磁共振成像在心尖肥厚型心肌病中的诊断价值

Application value of magnetic resonance imaging in patients with apical hypertrophy cardiomyopathy

目的评价心脏磁共振在心尖肥厚型心肌病诊断方面的临床应用价值。方法回顾性分析2017～2018年在我院就诊的9例心尖肥厚型心肌病患者,所有患者均行心脏磁共振检查,观察心肌受累节段,测量心肌厚度、心室心房容积、左心室射血分数,评价心肌首过灌注及延迟强化特点。结果 9例患者心脏磁共振表现为左心室心尖部心肌肥厚,符合心尖肥厚型心肌病诊断标准。分析磁共振图像特点,将患者分为单纯型和混合型。其中单纯型心尖肥厚型心肌病6例,混合型心尖肥厚型心肌病3例。3例可见心尖室壁瘤。8例出现延迟强化,表现为肥厚的心肌内斑片样、点灶样强化。其中5例单纯型延迟强化范围局限在心尖部,3例混合型延迟强化范围累及左室中部、甚至乳头肌。结论心脏磁共振一站式成像对于诊断心尖肥厚型心肌病有独特作用,磁共振对比剂延迟强化,提示心肌纤维化,对临床治疗和预后有指导意义。

Objective To evaluate the clinical value of cardiac magnetic resonance(CMR)in the diagnosis of apical hypertrophic cardiomyopathy(AHCM).Methods Nine patients with AHCM from 2017 to 2018 in our hospital were successfully underwent magnetic resonance scanning.Myocardial thickness,ventricular atrial volume,left ventricular ejection fraction were measured.Myocardial involvement segments,the characteristics of myocardial first perfusion and delayed enhancement were evaluated.Results CMR showed apical hypertrophic in all the patients.These patients were divided into two groups:pure AHCH and mixed AHCH.Among them,6 patients were pure AHCM,3 patients were mixed AHCM.3 patients had apical aneurysm.All patients underwent myocardial contrast enhancement scanning,8 patients presented late gadolinium enhancement(LGE)which showed plaques and focal enhancement.5 pure AHCH’s LGE were located in the apex.3 mixed AHCH’s LGE were involved the central left ventricle and even the papillary muscles.Conclusions CMR is best diagnostic modality for AHCM.LGE can characterize areas of myocardial fibrosis,which plays an important role in the natural history of AHCM.