缺血性心肌病变即急性心肌梗死的定量成像诊断价值  

The diagnostic value of quantitative imaging for acute myocardial infarction

作　　者：崔倩[1] 于静[1] 葛夕洪[1] 高光峰[1] 刘洋[1] 何强[2] 崔祺 王洪乐 沈文[1] Cui Qian;Yu Jing;Ge Xihong;Gao Guangfeng;Liu Yang;He Qiang;Cui Qi;Wang Hongle;Shen Wen(Department of Radiology,Tianjin First Center Hospital,Tianjin 300192,China;Department of Cardiology,Tianjin First Center Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院放射科,天津300192 [2]天津市第一中心医院心脏内科,天津300192

出　　处：《中华危重病急救医学》2022年第2期178-182,共5页Chinese Critical Care Medicine

基　　金：天津市卫生健康委员会科技人才培育项目(RC20184)。

摘　　要：目的探讨心血管磁共振成像(CMR)技术纵向弛豫时间定量成像(T1 mapping)联合横向弛豫时间定量成像(T2 mapping)对缺血性心肌病变急性期的诊断价值。方法选取2020年5月至2021年4月在天津市第一中心医院因急性心力衰竭(心衰)通过冠状动脉(冠脉)造影确诊为急性心肌梗死(AMI)的24例患者,使用3.0T飞利浦Ingenia核磁,在明确诊断AMI后于平均(9±4)d内行CMR检查,作为首诊参照,并于3个月后及6个月后的慢性心肌梗死(CMI)期各行一次CMR复查;并选取同一时段性别、年龄匹配的26例健康志愿者和门诊非特异性胸痛而行CMR检查无异常者作为对照组。平扫检查包括电影序列、T2加权成像(T2WI;STIR序列)、增强前T1 mapping和T2 mapping;增强检查包括首过灌注、延迟增强及增强后T1 mapping。比较心肌梗死前后心肌定量参数的变化;制作受试者工作特征曲线(ROC曲线),评估、对比并区分AMI组和6个月后CMI组各指标的变化。结果AMI组患者增强前T1值、T2值及细胞外容积(ECV)均较对照组升高,差异均有统计学意义〔增强前T1值(ms):1438.7±173.4比1269.2±42.3,增强前T2值(ms):49.8±9.3比21.7±4.0,ECV(%):33.2±10.2比27.2±2.1,均P<0.05〕。ECV在AMI时明显增高(%:33.2±10.2比27.2±2.1),但于3个月后趋于稳定(%:33.2±10.2比32.4±5.1),在AMI 6个月后(%:27.7±4.9比32.4±5.1)无明显差异(均P>0.05)。AMI组增强前T1值和T2值在AMI时明显增高,3个月后出现降低,但于6个月后明显降低〔增强前T1值(ms):1438.7±173.4比1272.1±25.2,增强前T2值(ms):49.8±9.3比29.0±4.0,均P<0.05〕,AMI和CMI增强前T1值和T2值ROC曲线分析得出特异度均为100%,敏感度分别为72.7%和100%,增强前T1值和T2值是可以较好区分AMI和CMI的诊断方法。结论使用T1 mapping和T2 mapping并结合ECV,对缺血性心肌病变的诊断明确,尤其是增强前心肌T1值和T2值是诊断AMI非侵入式评估手段,并可区分AMI和CMI,对患者的临床治疗和随访有�Objective To explore the diagnostic performance of cardiac magnetic resonance imaging(CMR)with T1 mapping and T2 mapping for detection of acute phase of ischemic cardiomyopathy.Methods Twenty-four patients with acute myocardial infarction(AMI)detected by coronary angiography from May 2020 to April 2021 in Tianjin First Center Hospital were selected.All patients underwent CMR(Philips Ingenia 3.0-T)at(9±4)days after definite diagnosis,which was defined as the first diagnosis.After 3 months and 6 months of chronic myocardial infarction(CMI)phase,one CMR was performed.On the same period with age and sex matching,a total of 26 cases of healthy volunteers and outpatient with non-specific chest pain and CMR examination without abnormality as control group.Plain scan included Cine,T2-weighted(STIR),and native T1/T2 mapping.The enhanced scan included perfusion,late gadolinium enhancement,post-T1 mapping.The changes of myocardial quantitative parameters before and after myocardial infarction were compared.Receiver operator characteristic curves(ROC curve)were developed to evaluate,compare,and distinguish the changes in the AMI group and the CMI group after 6 months.Results Pre-enhanced T1 value,T2 value and extracellular volume(ECV)of AMI group were significantly higher than those of control group[pre-enhanced T1 value(ms):1438.7±173.4 vs.1269.2±42.3,pre-enhanced T2 value(ms):49.8±9.3 vs.21.7±4.0,ECV(%):33.2±10.2 vs.27.2±2.1,all P<0.05].ECV was significantly higher in AMI(%:33.2±10.2 vs.27.2±2.1),but stabilized after 3 months(%:33.2±10.2 vs.32.4±5.1),and after 6 months later(%:27.7±4.9 vs.32.4±5.1),there were no significant difference(all P>0.05).Pre-enhanced T1 and T2 values were significantly higher in AMI,lower after 3 months,but significantly decreased after 6 months[pre-enhanced T1 values(ms):1438.7±173.4 vs.1272.1±25.2,pre-enhanced T2 values(ms):49.8±9.3 vs.29.0±4.0,all P<0.05].The ROC curve showed that the specificity of pre-enhanced T1 and T2 values between AMI and CMI were 100%,and the sensitivity

关 键 词：定量成像 缺血性心肌病 急性心肌梗死 

分 类 号：R542.22[医药卫生—心血管疾病]