潘生丁负荷MR首次通过灌注显像评价心肌缺血

Assessment of myocardial ischemia by MR first-pass perfusion imaging

目的 了解潘生丁负荷MR首过灌注 (MRFP)显像在冠心病诊断中的临床意义。方法 42例拟诊冠心病的患者 ,按临床分为心肌梗死、心肌缺血、正常三组 ,行MRFP显像 ,其中 2 5例行冠状动脉造影 (CAG ) ,并按冠脉狭窄程度分为狭窄 <5 0 %,5 0 %～ 99%和 10 0 %三组。制定 5分制标准 ,定性判断MRFP图像。分别分析临床分组和CAG分组的MR心肌灌注显像结果。结果 定性判断MRFP图像对冠心病诊断的敏感性、特异性与准确性分别为 90 %、70 %和 80 %。MRFP与临床分组的相关系数r =0 .3 5 2 (P =0 .0 41) ;MRFP与CAG分组的相关系数r =0 .40 2 (P =0 .0 0 1)。出现灌注缺损的比例在临床分组中 ,分别为 85 .7%、61.1%和 3 3 .3 %;在CAG分组中 ,分别为 2 0 %、60 %和 10 0 %。结论 MRFP显像能够区分缺血和正常心肌 ,对冠心病诊断有一定意义。

Objective To assess magnetic resonance first-pass (MRFP) perfusion imaging with dipyridamole stress in myocardial ischemia. Methods Forty-two patients suspected as coronary artery disease were divided into three clinical groups: myocardial infarction (8 cases),myocardial ischemia (23 cases),and normal (11 cases). 25 of 42 patients underwent coronary angiography (CAG),and they were divided into three CAG groups according to the extent of coronary stenosis (degree <50%,50%-99%,100%). The images were evaluated with 5-point scale methods. The relationship between the final results of MRFP and the clinical and CAG groups was expressed by Spearman correlation coefficient. Results The sensitivity,specificity and diagnostic accuracy of MRFP for detection of coronary artery disease were 90%,70%,and 80%,respectively. The Spearman correlation coefficient was 0.408 ( P =0.017) and 0.402 ( P =0.001) for MRFP correlating with the clinical and CAG groups,respectively. The proportion of perfusion defection of myocardium in the three clinical groups were 85.7%,61.1%,and 33.3%,respectively,and in the three CAG groups were 20%,60% and 100%,respectively. Conclusion MRFP perfusion imaging is a promising method to evaluate the ischemia heart disease.