MRI心肌灌注结合MR心脏电影对评价心肌活性的价值

Value of MR Myocardial Perfusion Imaging Combined with MR-cine in Assessing Myocardial Viability

【目的】评价MR心肌灌注成像（MR myocardial perfusion imagingMRMPI）及心脏电影对心肌活性的价值。【方法】选择有冠心病心肌梗死病史的患者28例，利用反转恢复快速小角度激励（IRturbo—FLASH）序列及心电门控技术，由肘静脉注射钆喷酸葡胺（Gd—DTPA）后，进行首过灌注成像及5～10min延迟期成像。注射造影剂前常规行心脏电影成像，评价心脏收缩功能。【结果】19例（67．9％）首过期显示灌注减低；28例（92．9％）延迟增强，其中单纯透壁型增强9例（34．6％），单纯非透壁增强6例（23．1％），混合型11例（42．3％）；2倒（7．1％）无增强。室壁节段运动降低14例，消失6例，矛盾运动5例，正常3例。28例中82个心肌节段受损：63个节段的室壁增厚率下降，19个正常。【结论】MRMPI结合MR心脏电影对评价冠心病心肌梗死存活和非存活心肌的程度和范围具有显著临床意义。

[Objective]To assess the value of MR myocardial perfusion imaging（MRMPI） combined with MR-cine in detecting the viability of myocardium in patients with myocardial infarction. [Methods]MRMPI was performed with IR-turbo-FLASH sequence in 25 patients Suffering from myocardial infarction with 1. 5TMR scanner. All patients were imaged during the first-pass and delayed phase 5-10 min after injection of Gd-DTPA. MR-cine was used before MRMPI. [Results] Nineteen cases（67.9%） showed hypo-enhancement during the first-pass imaging. Twenty six cases （92. 9%） revealed delayed hyper-enhancement including 9 （34.6%） transmural, 6（23.1%） non-transmural and 11（42.3%）mixed. Another 2 cases was normal in delayed hyper-enhancement. The motion of myocardial wall decreased in 14 cases, disappear 6, inconsistent motion 5 and normal 3. Systolic thickening ratio decreased in 63 myocardial segments and normal in 18. [Conclusion] The severity and extent of myocardial viability and non-viability of myocardial infarction could be effectively evaluated with MRMPI combined with MR-cine.