心脏MRI全定量静息灌注在心肌缺血中应用价值  

Application of fully quantitative rest perfusion of cardiovascular magnetic resonance imaging in myocardial ischemia

作　　者：王佳佳 林青 潘玉坤 张继良 谢瑞刚 葛英辉 WANG Jia-jia;LIN Qing;PAN Yu-kun;ZHANG Ji-liang;XIE Rui-gang;GE Ying-hui(Department of Radiology,Fuwai Central China Cardiovascular Hospital,Henan Provincial People's Hospital,Zhengzhou,Henan 451450,China)

机构地区：[1]阜外华中心血管病医院,河南省人民医院放射科,河南郑州451450

出　　处：《中华实用诊断与治疗杂志》2022年第12期1264-1268,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划省部共建项目(SB201901097)。

摘　　要：目的应用心脏MRI全定量静息灌注评估疑似心肌缺血患者心肌灌注异常情况,探讨心脏MRI全定量静息灌注诊断心肌缺血的价值。方法30例已知或疑似心肌缺血患者(480个心肌节段)分别行心脏MRI全定量静息灌注和SPECT静息心肌灌注,以SPECT静息心肌灌注结果为标准,将480个心肌节段分为灌注异常节段组165个和灌注正常节段组315个;10例健康对照者(160个心肌节段为对照节段组)行心脏MRI全定量静息灌注。测量3组心脏MRI左心室心肌节段的全定量参数心肌血流量(myocardial blood flow,MBF)、相对心肌血流量(relative myocardial blood flow,rMBF)及半定量参数时间-信号强度曲线最大斜率(slope max,Smax)、信号强度峰值(peak,P)、达峰时间(time to peak,T),并进行比较。采用视觉分析法对30例患者480个心肌节段SPECT和心脏MRI静息灌注情况进行定性评估,比较SPECT与心脏MRI静息灌注定性评估灌注异常节段比率。绘制ROC曲线,评估心脏MRI心肌节段的定性评估及半定量(Smax、P、T)、全定量(MBF、rMBF)静息灌注参数诊断心肌缺血的效能。结果灌注异常节段组MBF[(1.33±0.47)mL/(g·min)]、rMBF(0.70±0.18)均低于灌注正常节段组[(1.62±0.55)mL/(g·min)、0.81±0.17]、对照节段组[(1.46±0.42)mL/(g·min)、0.81±0.16](P<0.05);灌注正常节段组MBF高于对照节段组(P<0.05),rMBF与对照节段组比较差异无统计学意义(P>0.05)。灌注异常节段组Smax[(1.24±1.40)SI/s]低于灌注正常节段组[(1.66±1.01)SI/s]、对照节段组[(1.63±1.06)SI/s](P<0.05),T[(38.96±13.61)s]高于灌注正常节段组[(33.17±10.13)s]、对照节段组[(27.23±7.10)s](P<0.05),P[(24.28±13.00)SI]与灌注正常节段组[(26.46±10.61)SI]、对照节段组[(23.41±10.91)SI]比较差异均无统计学意义(P>0.05);灌注正常节段组P、T均高于对照节段组(P<0.05),Smax与对照节段组比较差异无统计学意义(P>0.05)。心脏MRI静息灌定性注评估灌注异常节段比率(30.6%Objective To evaluate myocardial perfusion abnormalities in patients with suspected myocardial ischemia by fully quantitative rest perfusion of cardiovascular magnetic resonance imaging(MRI),and to explore the value of fully quantitative rest perfusion of cardiovascular MRI to the diagnosis of myocardial ischemia.Methods Thirty patients with known or suspected myocardial ischemia(480 myocardial segments)underwent fully quantitative rest perfusion of cardiovascular MRI and rest single-photon emission computed tomography myocardial perfusion imaging(SPECT-MPI),respectively.Based on the results of rest SPECT-MPI,480myocardial segments were divided into abnormal perfusion group(165segments)and normal perfusion group(315segments).Another 160myocardial segments of 10healthy volunteers(control group)underwent fully quantitative rest perfusion of cardiovascular MRI.Fully quantitative parameters as myocardial blood flow(MBF)and relative myocardial blood flow(rMBF)as well as semi-quantitative parameters as slope max(Smax),peak(P)and time to peak(T)were measured and compared in all left ventricular myocardial segments on cardiovascular MRI.Visual analysis was used to qualitatively evaluate rest perfusion of 480 myocardial segments in 30patients by SPECT and cardiovascular MRI,and the ratio of abnormal perfusion segments was compared.ROC curves were drawn to evaluate the diagnostic efficiency of qualitative evaluation,fully quantitative parameters(MBF,rMBF)and semi-quantitative parameters(Smax,P,T)on perfusion of myocardial segments in patients with suspected myocardial ischemia.Results The MBF and rMBF were lower in abnormal perfusion group[(1.33±0.47)mL/(g·min),0.70±0.18]than those in normal perfusion group[(1.62±0.55)mL/(g·min),0.81±0.17]and control group[(1.46±0.42)mL/(g·min),0.81±0.16](P<0.05),MBF was higher in normal perfusion group than that in control group(P<0.05),and rMBF showed no significant difference between normal perfusion group and control group(P>0.05).Smax was lower in abnormal perfusion group[(1.

关 键 词：心肌缺血 心脏MRI SPECT静息心肌灌注 全定量静息灌注 

分 类 号：R445.2[医药卫生—影像医学与核医学] R542.2[医药卫生—诊断学]