心血管磁共振成像钆剂延迟增强在心肌病变中的应用  

Evaluation of cardiomyopathy by late gadolinium-enhanced cardiovascular magnetic resonance imaging

作　　者：许化致[1] 李建策[1] 王美豪[1] 王溯源[1] 陈勇春[1] 闻彩云[1] 陈伟建[1] 黄伟剑[2] 

机构地区：[1]温州医学院附属第一医院放射科,325000 [2]温州医学院附属第一医院心内科,325000

出　　处：《浙江医学》2014年第6期463-466,478,共5页Zhejiang Medical Journal

基　　金：863计划项目(2012AA02A602)

摘　　要：目的评估钆剂延迟增强(LGE)对心肌病变的诊断价值。方法收集2010-01—2013-01具有完整心血管磁共振(CMR)图像病例51例,其中男32例。女19例,年龄17-79(49.8±16.0)岁。由2位影像诊断医师独立盲法评估CMR图像中LGE有无、LGE部位(心内膜下、透壁、壁间、心外膜下)及形态(斑点/斑片样、线条样、片状/片状),并行Kappa一致性检验,同时评价LGE与心肌病变的关系。结果临床确诊有心肌病变39例,2位影像诊断医师对LGE征象有无、部位、形态的判定一致性较好(Kappa=0.876、0.678、0.686,均P<0.01或0.05)。CMR-LGE可以显示心肌病变(X^2=13.226,P<0.05).其敏感度、特异度、阳性预测值、阴性预测值分别为79.5%、83.3%、93.9%、55.6%。其中缺血性心肌病LGE主要为心内膜下或透壁型,占81.8%(9/11),以片状强化多见72.7%(8/11)。炎性心肌病变主要位于心肌壁间75.0%(6/8)。强化形态多样,斑点/斑片样、线条样、片状均可见。而非缺血性心肌病中。LGE征象可出现于心内膜下、透壁、壁间,形态以斑点、斑片样多见。结论 LGE是CMR检查的一个重要组成部分。可以检测心肌病变的有无及范围,有助于临床医师识别与心脏有关的症状和病因。Objective To evaluate the application of late gadolinium-enhanced cardiovascular magnetic resonance （LGE-CMR） images in diagnosis of myocardiepathy. Methods Fifty one patients, including 32 males and 19 females aged 17-79y received LGE-CMR examination during January 2010 and January 2013. The LGE-CMR images were evaluated by two radiologists independentLy, in terms of LGE Locations （subendocardial, transmural, mid-wall, subepicardial） and LGE patterns （spot/spots, linear, patchy）. Kappa test for consistency and x＂ for the relationship between LGE and cardiomyopathy were per- formed. Results Myocardial lesions were found in 39 cases by clinical follow-up or pathology. There was a good consistency in diagnosis, LGE location and pattern between 2 radiologists （Kappa= 0.876, 0.678, 0.686, P〈0.05 or 0.01）. LGE-CMR well demonstrated myocardial lesions （x-~= 13.226, P〈0.05） with a sensitivity, specificity, positive predictive value and negative predic- tive value of 79.5%, 83.3%, 93.9% and 55.6%, respectively. The LGE in ischemic cardiomyopathy was mostly located in suben- docardial or transmural （81.8%） sites, and patchy enhancement was common （72.7%）.The LGE in inflammatory cardiomyopathy was mainly situated in mid-wall （75.0%）, and spot/spots （3/8）, linear （3/8）, patchy （2/8） enhancements were all visible. In the non-ischemic cardiomyopathy, LGE signs were in subendocardial, transmural or mid-wall sites, and inclined to be spot/spots-like enhancement. Conclusion LGE-CMR is helpful in evaluation of cardiac lesions and its features in patients with cardiomyopathy.

关 键 词：心血管磁共振钆剂延迟增强心肌病变 

分 类 号：R445.2[医药卫生—影像医学与核医学]