Vogel-Claussen Jens, Skrok Jan, Dombroski David, Shea Steven M, Shapiro Edward P, Bohlman Mark, Lorenz Christine H, Lima Joao A C, Bluemke David A
Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology, Baltimore, Maryland 21287, USA.
J Magn Reson Imaging. 2009 Oct;30(4):753-62. doi: 10.1002/jmri.21899.
To compare standard of care nuclear SPECT imaging with cardiac magnetic resonance imaging (MRI) for emergency room (ER) patients with chest pain and intermediate probability for coronary artery disease.
Thirty-one patients with chest pain, negative electrocardiogram (ECG), and negative cardiac enzymes who underwent cardiac single photon emission tomography (SPECT) within 24 h of ER admission were enrolled. Patients underwent a comprehensive cardiac MRI exam including gated cine imaging, adenosine stress and rest perfusion imaging and delayed enhancement imaging. Patients were followed for 14 +/- 4.7 months.
Of 27 patients, 8 (30%) showed subendocardial hypoperfusion on MRI that was not detected on SPECT. These patients had a higher rate of diabetes (P = 0.01) and hypertension (P = 0.01) and a lower global myocardial perfusion reserve (P = 0.01) compared with patients with a normal cardiac MRI (n = 10). Patients with subendocardial hypoperfusion had more risk factors for cardiovascular disease (mean 4.4) compared with patients with a normal MRI (mean 2.5; P = 0.005). During the follow-up period, patients with subendocardial hypoperfusion on stress MRI were more likely to return to the ER with chest pain compared with patients who had a normal cardiac MRI (P = 0.02). Four patients did not finish the MR exam due to claustrophobia.
In patients with chest pain, diabetes and hypertension, cardiac stress perfusion MRI identified diffuse subendocardial hypoperfusion defects in the ER setting not seen on cardiac SPECT, which is suspected to reflect microvascular disease.
比较标准护理下的核素单光子发射计算机断层显像（SPECT）与心脏磁共振成像（MRI）在急诊室（ER）胸痛且冠心病可能性为中等的患者中的应用。
纳入31例胸痛、心电图（ECG）阴性且心肌酶阴性的患者，这些患者在ER入院后24小时内接受了心脏单光子发射断层扫描（SPECT）。患者接受了全面的心脏MRI检查，包括门控电影成像、腺苷负荷及静息灌注成像和延迟强化成像。对患者进行了14±4.7个月的随访。
27例患者中，8例（30%）在MRI上显示心内膜下灌注不足，而SPECT未检测到。与心脏MRI正常的患者（n = 10）相比，这些患者的糖尿病发生率更高（P = 0.01）、高血压发生率更高（P = 0.01）且整体心肌灌注储备更低（P = 0.01）。与MRI正常的患者相比，心内膜下灌注不足的患者有更多的心血管疾病危险因素（平均4.4个）（平均2.5个；P = 0.005）。在随访期间，与心脏MRI正常的患者相比，负荷MRI上心内膜下灌注不足的患者因胸痛返回ER的可能性更大（P = 0.02）。4例患者因幽闭恐惧症未完成MR检查。
在胸痛、糖尿病和高血压患者中，心脏负荷灌注MRI在ER环境中发现了心脏SPECT未发现的心内膜下弥漫性灌注不足缺陷，怀疑这反映了微血管疾病。
