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心脏腺苷负荷磁共振成像在冠心病早期诊断中的应用(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2011年第4期
页码:
525
栏目:
临床研究
出版日期:
2011-08-25

文章信息/Info

Title:
Effects of adenosine stress cardiac magnetic resonance imaging on diagnosis of early coronary artery disease
作者:
余静; 孙立军; 齐顺; 郝跃文; 何左祥
第四军医大学西京医院放射科，陕西 西安 710032
Author(s):
YU Jing;  SUN Li-jun;  QI Shun;  HAO Yue-wen;  HE Zuo-xiang
Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, Shaanxi, China
关键词:
冠状动脉狭窄; 急性冠脉综合征; 磁共振; 心肌灌注; 腺苷负荷试验
Keywords:
coronary stenosis;  acute coronary artery syndrome;  myocardial perfusion;  adenosine load test
分类号:
R445；R541.4
DOI:
61-1268/R.20110503.1643.027
文献标识码:
A
摘要:
目的:评价心脏腺苷负荷磁共振成像在冠心病早期诊断中的作用。方法： 选择临床无急性冠脉综合征，选择性冠状动脉造影（CAG）证实冠脉有不同程度狭窄的患者34例，根据CAG结果将患者分为3组，第1组管腔狭窄＞75%、第2组狭窄50%~75%以及第3组狭窄<50%。在3.0T磁共振成像仪上分别行静息和腺苷负荷磁共振心脏灌注扫描和延迟增强成像，对比分析不同状态下磁共振（MR）成像心肌灌注变化。结果： 在未发生急性冠脉综合征患者，静息磁共振心肌灌注成像显示心肌缺血主要表现为心肌灌注减少，总阳性率38%(13/34)，不同冠状动脉狭窄组间无显著性差异。磁共振腺苷负荷试验可增加患者心肌灌注降低检测的阳性率［62%(21/34)］。统计结果显示，对于心肌缺血的检测，心脏磁共振腺苷负荷试验与静息心脏磁共振心肌灌注之间有显著性差异(P<0.01)。延迟扫描成像在34例患者中无延迟增强改变。结论： 腺苷负荷MR灌注成像可以显著提高心肌缺血诊断的阳性率，有助于冠心病的早期诊断。
Abstract:
AIM:To evaluate the effects of adenosine stress cardiac magnetic resonance (CMR) imaging on the diagnosis of early coronary artery disease (CAD). METHODS: Thirty-four patients with nonclinically acute coronary syndrome but with angiographically varying degrees of stenosis of coronary arteries underwent rest and adenosine-stress and delayed-enhancement CMR imaging at 3.0 tesla. Patients were divided into three groups according to the outcomes of standard selective coronary angiography. In group 1, the stenosis diameter of the coronary artery was defined as >75%. In group 2, the stenosis diameter of the coronary artery was defined as 50-75%, and in group 3 the stenosis diameter of the coronary artery was defined as <50%. The changes of myocardial magnetic resonance perfusion under different conditions were comparatively analyzed. RESULTS: Rest CMR imaging showed that the main presentation of myocardial ischemia was the decrease of myocardial perfusion in patients with nonacute coronary artery syndrome. The total positive rate was 38% (13/34), and no significant difference was found between various groups with coronary artery stenosis. Compared with rest CMR imaging, adenosine-induced stress perfusion CMR imaging increased the positive rate of myocardial ischemia (62%, 21/34). A significant difference was found in the detection of myocardial ischemia between rest CMR and adenosine stress CMR (P<0.01). No delayed gadolinium enhancements were seen at delayed CMR imaging in all 34 patients. CONCLUSION: There was no positive correlation between extent of myocardial ischemia and degree of coronary artery stenosis at rest CMR imaging. Adenosine stress CMR imaging can significantly increase the positive rate for the detection of myocardial ischemia, which is helpful in the early diagnosis of CAD.

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备注/Memo

备注/Memo:
收稿日期：2010-12-27.基金项目：2007年科技部“十一五”支撑课题资助（2007BAI05B01） 通讯作者：孙立军,主任医师,主要从事心血管系统疾病影像诊断的研究Email:sunlijun_fmmu@sina.com 作者简介：余静,硕士生Email:yujing628305@163.com
更新日期/Last Update: 2011-06-02