MRI、SPECT和二维超声心动图评价原发性扩张型心肌病心功能的比较影像学研究

MRI,SPECT and 2D echocardiography in assessing cardiac function of patients with idiopathic dilated cardiomyopathy

目的应用MRI与二维超声心动图(2DE)、99Tcm-MIBISPECT对原发扩张型心肌病(IDCM)定量评价左室功能和容积;比较三种影像学方法评价心功能与NYHA分级的相关性。方法使用MRI与2DE、SPECT对42例IDCM患者分别进行左室容积和功能测量。NYHAⅠ～Ⅱ级11例,Ⅲ级16例,Ⅳ级15例。MRI采用Argus软件MassAnalysis功能进行测量和计算,2DE采用Simspon法测算,SPECT采用QGS软件处理。结果三种检查方法对EDV、ESV、EF的测值相关性好,MRI与SPECT所测指标的r值大于0.9;MRI与2DE所测指标r值为0.699～0.878。MRI与2DE、SPECT比较左室容积差异均有统计学意义,然而2DE和SPECT均低估左室容积;与MRI比较,2DE低估EF值,而SPECT没有低估。MRI与NYHA心功分级比较:心功能Ⅲ、Ⅳ级与心功能Ⅰ～Ⅱ级比较,ESV、SV、EF、PER、PFR、EDD、ESD的差异有统计学意义;2DE与NYHA心功分级比较:心功能Ⅲ、Ⅳ级与心功能Ⅰ～Ⅱ级比较,ESV和EF的差异有统计学意义;Ⅳ级与心功能Ⅰ～Ⅱ级比较,EDD、ESD差异有统计学意义;SPECT与NYHA心功分级比较:心功能Ⅲ、Ⅳ级与心功能Ⅰ～Ⅱ级比较,ESV和EF差异有统计学意义。结论 MRI与SPECT比较心功能指标之间相关性良好,MRI较2DE提供更多的左室功能和容积参数,而2DE低估左室容积;三种方法与NYHA心功能分级均有良好的相关性。

Objective：To compare two-dimensional echocardiography （2DE）,SPECT and MRI for evaluation of cardiac function in patients with idiopathic dilated cardiomyopathy （IDCM）. Materials and Methods：Cardiac MRI,gated SPECT and 2DE were performed in 42 IDCM patients. NYHA functional classification：11 cases of class I-II,16 cases of class III,15 cases of class IV. Left ventricular （LV） function and volumes were measured using Simspon for 2DE,QGS software for gated SPECT,and ARGUS auto-quantitative program for MRI. Results：The correlation between MRI and gated SPECT （r≥0.9,P≤0.001）,2DE （r=0.699-0.878,P≤0.001） was good for the assessment of LVEF,EDV and ESV. There was significant difference between MRI and SPECT,2DE in the estimation of LV volume,but EDV and ESV were underestimated by SPECT and 2DE. Comparing with MRI,the EF was underestimated by 2DE,but not by SPECT. MRI with NYHA classification：ESV,SV,EF,PER,PFR,EDD and ESD of class III/IV compared with class I-II had signifi cance; 2DE with NYHA classification：ESV and EF of class III/IV compared with class I-II had significance,EDD and ESD IV compared with class I-II had signifi cance; SPECT with NYHA classification：ESV and EF of class III/IV compared with class I-II had significance. Conclusion：Gated SPECT and 2DE correlate well for the assessment of LV function and volumes. However,both 2DE and SPECT underestimated LV volumes. Comparing with 2DE or SPECT,MRI can provide more information about LV function and volumes. These three methods have good correlation with the NYHA functional classification.