磁共振心肌灌注延迟增强与核素心肌灌注/代谢显像识别存活心肌对比研究  

Identification of viable myocardium delayed enhancement magnetic resonance imaging and ^(99)Tc^m-sestamibi or ^(18)F-fluorodeoxyglucose single photon emission computed tomography

作　　者：赵世华[1] 闫朝武[1] 杨敏福[2] 陆敏杰[1] 蒋世良[1] 李世国[1] 张岩[1] 刘琼[1] 刘玉清[1] 何作祥[2] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院放射科,北京100037 [2]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院核医学科,北京100037

出　　处：《中华心血管病杂志》2006年第12期1072-1076,共5页Chinese Journal of Cardiology

基　　金：国家自然科学基金资助项目(30670609);国家教委博士点专项科研基金资助项目(20050023042)

摘　　要：目的应用磁共振成像心肌灌注延迟显像(DE-MRI)所显示的高信号识别存活心肌和瘢痕组织,通过与99Tcm-甲氧基异丁基异腈(MIBI)单光子发射型计算机断层(SPECT)和18F-脱氧葡萄糖(FDG)SPECT进行对比研究,评估其诊断的敏感性和特异性,并分析两种方法的一致性。方法34例临床确诊的心肌梗死患者,拟行再血管化手术治疗。男性29例,女性5例,年龄(58.0±9.8)岁,接受心脏MRI及SPECT灌注/代谢显像检查。两种方法各划分5个等级,依据17节段分析法,分析34例患者共578个节段,并对两种评价心肌存活的方法行一致性分析。结果DE-MRI判断存活心肌431段(74.6%),坏死心肌147段(25.4%)。SPECT灌注/代谢显像诊断正常心肌336段(58.1%),坏死心肌212段(36.7%),缺血心肌30段(5.2%)。两种方法半定量分析显示一致性较好,Kappa值为0.51(>0.4)。以节段为单位,DE-MRI的敏感性为61.3%,特异性为95.4%。结论DE-MRI能够有效地识别存活心肌和瘢痕组织,并与18F-FDGSPECT一致性较好。Objective The aim of this study was to investigate the feasibility and accuracy of delayed enhancement magnetic resonance imaging （DE-MRI） for the assessment of myocardial viability in patients with myocardial infarction in comparison with ^99Tc^m-scstamibi （MIBI） single photon emission computed tomagraphy（SPECT） and ^18F-fluoredeoxyglucosc （FDG） SPECT. Scar was defined as regionally increased MRI signal intensity 15 minutes after injection of 0. 2 mmoL/kg gadolinium-diethylenetriamine pentoacctic acid or reduced perfusion and glucose metabolism defined by SPECT. Methods A total of 34 patients with myocardial infarction （29 males, 58.0 ± 9. 8 years ） were imaged with MRI and SPECT. Results A total of 578 scgments were analyzed. DE-MRI and SPECT identified 431 and 336 viable segments respectively and SPECT also identified 30 ischcmic segments. Necrotic segments identified by DE- MRI and SPECT were 147 and 212 respectively. Sensitivity and specificity of DE-MRI in identifying segments with matched flow/metabolism defects （ scar tissues ） was 61.3% and 95.4% , respectively. Quantitatively assessed relative MRI infarct area correlated well with SPECT infarct size. The value of Kappa was 0. 51. Conclusion DE-MRI provides a good tool for differentiating viable myocardium from scar tissues and the detection accuracy is comparable between DE-MRI and SPECT.

关 键 词：磁共振成像 冠状动脉疾病 心肌梗塞 

分 类 号：R445[医药卫生—影像医学与核医学]