磁共振成像在鉴别心肌梗死后左心室室壁瘤中的应用  

Differentiation of true from false left ventricular aneurysm with magnetic resonance imaging in patients after myocardial infarction

作　　者：闫朝武[1] 李华[4] 赵世华[1] 蒋世良[1] 陆敏杰[1] 张岩[1] 凌坚[1] 韦云青[1] 杨敏福[2] 方纬[2] 赵红[3] 

机构地区：[1]中国医学科学院北京协和医学院心血管病研究所阜外心血管病医院放射科,100037 [2]中国医学科学院北京协和医学院心血管病研究所阜外心血管病医院核医学科,100037 [3]中国医学科学院北京协和医学院心血管病研究所阜外心血管病医院病理科,100037 [4]首都医科大学附属北京同仁医院心血管中心

出　　处：《中华心血管病杂志》2011年第1期45-48,共4页Chinese Journal of Cardiology

基　　金：＂十一五＂国家科技支撑计划课题（2007BAI05B01）;首都医学发展科研基金联合攻关项目（2009-1004）;国家自然科学基金资助项目（81071199）

摘　　要：目的 探讨心脏磁共振成像（MRI）鉴别诊断心肌梗死后左心室真、假性室壁瘤的价值.方法 分析经病理证实的心肌梗死后左心室室壁瘤患者共26例（男22例,女4例）.所有患者均行心脏MRI、超声心动图及冠状动脉造影检查,并与病理检查结果对照.结果 患者平均年龄（59.3±9.3）岁.其中胸闷气短24例,15例伴发高血压.超声心动图检查诊断左心室真性室壁瘤22例,假性室壁瘤4例;左心室附壁血栓5例,左心室射血分数为36.9%±9.1%.心脏MRI发现24例患者受累左心室壁厚度＜5.5 mm,2例患者厚度5.5～8.0 mm.24例患者左心室室壁存在矛盾运动,2例患者受累室壁无运动;左心室舒张末期横径（67.8±9.3）mm,室壁瘤最宽处直径（35.1±13.8）mm.心脏MRI诊断真性室壁瘤23例,假性室壁瘤3例,7例患者左心室存在附壁血栓.与病理结果对照,心脏MRI诊断结果与病理一致,而超声心动图检查误诊假性室壁瘤1例,漏诊左心室附壁血栓2例.结论 心脏 MRI 能够准确鉴别心肌梗死后左心室真、假性室壁瘤.Objective To observe the value of cardiac magnetic resonance imaging（MRI）for differentiation of true from false left ventricular aneurysm in patients after myocardial infraction（MI）.Methods Twenty-six patients[22 males/4 females, mean age（59.3 ± 9. 3）years]with left ventricular aneurysm after MI were imaged with MRI, echocardiography and coronary angiography. The respective findings were compared with surgical pathology results. Results There were 24 patients with dyspnea and 15patients with hypertension. LVEF measured by echocardiography was 36. 9% ±9. 1% in this patient cohort.Cardiac MRI showed that the left ventricular end diastolic wall thickness was thinner than 5.5 mm in 24cases, and between 5.5 to 8 mm in 2 cases. The dimension of left ventricle was（67. 8 ± 9. 3）mm.Dyskinesia presented in 24 cases, and akinesia in 2 cases. Delayed enhancement was shown in all cases by MRI. Cardiac MRI detected left ventricular true aneurysm in 23 cases, false aneurysm in 3 case and left ventricular thrombi in 7 cases. The diagnosis by magnetic resonance imaging corresponded well to pathological findings. Echocardiography misdiagnosed pseudoaneurysm in 1 patient, and failed to detected left ventricular thrombi in 2 cases. Conclusion Cardiac MRI could correctly differentiate true from false left ventricular aneurysm in patients after MI.

关 键 词：心肌梗死 磁共振成像 心脏室壁瘤 

分 类 号：R445.2[医药卫生—影像医学与核医学]