心脏MRI对急性心肌梗死的诊断价值  

The Diagnostic Value of Cardiovascular MRI for Acute Myocardial Infarction

作　　者：张青[1] 王振常[1] 鲜军舫[1] 田其昌[1] 赵波[1] 吴超[1] 张华[1] 史旭波[2] 李田昌[2] 

机构地区：[1]首都医科大学附属北京同仁医院影像中心,100730 [2]首都医科大学附属北京同仁医院心血管中心,100730

出　　处：《临床放射学杂志》2008年第8期1027-1031,共5页Journal of Clinical Radiology

摘　　要：目的探讨心脏MRI对急性心肌梗死的部位、大小、透壁程度、左室功能参数的诊断价值。资料与方法对19例发病3～7天的首次急性心肌梗死患者行心脏MRI及心电图(ECG)检查。采用1.5T磁共振仪,行常规电影MRI后,以4ml/s的流率静脉注射Gd-DTPA0.1mmol/kg体重行首过灌注成像,随后以2.5ml/s的流率静脉注射Gd-DTPA0.1mmol/kg体重,延迟5～10min后行延迟增强成像,所用对比剂总量为0.2mmol/kg体重。在短轴像上根据16段心脏模型分别评价每例患者的梗死部位、受累段数、梗死质量、梗死百分比、透壁程度及左室功能参数,分析急性期ECG。结果4例非ST段抬高心肌梗死及15例ST段抬高心肌梗死(其中包括4例右室心肌梗死)均清晰显示。透壁心肌梗死12例,非透壁心肌梗死7例。受累段数平均为3.1±1.8,梗死质量平均为(8.8±7.5)g,梗死百分比平均为(7.9±6.4)%,射血分数平均为(54.1±15.4)%,每搏输出量平均为(57.6±15.0)ml。结论急性心肌梗死行MRI检查安全、可行,可客观显示梗死情况,对临床诊断、治疗及判断预后有很大帮助。Objective The aim of the current study was to determine the diagnostic value of cardiovascular magnetic resonance imaging （ MRI ） assessing of acute myocardial infarction （ MI ） in humans. Materials and Methods Within 3--7 days from the symptoms onset,patients with first acute MI （n = 19） were selected to undergo cardiovascular MRI on a 1.5 Tesla system. A stack of short axis slices encompassing the entire ventricles and the global LV functions were calculated in a standard cine MRI. A first-pass perfusion scan was acquired simultaneously with the administration of Gd-DTPA at a dose of 0.1 mmot/kg body weight. Following with a second bolus of 0.1 mmot/kg body weight,myocardial delayed enhancement was performed 5 to 10 minutes later by using an ECG-gated inversion-recovery fast-gradient echo-pulse sequence. The totle volume of the contrast was 0.2 mmot/kg body weight. The infarcted location, size, transmural extent, infarct mass （IM） ,percentage size of infarction （PSI）,and left ventricle （LV） functions were evaluated for each patient. The 12-lead ECG were analysed for ST-elevation on admission. Results The infarction size was clear for 4 patients with non ST-elevation myocardial infarction and 15 patients with ST-elevation myocardial infarction, including 4 patients with right ventricle infarction. 12 of patients were transmural MI ,while 7 of those exhibited transmural MI. The mean involved segments was 3.1 ±1.8,themeanlM was （8.8 ±7.5） g,the mean PSI was （7.9 ±6.4）%,the mean LV stroke volume （LVSV） was （57.6±15.0）ml,andthemeanLVejectionfraction（LVEF）was（54.1±15.4）%. Conclusion It was safe and feasi- ble to perform cardiovascular MRI in acute MI patients. Revealing the condition of the infarcted area was helpful for the diagnosis, therapy and prognosis.

关 键 词：急性心肌梗死 磁共振成像 心电图 

分 类 号：R542.22[医药卫生—心血管疾病] R445.2[医药卫生—内科学]