Schmidt M, Theissen P, Crnac J, Jochims M, Voth E, Baer F M, Schicha H, Erdmann E
Klinik und Poliklinik für Nuklearmedizin, Universität Köln.
Dtsch Med Wochenschr. 1999 Nov 5;124(44):1294-300. doi: 10.1055/s-2007-1024534.
The development of ultra-rapid gradient-echo sequence magnetic resonance imaging (MRI) makes it possible to visualize coronary arteries. But the clinical value of coronary artery MRI (MRCA) still needs to be established. It was the aim of this study to determine whether MRCA can demonstrate proximal parts of the coronary arteries and visualize haemodynamically relevant stenoses.
MRCA was performed, using segmented 2D sequences and a navigator pulse, in 29 patients (22 men, seven women, mean age 60 +/- 10 years) in whom coronary heart disease (CHD) was suspected or who, with proven CHD (> or = 50% stenosis) further treatment was to be established. Exercise myocardial scintigraphy with single proton emission tomography (SPECT) was additionally performed in 20 of the patients.
Seven of 87 coronary arteries (8%) could not be demonstrated because the patients' claustrophobia necessitated premature termination of the investigation: these vessels were excluded from the final analysis. The mean length of the visualized coronary arteries was 12 +/- 4 mm for the main stem (LM), 36 +/- 14 mm for the left interventricular branch (LAD), 18 +/- 12 mm for the circumflex branch (CX) and 67 +/- 23 mm for the right coronary artery (RCA). Of 37 stenoses demonstrated by coronary angiography 29 were also visualized by MRCA: 13 of 18 LAD stenoses, two of three CX stenoses and 14 of 16 RCA stenoses. Mean sensitivity of MRCA was 78%, mean specificity 86%. In patients who had undergone exercise SPECT, coronary angiography demonstrated 26 stenoses, of which 16 (six LAD, two CX and eight RCA stenoses) were haemodynamically significant. Of these 16 stenoses MRCA demonstrated 13, but three stenoses (one RCA and two LAD stenoses) were not visualized, because the stenoses were distal to the demonstrated segments.
MRCA can visualize moderately severe stenoses, especially of the proximal coronary arterial segments. This method represents an new approach to noninvasive diagnosis of CHD, but additional technical improvements will have to be made.
超快速梯度回波序列磁共振成像（MRI）技术的发展使冠状动脉显影成为可能。但冠状动脉MRI（MRCA）的临床价值仍有待确定。本研究旨在确定MRCA能否显示冠状动脉近端部分并使血流动力学相关狭窄显影。
对29例疑似冠心病（CHD）或已确诊冠心病（狭窄≥50%）且需进一步治疗的患者（22例男性，7例女性，平均年龄60±10岁），采用分段二维序列和导航脉冲进行MRCA检查。另外20例患者还进行了单光子发射计算机断层扫描（SPECT）运动心肌显像。
87支冠状动脉中有7支（8%）因患者幽闭恐惧症导致检查提前终止而未能显影，这些血管被排除在最终分析之外。显影的冠状动脉主干（LM）平均长度为12±4mm，左室间支（LAD）为36±14mm，回旋支（CX）为18±12mm，右冠状动脉（RCA）为67±23mm。冠状动脉造影显示的37处狭窄中，29处也被MRCA显示：LAD的18处狭窄中有13处，CX的3处狭窄中有2处，RCA的16处狭窄中有14处。MRCA的平均敏感性为78%，平均特异性为86%。在进行运动SPECT检查的患者中，冠状动脉造影显示26处狭窄，其中16处（6处LAD、2处CX和8处RCA狭窄）具有血流动力学意义。在这16处狭窄中，MRCA显示了13处，但有3处狭窄（1处RCA和2处LAD狭窄）未显影，因为这些狭窄位于已显示节段的远端。
MRCA能够使中度严重狭窄显影，尤其是冠状动脉近端节段。该方法代表了一种无创诊断冠心病的新途径，但仍需进一步改进技术。
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