心脏MR延迟增强成像联合核素显像评价缺血性心肌病患者的存活心肌  

Combination of contrast-enhanced cardiac MR and nuclear myocardial imaging in evaluation of myocardial viability in ischemic cardiomyopathy

作　　者：李燕[1] 陆敏杰[2] 王丽[3] 何作祥[1] 赵世华[2] 杨敏福[4] 

机构地区：[1]中国医学科学院 北京协和医学院 国家心血管病中心 阜外心血管病医院核医学科,100037 [2]阜外心血管病医院磁共振成像科 [3]中国医学科学院肿瘤医院核医学科 [4]首都医科大学附属北京朝阳医院核医学科

出　　处：《中华放射学杂志》2015年第6期425-429,共5页Chinese Journal of Radiology

基　　金：北京市卫生系统高层次人才培养项目（2013-3-019）

摘　　要：目的：探讨心脏MR（CMR）延迟增强成像和核素心肌显像评价缺血性心肌病患者存活心肌的显像特征及互补性。方法搜集111例缺血性心肌病患者（冠心病患者且左心室射血分数≤50%）的临床和影像资料进行回顾性分析。所有患者均在同期（间隔时间〈1个月）进行了CMR和核素心肌显像[99Tcm-甲氧基异丁基异腈（MIBI）SPECT静息心肌灌注显像和18F-脱氧葡萄糖（FDG）PET-CT心肌代谢显像]。首先利用CMR评价左心功能和室壁运动。再利用标准的17节段5分法对延迟增强显像和心肌灌注/代谢显像进行半定量分析。对于室壁运动异常的心肌节段，分别根据延迟增强CMR和核素心肌显像的结果进行存活性评价，利用Kappa检验分析两种方法的一致性。结果111例患者的1887个心肌节段中，有80.3%（1516/1887）存在室壁运动异常。延迟增强CMR和心肌核素显像显示心肌存活的比例分别为63.3%（959/1516）和79.7%（1208/1516）。在存活心肌的判定上，两种成像方法的符合率为77.4%（1173/1516），有中等程度的一致性（Kappa值为0.46，P〈0.01）。进一步分析发现在核素灌注和代谢显像均正常的节段中，有73.9%（431/583）存在不同程度的延迟强化，但主要为心内膜下强化（84.2%，363/431）；在CMR判定为心肌不存活（透壁性强化）的节段中，有21.0%（117/557）为冬眠心肌。结论延迟增强CMR和核素心肌显像评价存活心肌有中等程度的一致性。二者的联合应用有望提高存活心肌检测的准确性。Objective To explore the imaging characteristics and the complementarity of contrast-enhanced cardiac magnetic resonance CMR and nuclear myocardial perfusion/metabolic imaging in the evaluation of myocardial viability in patients with ischemic cardiomyopathy. Methods A total of 111 patients with diagnosed coronary artery disease and left ventricular dysfunction were retrospectively enrolled in this study. All patients underwent CMR and nuclear myocardial imaging within 1 month. Cine CMR was employed to evaluate cardiac function and wall motion. Contrast-enhanced CMR and myocardial perfusion/metabolic images were quantitatively assessed using a standard 17-segment and 5-score system. Dysfunctional segments were classified as viable or non-viable based on contrast-enhanced CMR and myocardial perfusion/metabolic imaging, respectively. No enhancement or sub-endocardial enhancement was defined as viable, while transmural enhancement was defined as non-viable. Severely matched perfusion/metabolism defects on nuclear imaging were assigned as non-viable while other patterns were considered as viable. Kappa index was calculated to evaluate the diagnostic concordance in assessing myocardial viability＆amp;nbsp;between contrast-enhanced CMR and myocardial perfusion/metabolic imaging. Results Among 1 887 segments in 111 patients, 80.3%（1 516/1 887） were dysfunctional. Of them, 63.3%（959/1 516） were viable and 36.7%（557/1 516） were non-viable on contrast-enhanced CMR, while 79.7%（1 208/1 516） were viable and 20.3%（308/1 516） were non-viable on nuclear myocardial imaging. The two modalities had a moderate concordance （Kappa=0.46,P〈0.01）. In segments with normal perfusion and metabolism, 73.9% （431/583） had various extent of enhancement but most of them（84.2%, 363/431） were subendocardial. On the other hand, 21.0%（117/557） segments with transmural enhancement had hibernating myocardium on nuclear imaging. Conclusions Contrast-enhanced CMR and nuclear myocardial imaging have a moderate conc

关 键 词：心肌 磁共振成像 放射性核素显像 心肌缺血 

分 类 号：R542.2[医药卫生—心血管疾病]