用于检测心肌梗死的3D和2D延迟强化磁共振成像：临床前和临床结果

3D and 2D delayed-enhancement magnetic resonance imaging for detection of myocardial infarction: preclinical and clinical results.

作者信息

Peukert Daniel, Laule Michael, Taupitz Matthias, Kaufels Nicola, Hamm Bernd, Dewey Marc

机构信息

Department of Radiology, Charité, Humboldt Universität zu Berlin, Institut für Radiologie, Charitéplatz 1, 10117 Berlin, Germany.

出版信息

Acad Radiol. 2007 Jul;14(7):788-94. doi: 10.1016/j.acra.2007.03.006.

DOI:10.1016/j.acra.2007.03.006

PMID:17574129

Abstract

RATIONALE AND OBJECTIVES

The purpose was to verify whether myocardial viability can be detected by a delayed enhancement magnetic resonance imaging (MRI) approach using a rapid three-dimensional inversion-recovery fast low-angle shot (3D IR-FLASH) sequence in a preclinical and clinical setting.

MATERIALS AND METHODS

Nonreperfused myocardial infarctions were induced in eight minipigs. Both the pigs and 15 patients with suspected myocardial infarction underwent MRI using a rapid 3D IR-FLASH sequence and a two-dimensional IR-FLASH sequence as the reference standard.

RESULTS

In the pigs, a total of 52 segments with myocardial infarction were identified with both sequences and there was good agreement in transmurality of 99.5%. The infarction volume determined with the 3D IR-FLASH in the animal study (2.4 +/- 1.5 cm(3)) showed a good correlation with the histomorphometrically determined volume using triphenyltetrazolium chloride (2.3 +/- 1.2 cm(3), r = 0.98, P < .001) and the two-dimensional IR-FLASH sequence (2.3 +/- 1.4 cm(3), r = 0.99, P < .001). Eleven of 15 patients were found to have myocardial infarction in 37 myocardial segments with both sequences and there was a good agreement in transmurality of 98.8%. There was also a good correlation in the clinical study between the 3D and 2D sequences (6.9 +/- 6.7 cm(3) vs. 6.8 +/- 6.5 cm(3), r = 0.98, P < .001). In Bland-Altman analysis there was no significant under- or overestimation of the myocardial infarction volume using the 3D IR-FLASH sequence in comparison to the two-dimensional reference standard in both the preclinical and clinical study. The contrast-to-noise ratios were not significantly different between 3D and 2D sequences in the animal (34.7 +/- 1.5 vs. 33.8 +/- 2.6; P = .51) and clinical study (31.4 +/- 12.5 vs. 36.7 +/- 11.5; P = .31). The breathhold time for the 3D IR-FLASH sequence in the clinical study (20.4 +/- 2.2 s) was significantly shorter than that of the 2D IR-FLASH sequence (190.1 +/- 20.8 s, P < .001).

CONCLUSIONS

The rapid 3D IR-FLASH sequence detects myocardial infarction with high accuracy and allows a relevant reduction in acquisition time.

摘要

原理与目的

目的是验证在临床前和临床环境中，使用快速三维反转恢复快速低角度激发（3D IR-FLASH）序列的延迟增强磁共振成像（MRI）方法能否检测心肌存活情况。

材料与方法

在八只小型猪中诱导出非再灌注心肌梗死。这些猪和15例疑似心肌梗死的患者均接受了使用快速3D IR-FLASH序列和二维IR-FLASH序列作为参考标准的MRI检查。

结果

在猪中，两种序列共识别出52个心肌梗死节段，透壁性的一致性良好，为99.5%。动物研究中用3D IR-FLASH测定的梗死体积（2.4±1.5 cm³）与用氯化三苯基四氮唑组织形态计量学测定的体积（2.3±1.2 cm³，r = 0.98，P <.001）以及二维IR-FLASH序列（2.3±1.4 cm³，r = 0.99，P <.001）显示出良好的相关性。15例患者中有11例在37个心肌节段中被两种序列均检测出心肌梗死，透壁性的一致性良好，为98.8%。临床研究中3D和2D序列之间也有良好的相关性（6.9±6.7 cm³对6.8±6.5 cm³，r = 0.98，P <.001）。在Bland-Altman分析中，与二维参考标准相比，临床前和临床研究中使用3D IR-FLASH序列对心肌梗死体积均无显著低估或高估。动物研究（34.7±1.5对33.8±2.6；P = 0.51）和临床研究（31.4±12.5对36.7±11.5；P = 0.31）中3D和2D序列的对比噪声比无显著差异。临床研究中3D IR-FLASH序列的屏气时间（20.4±2.2 s）明显短于二维IR-FLASH序列（190.1±20.8 s，P <.001）。