心血管MR T_(2)WI序列评估急性心肌梗死患者心肌损害与左心室舒张功能关系的研究  

Evaluation of the relationship between myocardial damage and left ventricular diastolic function in patients with acute myocardial infarction using cardiovascular MR T_(2)WI sequences

作　　者：张艳楠 殷子惠 ZHANG Yannan;YIN Zihui(Department of Radiology,Wuhan Fourth Hospital,Wuhan 430000,China)

机构地区：[1]武汉市第四医院放射科,湖北武汉430000

出　　处：《实用放射学杂志》2025年第1期41-45,共5页Journal of Practical Radiology

摘　　要：目的探讨心血管MR T_(2)WI序列评估急性心肌梗死(AMI)患者心肌损害与左心室舒张功能的关系。方法选取155例AMI患者,根据是否发生左心室舒张功能不全,将患者分为舒张功能不全组和舒张功能正常组,收集所有患者的临床资料、入院时的心肌损伤和心功能指标、心脏MR黑血T_(2)短时反转恢复(T_(2)-STIR)序列、亮血T_(2)预脉冲自由呼吸平衡稳态进动(T_(2) p-SSFP)序列图像。采用Pearson法分析T_(2)WI序列与心肌损伤和心功能指标的关系。采用多因素logistic回归分析与左心室舒张功能不全有关的影响因素。采用受试者工作特征(ROC)曲线分析心血管MR T_(2)WI序列对左心室舒张功能不全的诊断效能。结果与T_(2)-STIR序列相比,T_(2) p-SSFP序列显示的远端心肌信噪比(SNR)、水肿心肌SNR以及水肿心肌与远端心肌对比噪声比(CNR)明显降低(P<0.05)。T_(2)WI序列的远端心肌SNR、水肿心肌SNR和水肿心肌与远端心肌CNR与心肌肌钙蛋白(cTnI)、肌酸激酶同工酶MB型(CK-MB)、肌红蛋白(MB)和左心室射血分数(LVEF)均呈正相关(P<0.05)。舒张功能不全组患者在T_(2)-STIR序列和T_(2) p-SSFP序列中,远端心肌SNR、水肿心肌SNR以及水肿心肌与远端心肌CNR明显高于舒张功能正常组(P<0.05)。logistic回归分析显示,远端心肌SNR、水肿心肌SNR和水肿心肌与远端心肌CNR是AMI患者左心室舒张功能不全的危险因素(P<0.05)。ROC曲线分析显示,T_(2)WI序列的远端心肌SNR、水肿心肌SNR、水肿心肌与远端心肌CNR对AMI患者左心室舒张功能不全均有诊断价值。结论心血管MR T_(2)WI序列在AMI患者中显著表达,与心肌损伤呈正相关,可应用于疾病严重程度的评估,且在左心室舒张功能不全中具有明显预测价值。Objective To explore the evaluation of the relationship between myocardial damage and left ventricular diastolic function in patients with acute myocardial infarction(AMI)by using cardiovascular MR T_(2)WI sequences.Methods A total of 155 AMI patients were selected.All patients were divided into two groups based on whether left ventricular diastolic dysfunction occurred,including diastolic dysfunction group and diastolic normal group.Clinical data of all patients,myocardial injury and cardiac function indicators at admission,black blood T_(2) short time inversion recovery(T_(2)-STIR)sequence of cardiac MR,and T_(2) prepulse steady state free procession during free breathing(T_(2) p-SSFP)sequence images of bright blood were collected.Pearson’s method was used to analyze the relationship between T_(2)WI sequences and myocardial injury as well as cardiac function indicators.Multivariate logistic regression analysis was used to evaluate the influencing factors of left ventricular diastolic dysfunction.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of cardiovascular MR T_(2)WI sequences in left ventricular diastolic dysfunction.Results Compared with the T_(2)-STIR sequence,the T_(2) p-SSFP sequence showed a significant decrease in the signal-to-noise ratio(SNR)of the distal myocardial,the SNR of the edematous myocardial,and the contrast-to-noise ratio(CNR)of the edematous myocardial and the distal myocardial(P<0.05).The distal myocardial SNR,edematous myocardial SNR,and edematous myocardial and distal myocardial CNR of T_(2)WI sequences were positively correlated with cardiac troponin I(cTnI),creatine kinase isoenzyme MB(CK-MB),myoglobin(MB),and left ventricular ejection fraction(LVEF),respectively(P<0.05).Compared with diastolic normal group,patients in diastolic dysfunction group had significantly higher distal myocardial SNR,edematous myocardial SNR,and edematous myocardial and distal myocardial CNR in the T_(2)-STIR and T_(2) p-SSFP sequences(P<0.05).Logistic regression a

关 键 词：急性心肌梗死 心肌损害 左心室舒张功能 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R542.22[医药卫生—诊断学] R542.2[医药卫生—临床医学]