心脏磁共振延迟强化成像定量评价心肌梗死的研究

Quantification of myocardial infarcted size on delayed enhancement magnetic resonance imaging

目的研究计算机辅助测体积法（CAVM）与视觉评分法（VSM）在心脏磁共振延迟强化成像上评价梗死心肌大小的相关性，并探讨梗死心肌质量与室壁运动异常、左室功能的相关性。方法采用多次屏气平衡稳态自由进动快速成像（FIESTA）序列，对21例心肌梗死患者行心脏电影MRI及钆喷替酸葡甲胺（Gd—DTPA）增强的延迟强化成像。①用CAVM及VSM分别评价患者的梗死心肌质量及梗死心肌范围程度。用VSM评价时根据延迟强化的透壁程度分为0～4分；0=无强化，1=1％～25％强化，2=26％～50％强化，3=51％～75％，4=76％～100％强化；②评价患者的室壁运动异常及左室功能。结果两种方法评价梗死心肌高度相关（r=0．825，P〈0．001）；梗死心肌质量与室壁运动异常（r=0．740）、射血分数（r=-0．733）、收缩末期容积指数（r=0．702）、收缩末期容积（r=0．698）、舒张末期容积指数（r=0．657）、舒张末期客积（r=0．648）均密切相关（P≤0．001）。结论计算机辅助测体积法及视觉评分法均可准确定量梗死心肌，梗死心肌质量与室壁运动异常、左室功能有高度相关性.

Objective To compare the quantification of myocardial infarcted size on delayed enhancement magnetic resonance imaging （DE-MRI） by using computer-assisted volume method （CAVMM） and visual scoring method（VSM） ,and to study the relationships between the infarted mass and regional wall motion abnormality,and the left ventricular（LV） functions. Methods Twenty-one patients with myocardial infarction underwent cine and DE-MRI using a 1.5 T device： （1） infarted size was quantified by two methods： CAVMM and VSM （0-4）. According to the transmural extent of the hyperenhancement（HE）, score 0 = 0% HE, 1 ： 1%-25% HE, 2 = 26%-50% HE, 3 = 51%- 75% HE and 4： 76%-100% HE; （2） ventricular reginal wall motion abnormality and LV functions were assessed, respectively. Results Strong statistically correlations were found between.CAVM and VSM （ r =0. 825, P 〈0. 001）, infarcted mass and regional wall motion abnormality （ r = 0. 740）, and ejection fraction （ r = -0. 733）, and end-systolic volumes index （ r = 0. 702）,and end-systolic volumes （ r = 0. 698）, and end-diastolic volumes index （ r = 0. 657）, and end-diastolic volumes （ r =0. 648）, （ P ≤0. 001） ,respectively. Conclusion Quantification of infarcted size on DE-MRI using CAVM and VSM was accurate. There were high correlations between infarcted mass and regional wall motion abnormality and left ventricular functions.