Matoh Fumitaka, Hayashi Hideharu, Terada Hajime, Satoh Hiroshi, Katoh Hideki, Urushida Tsuyoshi, Shiraki Katsunori, Asai Masayoshi, Sakahara Harumi, Takehara Yasuo
Department of Emergency Medicine, Hamamatsu University School of Medicine, Japan.
Circ J. 2005 Dec;69(12):1556-9. doi: 10.1253/circj.69.1556.
Delayed enhancement magnetic resonance imaging (DE-MRI) has excellent spatial resolution and compared with other cardiac imaging techniques it can detect a small myocardial infarction (MI) or a subendocardial infarction. A 76-year-old man was admitted for loss of consciousness because of cardiac tamponade. The cause of tamponade was unknown, but electrocardiography and blood test suggested a recent MI. The removal of 100 ml bloody fluid by immediate pericardiocentesis normalized his hemodynamics, and he regained consciousness. Neither echocardiography nor scintigraphy could determine the location of the MI or rupture, but DE-MRI clearly demonstrated a transmural enhancement in a very narrow range of the lateral wall of the left ventricle. Coronary angiography revealed a severely stenotic lesion in the obtuse marginal branch of the left circumflex artery. DE-MRI is a powerful tool for diagnosing small MI that are undetectable with other imaging. Therefore, DE-MRI should be applied in cases with cardiac tamponade by unknown causes.
延迟强化磁共振成像（DE-MRI）具有出色的空间分辨率，与其他心脏成像技术相比，它能够检测出小面积心肌梗死（MI）或心内膜下梗死。一名76岁男性因心脏压塞导致意识丧失入院。压塞原因不明，但心电图和血液检查提示近期发生心肌梗死。立即进行心包穿刺抽出100 ml血性液体后，其血流动力学恢复正常，患者意识恢复。超声心动图和闪烁扫描均无法确定心肌梗死或破裂的位置，但DE-MRI清晰显示左心室侧壁非常狭窄区域的透壁强化。冠状动脉造影显示左旋支钝缘支有严重狭窄病变。DE-MRI是诊断其他成像无法检测到的小面积心肌梗死的有力工具。因此，对于原因不明的心脏压塞病例，应应用DE-MRI。
