄;负荷电影扫描见9只猪左心室收缩功能正常,有7只猪11个(3.44%)节段为缺血心肌,4只猪19个(5.94%)节段为坏死心肌。心肌灌注扫描共64个(20%)节段缺血,心肌活性扫描共检出25个(7.81%)节段坏死,病理检查发现有27个(8.44%)节段坏死,比磁共振电影扫描显示的梗死区多,差异有统计学意义(P=0.008);比磁共振活性扫描所显示的梗死区稍多,但差异无统计学意义(P=0.5)。磁共振电影扫描与TTC染色比较的Kappa值为0.813,磁共振活性扫描与TTC染色比较的Kappa值为0.958。结论半定量分析室壁运动能力不能有效确定微小梗死心肌或心内膜下梗死心肌,联合应用心肌灌注及延迟期扫描能够提高混杂于正常心肌内微小心内膜下梗死灶的检出,磁共振多种技术扫描可明显提高存活心肌的检出率和准确性,并且与病理结果有很高的一致性。Objective To evaluate the value of muhimodality MR imaging in detecting of myocardial viability. Methods Twenty-five pigs of chronic myocardium ischemia model were performed muhimodality MR imaging before and after establishing model 1 - 2 month. The multimodality MR imaging includes： morphology scanning, cine MRI, myocardial perfusion and viability imaging. The range of myocardial ischemia and necrosis in MRI was compared with pathological findings to assess its accuracy. Results Twenty pigs were completed all examinations successfully. Morphology scanning revealed thinning in lateral wall Of left ventricle in 3 pigs. Stress cine MRI detected normal wall motion in 11（11/20） pigs. It was found that 11 segments of 7（7/20） pigs hypokinetic, 19 segments of 4 （4/20） pigs akinetic in lateral wall of left ventricle in rest. Dobutamine stress cine MRI revealed increased regional motion of the lateral wall in hypokinetic segments, but the lateral wall remained akinetic in 19 segments. Myocardial perfusion scanning revealed that there were 64 （20 %） segments ischemia and 25 （7.81%） segments necrosis. The total segments of necrosis was 27 （8.44 %） in pathological examination. There were no significant difference between pathological and viability MR imaging （P = 0.5） findings. The Kappa value was 0.813 in cine MR imaging. TIC staining and 0.958 in viability MR imaging/33℃ staining. Conclusion Analysis of ventricular wall motion capability semiquantitatively can＇t determine the existense of small infarct myocardium or endocardium infarct myocardium effectively. Combined application of myocardial perfusion and viability MR imaging can increase the detection rate of small endoeardium infarction mixed in normal myocardium. Multimodality MR imaging technique may increase the detection rate and accuracy of myocardial viability obviously and it has high concordance with physiological findings.

关 键 词：磁共振成像 心肌活性 动物 

分 类 号：R445.2[医药卫生—影像医学与核医学] R541.404[医药卫生—诊断学]