自由呼吸并运动校正延迟强化MR成像用于冠心病合并心功能不全患者的研究

The study of single shot PSIR moco late gadolinium enhancement(LGE) cardiovascular MR in patients with coronary artery disease combined with heart failure

目的研究心脏磁共振(CMR)新序列——自由呼吸并运动校正延迟强化成像(LGE)序列用于冠心病合并心功能不全患者的临床应用价值。方法选择2014年8月—2015年12月在首都医科大学附属安贞医院医学影像科行CMR检查的拟诊冠心病合并心功能不全患者100例,采集屏气LGE和自由呼吸并运动校正(简称运动校正)LGE图像。其中41例患者由于图像质量或难以耐受屏气指令的原因,检查过程中放弃了屏气LGE图像的采集,共59例患者完成了全部屏气LGE和运动校正LGE扫描,比较屏气LGE和运动校正LGE图像心肌梗死病灶检出、扫描时间、图像质量之间的差异。结果检查结果显示屏气LGE和运动校正LGE在检出心肌梗死病灶方面具有较高一致性(Kappa=0.97)。盲法评价显示运动校正LGE较屏气LGE成像时间更短[(160±11)s vs.(330±13)s,t=-67.552,P<0.01],质量优良的图像更多。运动校正LGE可对全部患者进行风险分级,病灶范围与不良事件相关(r=0.593,P<0.01),而屏气LGE由于图像质量不佳或采集失败不能进行风险分级。结论对于能够耐受屏气LGE的患者,屏气和运动校正LGE对患者的延迟强化病灶定性和定量评价价值相似;运动校正LGE在采集时间、图像质量等方面优于屏气LGE,更适合临床应用。

Objective To investigate the value of single-shot PSIR moco late gadolinium enhancement（LCE） cardiovascular MR in patients with coronary artery disease combined with heart failure.Methods From August 2014 to December 2015,100 patients who were underwent cardiac magnetic resonance imaging（CMR） and suspected of coronary heart disease complicated with cardiac insufficiency were selected,we collected single shot PSIR moco LGE and conventional LGE images.In 41 patients,conventional LGE was abandoned because of image quality issues.The differences of scan time and image quality between single shot PSIR moco LGE and conventional LGE are compared.Results Single shot PSIR moco LGE and conventional LGE exam have high consistency in the detection of myocardial infarction（Kappa = 0.97）.Compared with the conventional LGE exam,Single shot PSIR moco LGE was faster[（160 ±11）s vs.（330±13）s,t =-67.552,P 0.01],and image quality was higher by blinded review（P 0.01）.Single shot PSIR moco LGE can achieve risk stratification in the full cohort（P 0.01）,but conventional LGE did not receive risk stratification because of arrhythmia or inability to hold breath.Conclusion The single shot PSIR moco LGE and conventional LGE have high consistency in myocardial infarction detection and quantification when conventional LGE can be acquired well.The single shot PSIR moco LGE are superior to conventional LGE exam in the aspects of acquisition time,image quality and the number of successfully scanned patients.Single shot PSIR moco LGE may be suitable for routine clinical application.