对比增强磁共振成像评估心肌活力及其与单光子发射计算机断层扫描的比较。

Assessment of myocardial viability with contrast-enhanced magnetic resonance imaging and comparison with single-photon emission computed tomography.

作者信息

Wang Yi-Ning, Jin Zheng-Yu, Zhang Zhu-Hua, Kong Ling-Yan, Chen Li-Bo, Zhou Lu, Sun Hong-Yi, Zhang Heng, Miao Qi

机构信息

Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730.

出版信息

Chin Med Sci J. 2006 Dec;21(4):239-44.

PMID:17249199

Abstract

OBJECTIVE

To compare contrast-enhanced magnetic resonance imaging (ceMRI) with nuclear metabolic imaging for the assessment of myocardial viability in patients with chronic ischemic heart disease.

METHODS

Twenty patients with suspected chronic ischemic heart disease underwent ceMRI and technetium-99m sestamibi single-photon emission computed tomography (SPECT). Patients with positive SPECT results also underwent 18F-fluorodeoxyglucose (FDG) SPECT. In a 17-segment model, the segmental extent of hyperenhancement (SEH) by ceMRI was compared with segmental FDG and sestamibi uptake by SPECT. Correlation between the extent of hyperenhancement by ceMRI and left ventricular function was analyzed.

RESULTS

Seven patients got negative results both in ceMRI and technetium-99m sestamibi SPECT. The rest 13 patients with positive results then underwent 18F-FDG SPECT. In 221 segments of 13 patients, SEH was (2.1 +/- 8.2)%, (25.0 +/- 13.7)%, and (57.7 +/- 23.6)% in segments with normal metabolism/perfusion, metabolism/perfusion mismatch, and matched defects, respectively, and there were significant differences between either two of them (all P < 0.05). By receiver operating characteristic curve analysis, the area under the curve was 0.95 for the differentiation between viable and non-viable segments. At the cutoff value of 34%, SEH optimally differentiated viable from non-viable segments defined by SPECT. Using this threshold, the sensitivity and specificity of ceMRI to detect non-viable myocardium as defined by SPECT were 92% and 93%, respectively. Hyperenhancement size by ceMRI was correlated negatively with the left ventricular ejection fraction (r = - 0.90, P < 0.01) and positively with left ventricular volumes (r = 0.62 for end-diastolic volume, r = 0.75 for end-systolic volume, both P < 0.05).

CONCLUSION

CeMRI allows assessment of myocardial viability with a high accuracy in patients with chronic ischemic heart disease.

摘要

目的

比较对比增强磁共振成像（ceMRI）与核代谢成像用于评估慢性缺血性心脏病患者的心肌存活性。

方法

20例疑似慢性缺血性心脏病患者接受了ceMRI及锝-99m甲氧基异丁基异腈单光子发射计算机断层扫描（SPECT）检查。SPECT结果阳性的患者还接受了18F-氟脱氧葡萄糖（FDG）SPECT检查。在17节段模型中，比较ceMRI的强化节段范围（SEH）与SPECT的节段FDG及甲氧基异丁基异腈摄取情况。分析ceMRI强化范围与左心室功能之间的相关性。

结果

7例患者ceMRI及锝-99m甲氧基异丁基异腈SPECT检查结果均为阴性。其余13例结果阳性的患者随后接受了18F-FDG SPECT检查。在13例患者的221个节段中，正常代谢/灌注、代谢/灌注不匹配及匹配缺损节段的SEH分别为（2.1±8.2）%、（25.0±13.7）%及（57.7±23.6）%，两两之间差异均有统计学意义（均P<0.05）。通过受试者工作特征曲线分析，区分存活与非存活节段的曲线下面积为0.95。在截断值为34%时，SEH能最佳地区分SPECT定义的存活与非存活节段。采用此阈值，ceMRI检测SPECT定义的非存活心肌的敏感性和特异性分别为92%和93%。ceMRI的强化大小与左心室射血分数呈负相关（r=-0.90，P<0.01），与左心室容积呈正相关（舒张末期容积r=0.62，收缩末期容积r=0.75，均P<0.05）。