磁共振延迟强化对急性心肌梗死的诊断价值  

Diagnosis value of late gadolinium enhancement derived from magnetic resonance imaging in patients with acute myocardial infarction

作　　者：侯洁[1] 肖俊睿 孙玉[1] 周巍[1] 周姝[1] 王薇[1] 李军辉[1] 杨本强[1] Hou Jie;Xiao Junrui;Sun Yu;Zhou Wei;Zhou Shu;Wang Wei;Li Junhui;Yang Benqiang(Department of Radiology,General Hospital of Shenyang Military Region,Shenyang 110016,China)

机构地区：[1]沈阳军区总医院放射诊断科,110016

出　　处：《中华心血管病杂志》2018年第8期635-639,共5页Chinese Journal of Cardiology

基　　金：2015辽宁省国产医疗器械研发、评价与推广协同创新工程（2015305010）;2016国家工信部、卫生与计划生育委员会两部委课题（2016MHD110002002101）

摘　　要：目的 探讨磁共振延迟强化（LGE）对急性心肌梗死（AMI）的诊断价值.方法 纳入2016年1月至2017年7月在沈阳军区总医院治疗的AMI患者52例,对其临床及心脏磁共振资料进行回顾性分析.患者均在入院1周内行心脏磁共振检查,根据心脏磁共振影像是否存在LGE,将AMI患者分为LGE阴性组（19例）和LGE阳性组（33例）;根据有无微循环障碍（MVO）和/或心肌内出血（IMH）,将LGE阳性AMI患者分为MVO/IMH阴性组（15例）和MVO/IMH阳性组（18例）.结果（1）LGE阳性组与LGE阴性组患者的年龄、性别、吸烟、高血压、糖尿病、血脂异常、室性心律失常、罪犯血管、左心室舒张末期容积和收缩末期容积差异均无统计学意义（P均〉0.05）.LGE阳性组的左心室射血分数低于LGE阴性组[（38.7±17.6）％比（51.2±7.9）％,P=0.001].（2）LGE阳性组患者的梗死面积百分比与左心室舒张末期容积和左心室收缩末期容积均呈正相关（分别为r=0.436,P=0.011;r=0.479、P=0.005）,与左心室射血分数呈负相关（r=-0.641,P〈0.001）.（3）MVO/IMH阳性组梗死面积百分比、左心室舒张末期容积和左心室收缩末期容积均高于MVO/IMH阴性组[分别为（26.5±7.3）％比（16.2±8.3）％,P=0.001;（145.7±40.9）ml比（112.2±23.8）ml,P=0.009;（90.0±30.8）ml比（61.4±19.0）ml,P=0.004],左心室射血分数低于MVO/IMH阴性组[（29.8±15.0）％比（49.3±14.5）％,P=0.001].结论 磁共振LGE可判断AMI患者心肌坏死程度,并评估MVO/IMH和心功能.Objective To explore the diagnosis value of late gadolinium enhancement（LGE） detected by magnetic resonance imaging（MRI） in acute myocardial infarction（AMI） patients.Methods The clinical and MRI data of 52 AMI patients hospitalized from January 2016 to July 2017 in our hospital were retrospectively analyzed. All patients received medication and revaseularization therapies after admission and cardiac magnetic resonance examination was performed within 1 week after admission. According to whether there was LGE, AMI patients were divided into LGE（＋） group（33 cases） and LGE（-） group（19 cases）. According to the existence of microvascular obstruction（MVO） and/or intramyocardial hemorrhage（IMH）, LGE（＋） patients were divided into MVO/IMH（＋） group（18 cases） and MVO/IMH（-） group（15 cases）. Results （1）There were no statistical significance between the LGE（＋）group and LGE（-）group in the age, gender, smoking history, hypertension, diabetes mellitus, dyslipidemia, ventricular arrhythmia, culprit vessel, left ventricular end-diastolic volume（LVEDV）, and left ventrienlar end-systolic volume（LVESV） （all P〉0.05）. The left ventrieular ejection fraction was significantly lower in LGE（＋） group than in LGE（-） group（（38.7± 17.6）% vs. （51.2±7.9）%, P=0.001）. （2）The infarct size was positively correlated with LVEDV and LVESV（r=0.436,P=0.011;r=0.479,P=0.005,respeetively）, and negatively correlated with left ventricular ejection fraction （r=-0.641, P〈0.001） in LGE（＋） group. （3） The infarct size, LVEDV, and LVESV were significantly higher in MVO/IMH（＋） group thanin MVO/IMH（-） group （（26.5±7.3）%vs. （16.2±8.3）%, P=0.001; （145.7 ± 40.9）ml vs. （112.2 ± 23.8）ml, P=0.009; （90.0 ± 30.8）ml vs. （61.4 ±19.0）ml, P=0.004, respectively）, and the left ventricular ejection fraction was significantly lower in MVO/IMH（＋） group than in MVO/IMH（-） group （（29.8± 15.0�

关 键 词：心肌梗死 磁共振成像 诊断 

分 类 号：R542.22[医药卫生—心血管疾病]