MR心肌灌注成像、CT冠脉成像与选择性冠脉造影的对比研究  

A comparative study between MR myocardial perfusion imaging,CT coronary angiography and selective coronary angiography

作　　者：吴梅[1] 梁志伟[1] 邝锦锋[1] 江新青[1] 古杰洪[1] 林竹[1] 

机构地区：[1]广州医学院附属广州市第一人民医院放射科,510180

出　　处：《中国CT和MRI杂志》2010年第2期10-12,共3页Chinese Journal of CT and MRI

基　　金：2008年广东省社会发展领域科技计划项目(83079)

摘　　要：目的探讨MR心肌灌注成像、CTCA诊断冠心病的临床价值。方法对30例SCA确诊的冠心病患者行ATP负荷MR首过心肌灌注、延迟增强成像、CTCA检查,并与DSA进行对比研究,计算敏感度、特异度和一致性检验kappa值。结果冠脉狭窄50%～70%23支,首过灌注减低18支(78.26%),延迟扫描心肌无强化。冠脉狭窄70%～90%17支,首过灌注减低15支(88.24%),延迟扫描心肌强化有8个区域。冠脉狭窄>90%5支,首过灌注减低5支(100%),延迟扫描均见心肌强化。13个心肌延迟强化区内,心肌透壁增强6例(46.15%),非透壁增强7例(53.85%)。以冠脉造影为参考标准,MR首过心肌灌注成像、CTCA检测狭窄50%以上冠状动脉病变的敏感度和特异度分别为84.44%、91.11%和90.48%、97.09%。MRMPI、CTCA与SCA一致性检验kappa值分别为0.76和0.88。结论MRMPI、CTCA与SCA检查结果具有高度一致性,具有高度的敏感度、特异度,MRMPI能有效检测心肌血流,CTCA能准确判断冠脉狭窄度,可为临床诊断及恰当治疗提供可靠的依据。Objective To evaluate efficacy of MR myocardial perfusion imaging（MRMPI） and CT coronary angiography（CTCA） in detecting coronary artery disease（CAD）.Methods 30 patients with CAD confirmed by selective coronary angiography（SCA） were enrolled.All patients underwent routine static and ATP-stress MRI to perform myocardial perfusion imaging in first-pass and delayed phase.All patients underwent CTCA.The results were compared with those obtained from SCA.Parameters as sensitivity,specificity and kappa value were calculated.Results 50%-70% stenosis was seen in 23 branches of the coronary artery,first-pass imaging found stenosis and poor perfusion in 18 branches（78.26%）;70%-90% stenosis in 17 branches,poor perfusion in 15（88.24%）,delayed enhancement in 8 branches; 90% stenosis in 5 branches,poor perfusion and delayed enhancement in 5 branches（100%）.6（46.15%）was transmural,7（53.85%）was nontransmural.By referring to coronary angiography,sensitivity and specificity for detecting stenosis more than 50% by first-pass imaging and CTCA were 84.44% 、91.11% and 90.48%、 97.09% respectively.The kappa value between MRMPI,CTCA and SCA were 0.76 and 0.88 respectively.Conclusion High consistency of the results was found between MRMPI、CTCA and SCA.They have high sensitivity and specificity in diagnosing CAD.MRMPI is effective in detecting blood flow of myocardium and CTCA can judge degree of stenosis accurately.They can supply valuable information and guidance for the diagnosis and treatment for the patients.

关 键 词：磁共振成像 心肌灌注 CT 冠状动脉造影 对比研究 

分 类 号：R814.42[医药卫生—影像医学与核医学] R445.2[医药卫生—放射医学]