磁共振心肌首过灌注成像评价肥厚型心肌病微循环功能障碍  

Magnetic resonance first-pass myocardial perfusion for evaluation on coronary microvascular dysfunction in hypertrophic cardiomyopathy

作　　者：黄璐[1] 夏黎明[1] 韩瑞[1] 孙子燕[1] 白杨[2] 

机构地区：[1]华中科技大学同济医学院附属同济医院放射科,湖北武汉430030 [2]华中科技大学同济医学院附属同济医院心血管内科,湖北武汉430030

出　　处：《中国医学影像技术》2013年第3期394-397,共4页Chinese Journal of Medical Imaging Technology

摘　　要：目的应用MR心肌首过灌注成像评价肥厚型心肌病患者局部心肌微循环障碍。方法选取22例肥厚型心肌病患者(HCM组)和13名健康志愿者(对照组)行心脏MR(CMR)检查(包括左心室短轴电影、心肌首过灌注和延迟增强序列),测量左心室舒张末期各心肌节段心肌壁厚度、心肌信号强度最大上升斜率(Slopemax)和心肌延迟强化(DE)。采用单因素方差分析比较对照组心肌节段、HCM组非肥厚性心肌节段亚组和肥厚性心肌节段亚组的Slopemax以及不同肥厚程度心肌节段的Slopemax,对有DE心肌节段和无DE心肌节段的Slopemax的差异采用独立样本t检验进行分析。结果 HCM组中非肥厚性心肌节段亚组和肥厚性心肌节段亚组Slopemax均明显低于对照组(P均<0.05),其中肥厚性心肌节段亚组的Slopemax较非肥厚性心肌节段亚组降低更为显著(P<0.05);轻度肥厚心肌节段Slopemax高于中度、重度肥厚心肌节段(P均<0.05),但中度与重度心肌肥厚节段Slopemax的差异无统计学意义(P>0.05)。DE心肌节段Slopemax明显低于无DE心肌节段(P<0.05)。结论MR心肌首过灌注成像能可靠地检出HCM局部心肌的微血管功能障碍,为临床对HCM患者进行风险分层、制定治疗计划和预后评估提供有价值的信息。Objective： To evaluate the coronary microvascular dysfunction in patients with hypertrophic cardiomyopathy （HCM） by MR first-pass perfusion. Methods： Totally 22 patients with HCM （HCM group） and 13 healthy volunteers （control group） underwent cardiac magnetic resonance （CMR）, including short axial cine, first-pass myocardial perfusion and myocardial delay enhanced scanning. The left ventricular end-diastolic wall thickness, maximal upslope of myocardial intensity enhancement （Slopemax） and myocardial delay enhancement （DE） were assessed. The difference of Slopemax between control group and HCM group, non-hypertrophic segments subgroup and hypertrophic segments subgroup, and among different levels of hypertrophic segments were compared by one-way ANOVA, and Slopemax of DE and non-DE segments also was compared by independent-sample t-test. Results： Compared to control group, Slopemax decreased in non-hypertrophic segments subgroup and hypertrophic segments subgroup （P〈0.05）, while reduced more significantly in hypertrophic segments subgroup. Slopemax of mild hypertrophic segments were higher than that of medium and severe hypertrophic segments （both P〈0.05）, but the difference of Slopemax between medium and severe hypertrophic segments was not significant （P〉0.05）.Slopemax of DE segments were significantly lower than that of non-DE segments （P〈0.05）. Conclusion： CMR resting first-pass myocardial perfusion is able to detect microvascular dysfunction in patients with HCM, therefore providing more information for risk stratification, therapy planning and prognosis evaluation of HCM patients.

关 键 词：心肌病 肥厚性 磁共振成像 微血管功能障碍 首过灌注 

分 类 号：R445.2[医药卫生—影像医学与核医学] R542.2[医药卫生—诊断学]