心肌应变力检测急性心肌梗死再灌注术后微循环障碍:基于特征追踪心脏MRI  

Strain analysis in the detection of microvascular after reperfusion in patients with acute myocardial infarction:based on feature tracking cardiac MRI

作　　者：晏乘曦 常莹[2] 任美吉 孙峥[1] 刘志[3] 杨旗[1] YAN Cheng-xi;CHANG Ying;REN Mei-ji(Department of Radiology,Xuanwu Hospital,the Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院放射科,北京100053 [2]首都医科大学宣武医院超声科,北京100053 [3]首都医科大学宣武医院心内科,北京100053 [4]首都医科大学附属佑安医院,北京100053

出　　处：《放射学实践》2020年第8期1025-1029,共5页Radiologic Practice

摘　　要：目的:运用特征追踪(FT-CMRI)技术心脏磁共振成像(CMRI),探讨急性心肌梗死后(AMI)微循环障碍(MVO)对心肌局部功能的影响。方法:前瞻性收集ST抬高型急性心肌梗死(STEMI)患者,对其在再灌注术后3~7天内行CMRI检查,包括常规心脏电影(cine)序列和钆对比增强(LGE)延迟期扫描。运用FT-CMRI后处理软件测量左心室整体及各节段心尖、中份、基底部)的径向应变力(RS)、环向应变力(CS)和纵向应变力(LS)。结果:26例患者均表现有心肌延迟强化,其中9例合并微循环障碍(MVO);共有78个心肌节段纳入观察,其中21个延迟强化节段合并MVO,37个延迟强化节段未合并MVO,20个心肌节段未见延迟强化。在患者水平,仅有CS能够区分梗死合并MVO与单纯梗死(P=0.003)。在节段水平:RS在单纯梗死与梗死合并MVO以及未受累心肌与梗死合并MVO间的差异均有统计学意义(P<0.05);CS在三组间的差异有统计学意义(P=0.000),且组间两两比较差异均有统计学意义(P<0.05);LS仅在梗死合并MVO与未梗死心肌之间的差异有统计学意义(P<0.05)。CS(AUC=0.879,P=0.000)在区分MVO与非MVO节段时优于RS(AUC=0.791,P=0.001)和LS(AUC=0.670,P=0.008)。结论:急性心肌梗死后微循环障碍的存在与心功能障碍具有相关性,CS在评估不同程度心肌梗死方面优于RS和LS,CS可以准确识别梗死合并MVO的心肌。Objective:To evaluate influence of microcirculation obstruction(MVO)on regional myocardial function of the patients with acute myocardial infarction after by feature tracking(FT)cardiac MRI(CMRI).Methods:Patients with ST-segment elevated myocardial infarction were recruited into the CMRI study in 3~7 days after reperfusion.All patients underwent cine-sequence and late-gadolinium-enhanced(LGE)CMRI at a 3.0T scanner.CMRI-FT of radial strain(RS),long strain(LS)and circumferential strain(CS)of global and base-,mid-,and apical-segments were performed to quantify the regional function of left ventricle.Results:Late contrast enhancement(LCE)was present in 26 patients including 9 with MVO.A total of 78 myocardial segments were included for observation,in which 21 segments of LCE were with MVO,37 segments without MVO,20 segments were without LCE.On per-patient analysis,only CS can discriminate LGE from LCE with MVO(P=0.003).On per-segment analysis:RS can discriminate LGE from LCE with MVO,non-LCE and LCE with MVO(P<0.05);the difference of CS in non-LCE,LCE,and LCE with MVO segments was statistically significant,and the difference was still significant with further pair-wise comparison analysis;there was significant difference in LS between LCE with MVO segments and non-LCE segments(P<0.05).CS(AUC=0.879,P=0.000)was superior to RS(AUC=0.791,P=0.001)and LS(AUC=0.670,P=0.008)in quantification of regional function influenced by MVO.Conclusion:There is a correlation between MVO and cardiac dysfunction in patients with AMI.CS is superior to RS and LS in distinguishing different degrees of myocardial infarction.CS can accurately identify myocardial infarction complicated with MVO.

关 键 词：急性心肌梗死 微循环障碍 应变力 冠状动脉 磁共振成像 特征追踪技术 

分 类 号：R445.2[医药卫生—影像医学与核医学] R541.4[医药卫生—诊断学]