心血管磁共振T2加权序列对急性心肌梗死后水肿心肌的诊断效能研究  

Diagnostic Efficacy of Cardiovascular Magnetic Resonance T2-weighted Sequence on Edematous Myocardium After Acute Myocardial Infarction

作　　者：孙峥[1] 胡莹莹 吴芳[2] 刘志[3] 张楠[1] 卢洁[2] SUN Zheng;HU Yingying;WU Fang;LIU Zhi;ZHANG Nan;LU Jie(Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application,School of Biomedical Engineering,Capital Medical University,Beijing(100069),China)

机构地区：[1]首都医科大学生物医学工程学院生物力学临床应用基础研究北京市重点实验室,北京市100069 [2]首都医科大学宣武医院放射与核医学科 [3]首都医科大学宣武医院心脏科

出　　处：《中国循环杂志》2022年第1期31-38,共8页Chinese Circulation Journal

基　　金：国家自然科学基金(61672362)。

摘　　要：目的:探讨心血管磁共振(CMR)黑血、亮血T2加权序列对急性心肌梗死患者再灌注血管开通后水肿心肌的诊断效能。方法:回顾分析2016年9月至2018年12月就诊于首都医科大学宣武医院的76例首次发作急性心肌梗死患者的临床影像资料。患者平均年龄(57±11)岁,其中男性66例。全部患者于1周内行CMR检查。收集并分析CMR黑血T2加权黑血反转恢复(T2-STIR)序列、亮血T2预脉冲自由呼吸平衡稳态进动(T2p-SSFP)序列图像,以定量T2-MAP序列为"金标准"评价识别水肿心肌的诊断效能。图像质量分析包含患者水平图像伪影识别,层面水平图像信噪比,对比噪声比比较;诊断效能包含节段水平水肿心肌识别的敏感度、特异度和准确度。结果:在患者水平,黑血T2-STIR和亮血T2p-SSFP产生运动伪影分别有24例和5例,磁敏感伪影分别有17例和2例,差异有统计学意义(P<0.05)。层面水平,黑血T2-STIR序列显示远端心肌、水肿心肌信噪比是亮血T2pSSFP序列的2倍(P<0.05),水肿心肌与远端心肌、与血池的对比噪声比黑血T2-STIR序列强于亮血T2p-SSFP序列,差异有统计学意义(P<0.05)。在节段水平,黑血T2-STIR对水肿心肌识别的敏感度高[87.4%(83.3%,90.8%)],亮血T2p-SSFP的特异度高[95.4%(89.5%,98.5%)],两者相结合可显著提升水肿心肌识别效能,敏感度达[93.7%(90.5,96.1)],约登指数提升至0.86。结论:心血管磁共振T2加权序列的优质图像质量,对急性心肌梗死后水肿心肌的识别具备临床实用价值,黑血T2-STIR和亮血T2p-SSFP序列相结合可显著提升识别敏感度和准确性。Objectives:To investigate the diagnostic efficacy of cardiovascular magnetic resonance black blood and bright blood T2-weighted sequence on edematous myocardium in patients with acute myocardial infarction after reperfusion.Methods:Seventy-six patients with first acute myocardial infarction admitted to Xuanwu Hospital of Capital Medical University from September 2016 to December 2018 were included in this study.The CMR T2-STIR and T2 p-SSFP images were collected and analyzed,and the diagnostic efficiency on identifying edema myocardium was evaluated using quantitative T2-MAP sequences as the gold standard.Image quality included image artifact recognition at patient level,signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)comparison at slice level.Diagnostic efficacy included sensitivity,specificity,and accuracy in the identification of myocardial edema at segment level.Results:The mean age of 76 patients with first AMI was(57±11)years,including 66 males.All patients underwent CMR examination within one week after admission.At the patient level,the motor artifacts of T2-STIR and T2 p-SSFP in black blood were 24 cases and 5 cases,and that of susceptibility artifacts were 17 cases and 2 cases,respectively.The difference was statistically significant(P<0.05).At the slice level,the SNR of remote myocardium and edematous myocardium in T2-STIR was twice higher than that in T2 p-SSFP(P<0.05).The CNR of edematous myocardium to remote myocardium and blood pool in T2-STIR was more robust than that in T2 p-SSFP,and the difference was statistically significant(P<0.05).At the segmental level,the sensitivity of T2-STIR was high(87.4%[83.3%,90.8%]),and the specificity of T2 p-SSFP was high(95.4%[89.5%,98.5%]).The combination of T2-STIR and T2 p-SSFP could significantly improve the sensitivity and accuracy of myocardial edema recognition,with a sensitivity of(93.7%[90.5%,96.1%])and a Youden index of 0.86.Conclusions:The high image quality of CMR T2-weighted sequence has practical clinical value on identifying edematous my

关 键 词：心血管磁共振 急性心肌梗死 水肿心肌 T2加权黑血反转恢复 T2预脉冲自由呼吸平衡稳态进动 

分 类 号：R54[医药卫生—心血管疾病]