MRI在川崎病冠状动脉和心肌病变评估中的应用  

Application of MRI in evaluation of coronary artery and myocardial lesions in patients with Kawasaki disease

作　　者：顾晓红[1] 孙爱敏[1] 王谦[1] 王静蕾 朱铭[1] 钟玉敏[1] GU Xiaohong;SUN Aimin;WANG Qian;WANG Jinlei;ZHU Ming;ZHONG Yumin(Department of Radiology,Shanghai Children's Medical Center,Medicine School of Shanghai Jiaotong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心放射科,上海200127

出　　处：《实用放射学杂志》2019年第5期798-802,共5页Journal of Practical Radiology

摘　　要：目的探讨MRI在儿童川崎病冠状动脉和心肌病变诊断中的应用价值。方法回顾性分析38例川崎病患者的心脏MRI:包括3D-SSFP的冠状动脉成像,首过灌注成像评估心肌缺血,对比剂延迟增强MRI评估心肌组织学特性,2D-SSFP电影序列评价心功能,同时对3D-SSFP和超声心动图测量的冠状动脉瘤最大径进行Bland-Altman比较。结果38例川崎病患者中28例(73.7%)右冠状动脉(RCA)或左冠状动脉(LCA)瘤样扩张,左前降支(LAD)瘤的发生率最高,为23例,其次为RCA 19例,RCA瘤最大径平均为(7.66±2.10)mm,高于LAD(6.11±1.96)mm(P<0.05)。5例心肌首过灌注显示左心室及室间隔心内膜下缺血,5例左心室游离壁及室间隔延迟异常强化,4例左心室射血分数<50%,平均为(34.0±15.9)%。3D-SSFP和超声心动图测量RCA和LAD瘤最大径的结果一致。结论利用MRI不同序列的成像特点,可对川崎病的冠状动脉和心肌组织学特性进行综合评估,包括冠状动脉瘤、血栓、心肌纤维化及心室功能的变化情况。Objective To explore the value of MRI in the diagnosis of coronary artery and myocardial lesions in children with Kawasaki disease.Methods Cardiac MRI of 38 patients with Kawasaki disease were retrospectively analyzed.MRI sequences included three dimensional steady-state free precession(3D-SSFP)coronary artery imaging,first-pass perfusion to assess myocardial ischemia,late gadoliniurn-enhanced magnetic resonance imaging(LGE-MRI)to assess myocardial histology features,and 2D SSFP cine sequence to evaluate cardiac function.The maximum diameters of coronary aneurysms measured in 3D-SSFP were compared with those measured in echocardiography(ECHO)by Bland-Altman analysis.Results Among the 38 cases,there were 28 cases(73.7%)with aneurysmal dilatation in right coronary artery(RCA)or left coronary artery(1CA).The highest incidence of aneurysmal dilatation was in left anterior descending branch(LAD)in 23 cases,and followed by RCA in 19 cases.The maximum diameter of RCA aneurysm(7.66士2.10)mm was higher than that of LAD aneurysm(6.11±1.96)mm with P<0.05.Myocardial first-pass perfusion in 5 cases showed left ventricular and ventricular septum subendocardial ischemia,LGE-MRI in 5 cases showed myocardial delayed enhancement in left ventricular free wall and ventricular septum,and the left ventricular ejection fractions in 4 cases were less than 50%,with an average of(34.0±15.9)%.3D-SSFP and ECHO showed good consistency in the maximal diameter measurement of RCA and LAD aneurysm.Conclusion The imaging features in different sequences of MRI can be used to comprehensively evaluate the coronary artery and myocardial histological characteristics of Kawasaki disease,including coronary aneurysms,thrombosis,myocardial fibrosis and changes of ventricular function.

关 键 词：磁共振成像 川崎病 冠状动脉瘤 心肌缺血 心肌梗死 

分 类 号：R445.2[医药卫生—影像医学与核医学] R725.4[医药卫生—诊断学]