负荷MR心肌灌注成像检测冠心病心肌缺血与冠状动脉造影及^(99m)Tc-SPECT对比的初步研究

Dipyridamole stress MR in assessment of myocardial perfusion in patients with coronary artery disease: comparison with coronary angiography and ^(99m)Tc-SPECT

目的探讨负荷MR首过心肌灌注成像检测冠心病的临床价值。方法33例经冠状动脉造影确诊的冠心病患者,男22例,女11例,平均年龄58.32岁。其中15例常规行静息-负荷99mTc-SPECT心肌灌注显像。采用IR-turboFLAS序H列行静息-负荷MR首过心肌灌注成像及延迟期心肌灌注成像,目测定性分析心肌灌注图像,将分析结果与冠脉造影及99mTc-SPECT进行比较,计算其敏感性和特异性。结果28例(28/33)191段心肌灌注减低,其中92段(92/191)可逆性灌注减低,99段(99/191)固定灌注减低;51支冠状动脉主干或其主要分支狭窄,MR首过心肌灌注成像42支狭窄冠脉供血区心肌灌注减低。以冠脉造影为参考标准,MR首过心肌灌注成像检测狭窄50%以上冠状动脉病变的敏感性及特异性分别为:82.35%和91.67%。MR首过心肌灌注成像与99mTc-MIBISPEC具T有很好的一致性,两者符合率为:92.5%。以99mTC-MIBISPEC为T参考标准,MR首过心肌灌注成像检测冠心病的敏感性及特异性分别为:94.74%、92.55%。结论负荷MR首过心肌灌注成像能有效检测冠心病心肌缺血;MR首过心肌灌注成像定性评价冠心病心肌缺血具有较高的临床实用价值。

Objective To evaluate efficacy ofdipyridamole-stress first-pass myocardial-perfitsion MR imaging in detecting coronary artery disease （CAD）. Methods 33 patients with CAD confirmed by coronary angiography were enrolled, including 22 men and 11 women, with an average age of 58.32. 15 patients underwent routine static and stress 99m^Tc-SPBCT to perform myocardial perfusion imaging. Using IR-TuborFLASH sequence to conduct myocardial perfusion imaging in first-pass and delayed phase. All the images were measured by naked eyes qualitatively. The results were cornparad with those obtained from coronary, angiography and 99m^Tc-SPECT. Parmeters as sertsidvity and specificity were calculated. Results 191 seginertts in 28 patients （28/33） had a poor perfusion, 92 segments （92/191 ） were reversible and 99 （99/191） were irreversible, Stenosis was seen in steins of branches of the coronary artery. First-pans imaging found stenosis and poor perfusion in 42 branches. By referring to coronary angiography, sertsitivity and specificity for detecting stenosis more than 50% by first-pass imaging was 82,35% and 91.67%, respectively. First-pass MR imaging was considerably coherent to 99m^TC-MIBI SPECT. with an agreement rate of 92.5%. In case 99m^TC-MIBI SPECT was referred to, first-pass MR. imaging detecting CAD had a sensitivity and specificity of 94.74% and 92.55%, respectively. Conclusion Dipyridamole-stress first-pass perfusion MR imaging is effecfive in detecting CAD, qualitatively assess CAD with first-pass perfusion imaging is of high value for clinical settings.