系列对比增强心脏磁共振成像显示急性心肌梗死后患者冠状动脉壁内强化的消退。
Serial contrast-enhanced cardiac magnetic resonance imaging demonstrates regression of hyperenhancement within the coronary artery wall in patients after acute myocardial infarction.
作者信息
Ibrahim Tareq, Makowski Markus R, Jankauskas Antanas, Maintz David, Karch Martin, Schachoff Sylvia, Manning Warren J, Schömig Albert, Schwaiger Markus, Botnar Rene M
机构信息
Deutsches Herzzentrum München and 1. Medizinische Klinik des Klinikums Rechts der Isar, Technische Universität München, München, Germany.
出版信息
JACC Cardiovasc Imaging. 2009 May;2(5):580-8. doi: 10.1016/j.jcmg.2008.12.029.
OBJECTIVES
Our aim was to determine whether serial contrast-enhanced cardiac magnetic resonance (CE-CMR) is useful for the characterization of tissue signal changes within the coronary vessel wall in patients after acute myocardial infarction (AMI).
BACKGROUND
Inflammation plays a key role in the development of AMI. CE-CMR of the vessel wall has been found useful for the characterization of inflammatory tissue signal changes in patients with carotid artery stenosis, giant cell arteritis, or Takayasu's arteritis; however, it has never been serially performed in the coronary artery wall in patients with acute and chronic myocardial infarction using a gadolinium-based contrast medium and compared with systemic markers of inflammation.
METHODS
CE-CMR using a T1-weighted 3-dimensional gradient echo inversion recovery sequence of the coronary artery wall and 0.2 mmol/kg of gadolinium-diethylenetriaminepentaacetic acid was performed in 10 patients with AMI 6 days and 3 months after coronary intervention and in 9 subjects without coronary artery disease on invasive coronary angiography. Contrast-to-noise ratio (CNR) within the coronary artery wall was quantified in comparison with blood signal.
RESULTS
Patients with AMI demonstrated a significantly increased coronary vessel wall enhancement 6 days after infarction compared with normal subjects (CNR 7.8 +/- 4.4 vs. 5.3 +/- 3.2, p < 0.001). Three months after infarction, CNR decreased to 6.5 +/- 4.7 (p < 0.03). This decrease paralleled declines in C-reactive protein. Angiographically normal segments showed no contrast changes, but CNR significantly decreased in stenotic segments, from 10.9 +/- 3.8 to 6.8 +/- 5.0 (p < 0.002), resulting in a reduction of enhanced segments from 70% to 25% (p < 0.01).
CONCLUSIONS
Serial CE-CMR identified changes in spatial extent and intensity of coronary contrast enhancement in patients after AMI. This technique may be useful for the characterization of transient coronary tissue signal changes, which may represent edema or inflammation during the post-infarction phase. In addition, CE-CMR may offer the potential for visualization of inflammatory activity in atherosclerosis associated with acute coronary syndromes.
目的
我们的目的是确定连续对比增强心脏磁共振成像（CE-CMR）是否有助于急性心肌梗死（AMI）患者冠状动脉血管壁内组织信号变化的特征描述。
背景
炎症在AMI的发生发展中起关键作用。血管壁的CE-CMR已被发现有助于颈动脉狭窄、巨细胞动脉炎或高安动脉炎患者炎症组织信号变化的特征描述；然而，对于急性和慢性心肌梗死患者，从未使用钆基造影剂对冠状动脉壁进行连续检查并与全身炎症标志物进行比较。
方法
对10例AMI患者在冠状动脉介入治疗后6天和3个月以及9例经有创冠状动脉造影证实无冠状动脉疾病的受试者，使用冠状动脉壁的T1加权三维梯度回波反转恢复序列和0.2 mmol/kg的钆喷酸葡胺进行CE-CMR检查。将冠状动脉壁内的对比噪声比（CNR）与血液信号进行比较并定量。
结果
与正常受试者相比，AMI患者在梗死后6天冠状动脉血管壁强化显著增加（CNR 7.8±4.4对5.3±3.2，p<0.001）。梗死后3个月，CNR降至6.5±4.7（p<0.03）。这种下降与C反应蛋白的下降平行。血管造影正常节段未显示对比变化，但狭窄节段的CNR显著下降，从10.9±3.8降至6.8±5.0（p<0.002），导致强化节段从70%降至25%（p<0.01）。
结论
连续CE-CMR可识别AMI患者冠状动脉对比增强的空间范围和强度变化。该技术可能有助于描述短暂的冠状动脉组织信号变化，这可能代表梗死后期的水肿或炎症。此外，CE-CMR可能为可视化与急性冠状动脉综合征相关的动脉粥样硬化中的炎症活动提供潜力。
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