磁共振成像在缺血性心脏病与特发性扩张型心肌病鉴别诊断中的价值

Contrast-enhanced Cardiovascular Magnetic Resonance Imaging for Differentiating the Patients With Ischemic Heart Disease and Primary Dilated Cardiomyopathy

目的:探讨对比增强心血管磁共振成像(CE-CMR)在缺血性心脏病和特发性扩张型心肌病鉴别诊断中的作用。方法:选取2008-01至2012-08于我院行CE-CMR检查和冠状动脉造影或冠状动脉计算机断层摄影术血管造影(CTA)检查,且伴有左心室扩张和收缩功能减低的患者102例,分为两组:扩张型心肌病组28例与缺血性心脏病组74例,观察左心室壁心肌延迟强化的部位、程度及范围。结果:扩张型心肌病组对比增强心血管磁共振扫描结果:8例患者可见左心室壁延迟强化,其中1例为心内膜下强化,3例为肌壁间强化,3例为散在强化,1例为斑片状强化。缺血性心脏病组对比增强心血管磁共振扫描结果:66例患者可见左心室壁延迟强化,其中58例为透壁性强化,8例为心内膜下强化。结论:对比增强心血管磁共振成像能够为扩张型心肌病与缺血性心脏病提供有价值的资料,钆对比剂延迟强化能够为两者提供有效的鉴别诊断信息。

Objective： To explore the contrast-enhanced cardiovascular magnetic resonance （CE-CMR） imaging for differentiating the patients with ischemic heart disease and primary dilated cardiomyopatby. Methods： A total of 102 patients of dilated left ventricle with decreased left ventricular systolic function were studied, all patients received CE-CMR and coronary angiography （CAG） or coronary computed tomography angiography （CTA） in our hospital from 2008-01 to 2012-08. The patients were divided into 2 groups, Primary dilated cardiomyopathy group, n=28 and Ischemic heart disease group, n=74. The position, extent and range of delayed enhancement in left ventricle were observed in both groups. Results： In Primary dilated cardiomyopathy group, there were 8 patients with delayed enhancement including 1 at subendocardial wall, 3 at mid-wall, 3 of scattered delayed enhancement and 1 with patchy delayed enhancement. In Ischemic heart disease group, there were 66 patients with delayed enhancement including 58 of transmural and 8 of subendocardial delayed enhancement. Conclusion： CE-CMR may provide valuble diagnostic imaging for primary dilated cardiomyopathy and ischemic heart disease, and late gadolinium enhancement could further differentiate the diagnosis.