ATP负荷MR心肌灌注成像对冠心病心肌缺血诊断的临床应用研究  

Clinical application research of ATP stress MR myocardial perfusion imaging in coronary artery disease myocardial ischemia

作　　者：曲晓峰[1] 边杰[1] 程绍玲[1] 杨淑琴[2] 杨超[1] 

机构地区：[1]大连医科大学附属二院放射科,辽宁大连116027 [2]吉林大学中日联谊医院放射线科

出　　处：《中国实验诊断学》2008年第7期871-874,共4页Chinese Journal of Laboratory Diagnosis

基　　金：辽宁省教育厅青年基金计划项目编号(05L119)

摘　　要：目的研究ATP负荷MR心肌灌注成像对冠心病心肌缺血诊断的临床应用价值。方法将临床通过DSA冠脉造影诊断为冠心病患者30例,无症状健康志愿者5例,进行ATP负荷MR心肌灌注成像,ATP负荷MR心肌灌注成像应用真正快速稳态梯度回波序列(fast imaging employ steady state quisition,FIESTA)用于观察心肌的运动,快速梯度回波序列(fastcard gradient echotrain,FGRE ET)用于心肌灌注首过时相MRI图像采集。反转恢复梯度回波序列(my-ocardial delay enhancement,MDE)用于完成心肌灌注延迟30分钟后MRI图像采集。应用GE AW4.0工作站DCEMI(Dynamic Contrast Enhanced Myocardial Imaging)心肌灌注图像分析软件,对左心室短轴心肌灌注首过时相图像进行分析,得到心肌灌注时间-信号强度曲线,观察曲线的上升斜率和信号强度的峰值。根据Brandt等描述的左心室短轴位与冠状动脉血管分布的对应关系,确定存在狭窄的冠状动脉血管。冠脉造影使用日本岛津公司DAR1200双C臂DSA机,以冠状动脉管径≤50%作为有临床意义的狭窄的诊断标准。结果通过ATP负荷MR心肌灌注成像测定心肌低灌注区信号强度以及时间-信号强度曲线上升斜率可以判定心肌缺血区域,判定结果与冠脉造影结果比较,其中25例结果一致,5例结果不一致,符合率为83%。结论ATP负荷MR心肌灌注成像通过测定心肌信号强度以及时间-信号强度曲线上升斜率量化指标,对于冠心病心肌缺血诊断结果与DSA冠脉造影检查结果具有高度的一致性,ATP负荷MR心肌灌注成像是一种无创性的测定心肌的血流的检查方法,通过这种无创性综合的检测技术可以为临床提供有价值的信息,为临床诊断及恰当治疗提供可靠的依据。Objective to study Clinical application of ATP stress MR myocardial perfusion imaging in coronary artery disease myocardial ischemia. Methods ATP stres MR myocardial perfusion imaging were performed to 30 patients of coronary heart disease with typical clinical symptoms and typical cardiogram.FIESTA was employed in MR myocardial imaging to observe the movement of the cardiac muscle. FGRE ET was employed to collect the MRI images of cardiac perfusion. MDE（myocardial delay enhancement）was employed in the collection of images 30 minutes after the myocardial perfusion. DCEMI（Dynamic Contrast Enhanced Myocardial Imaging） myocardial perfusion imaging analysis software for GE AW4.0 working station was employed to analyze the first pass phase images of the myocardial perfusion of the left ventricle short axle. A curve of the timeintensity of the cardiac muscle perfusion was obtained and the rising slope and the peak value of the intensity of the signal were observed. According to the description of the relation between the position of the short axle of left ventricle and the distribution of the coronary artery blood vessels, the existence of narrowed coronary artery was detemained. DSA machine of DAR 1200 double C arm was employed in the coronary artery imaging. Judkin method employing Seldinger＇ s method of femoral eentesis was carried out and value ≤50% of the diameter of the coronary artery was determined as the diagnostic standard of narrowness of clinical significance. Results The results of the two methods of 25 eases were consistent and 5 not. Conclusion ATP stress MR myocardial perfusion imaging is a non traumatic method to determine the blood flow of cardiac muscle and it can supply valuable information and guidance for the diagnosis and treatment of the patients.

关 键 词：ATP负荷 MR心肌灌注成像 心肌缺血 临床应用研究 

分 类 号：R541.4[医药卫生—心血管疾病]