磁共振与超声心动图负荷实验诊断心肌缺血的比较

Comparison of the Loading Tests between Magnetic Resonance Imaging and Echocardiography for Detecting Myocardial Ischemia

目的 将多巴酚丁胺超声心动图负荷实验方法与超高速磁共振成像结合起来 ,比较它和多巴酚丁胺超声心动图负荷实验 (DSE)对心肌缺血的诊断价值。方法 对 2 0 8例拟诊冠心病的连续病例先后进行二次谐波成像的超声心动图多巴酚丁胺负荷实验、多巴酚丁胺磁共振负荷实验 (stressMRI)和冠状动脉造影检查。超声心动图多巴酚丁胺负荷实验按常规方法进行。磁共振负荷实验采用标准的多巴酚丁胺 -阿托品负荷实验程序 ,直至达到目标心率。分别在静息时和各个负荷水平采用梯度回波技术 ,在短时屏气期间 ,采集 3个短轴平面、 1个四腔位和 1个二腔位MR图像。按 16节段模式判断局部室壁运动。结果 18例病人超声心动图检查失败 (图像质量差 ) ,4例没有达到目标心率。 11例病人不能接受磁共振检查 ,3例因为呼吸伪图像不能诊断。在 3种检查资料完整的 172例受检者中 ,10 9例诊断为冠心病。磁共振负荷实验的敏感性 (86 2 % )和特异性 (85 7% )与超声心动图比较差别有显著性意义 (敏感性74 3%、特异性 6 9 8% ,χ2 =4 5 9,P <0 0 5 )。MRI的准确性也较高 (86 0 %vs 72 7% ,P <0 0 0 5 )。结论 标准的多巴酚丁胺 -阿托品负荷实验程序同样可以用在磁共振负荷实验中。与超声心动图相比 ,对于判断室壁运动异常 ,多巴?

Objective Combining dopamine stress echocardiography (DSE) and ultra fast magnetic resonance topography,and comparing their diagnosing value for myocardial ischemia.Methods 208 consecutive patients (147 men,61 women) with suspected coronary artery disease were examined twice by DSE,dopamine stress magnetic resonance (MR) and coronary arteriography.The loading test of dopamine echocardiography was performed as routine treatment;the loading test on magnetic resonance adopted the standard dopamine-atropine experimental procedure,until reached the objective heart rate.The staircase recoil-wave shill was adopted at rest and each loading level,MRI images were acquired during short breath-holds in 3 short-axis views and a 4- and a 2-chambre view.Regional wall motion was assessed in a 16-segment model.Results 18 patients failed to echocardiography test (poor quality of their images),4 patients did not reach the objective heart rate,11 patients could not accept MR test,3 could not be diagnosed for false images of respiration,172 had 3 test documents,109 were diagnosed as coronary artery disease.Sensitivity (86.2%) and specificity (85.7%) of MR loading test were obviously different from those (74.3% & 69.8%) in echocardiography (P<0.05).The accuracy of MR was higher (86.0% vs 72.7%,P<0.005).Conclusion The standard dopamine-atropine loading test procedure can be also used in MR loading test.Compared with echocardiography,dopamine magnetic resonance imagining has higher diagnosing standard in detecting wall motion abnormalities.