MR单次激发相位反转恢复稳态快速成像序列在心律失常患者心肌延迟显像中的价值  

Assessment of late gadolinium enhancement in patients with cardiac arrhythmias with MR phase-sensitive inversion recovery single-shot true fast imaging with steady-state precession sequence

作　　者：夏春潮[1] 李真林[1] 孙家瑜[1] 程巍[1] 陈宪[1] 宋彬[1] 陈玉成[2] 

机构地区：[1]四川大学华西医院放射科,成都610041 [2]四川大学华西医院心内科,成都610041

出　　处：《中华放射学杂志》2014年第11期943-946,共4页Chinese Journal of Radiology

基　　金：国家自然科学基金面上项目（81271531）

摘　　要：目的 探讨采用单次激发相位反转恢复稳态快速成像序列对心律失常患者行心肌延迟强化成像的可行性及其临床应用价值.方法 前瞻性收集心电图确诊为心律失常,且行MR扫描时有心律失常的56例患者纳入研究.患者均行MR单次激发相位反转恢复稳态快速成像序列（序列1）与常规节段磁化相位敏感反转恢复快速小角度激发序列（序列2）心肌延迟强化成像.由2名高年资放射科医师采用盲法对图像质量进行独立评价（分为4级）.对2种序列图像质量的比较采用等级资料χ^2检验和Fisher精确概率法进行比较,对2名医师评价同一序列图像质量的一致性采用加权Kappa检验.结果 56例患者均完成了2种序列的心肌延迟强化成像检查.序列1图像质量均达3级及以上,满足临床诊断要求,19例检出心肌延迟强化.序列2图像均出现了不同程度的伪影,尤其是对于有严重心律不齐、屏气配合困难的患者图像质量不佳影响临床诊断.医师1对序列1图像进行评价,4级50例、3级6例,序列2图像2级15例、1级41例;医师2对序列1图像进行评价,4级48例、3级8例,序列2图像2级13例、1级43例.2名医师序列1的图像质量均高于序列2,差异均有统计学意义（χ^2分别为141.329和141.177,P均＜0.01）.2名医师评价序列1和序列2的图像质量一致性结果均为优（Kappa值分别为0.837和0.905,P均＜0.01）.结论 采用序列1对心律失常患者进行心肌延迟强化成像,图像质量较好,有较大的应用价值.Objective To evaluate the feasibility and its clinical application of 3.0 T MRI in the assessment of the late gadolinium enhancement in patients with cardiac arrhythmias with phase-sensitive inversion recovery （PSIR） single-shot true fast imaging with steady-state precession （True FISP） sequence.Methods Fifty-six patients with arrhythmia confirmed by electrocardiogram underwent MRI in this prospective study.Late gadolinium enhancement were performed with both PSIR single-shot True FISP （sequence 1） and conventional segmented PSIR Turbo FLASH sequences （sequence 2）.The overall image quality （4 scales） was assessed and recorded independently by two experienced radiologists.Statistical analysis was performed with Chi-square test and weighted Kappa test.Results Late gadolinium enhancement of all the 56 patients were successfully examined with the sequence 1 and 2.All the image qualities of sequence 1 reached 3 scales or more and met the requirements of clinical diagnosis,and late gadolinium enhancement lesions were detection in 19 patients.All the sequence 2 images were improperly used for clinical diagnosis of the different degrees of artifacts,especially in patients with severe arrhythmia and those who breath-hold with difficulty.Sequence 1 images were classified as scale 4 in 50 cases and scale 3 in 6 cases by Doctor 1,while scale 4 in 48 cases and scale 3 in 8 cases by Doctor 2,respectively.However,sequence 2 images were classified as scale 2 in 15 cases and scale 1 in 41 cases by Doctor 1,as well as scale 2 in 13 cases and scale 1 in 43 cases by Doctor 2,respectively.Sequence 1 image qualities were significantly higher than those of the segmented sequence 2 （χ^2 values were 141.329 and 141.177,P〈0.01）.Excellent agreements between two observers of the 2 sequences （Kappa values were 0.837 and 0.905,P〈 0.01） were found.Conclusion PSIR single-shot True FISP sequence provides higher reliability for image quality of late gadolinium enhancement in patients with cardiac arrhythmia,which

关 键 词：心律失常 磁共振成像 对比研究 

分 类 号：R445.2[医药卫生—影像医学与核医学]