Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina 27710, USA.
J Am Coll Cardiol. 2009 Dec 29;55(1):1-16. doi: 10.1016/j.jacc.2009.06.059.
In patients with known or suspected myocardial infarction (MI), cardiovascular magnetic resonance (CMR) provides a comprehensive, multifaceted view of the heart. The data, including that from a recent multicenter clinical trial, indicate that delayed-enhancement cardiac magnetic resonance imaging (DE-CMR) is a well-validated, robust technique that can be easily implemented on scanners that are commonly available worldwide, with an effectiveness that clearly rivals the best available imaging techniques for the detection and assessment of acute and chronic MI. When patients present outside the diagnostic window of cardiac troponins, DE-CMR may be especially useful. Moreover, because DE-CMR can uniquely differentiate between ischemic and various nonischemic forms of myocardial injury, it may be helpful in cases of diagnostic uncertainty, such as in patients with classical features of MI in whom coronary angiography does not show a culprit lesion. Even after the diagnosis of MI has been made, CMR provides clinically relevant information by identifying residual viability, microvascular damage, stunning, and right ventricular infarction. In addition, post-MI sequelae, including left ventricular thrombus and pericarditis, are easily identified. Given that quantification of infarct size by DE-CMR is highly reproducible, this technique may provide a useful surrogate end point for clinical trials with appreciable reductions in sample size compared with alternative methods.
在已知或疑似心肌梗死（MI）的患者中，心血管磁共振（CMR）可提供心脏的全面、多方面视图。包括来自最近的多中心临床试验的数据表明，延迟增强心脏磁共振成像（DE-CMR）是一种经过充分验证、强大的技术，可在全球范围内广泛使用的扫描仪上轻松实现，其有效性可与用于检测和评估急性和慢性 MI 的最佳现有成像技术相媲美。当患者在心脏肌钙蛋白的诊断窗口期之外就诊时，DE-CMR 可能特别有用。此外，由于 DE-CMR 可以独特地区分缺血和各种非缺血性心肌损伤形式，因此在诊断不确定的情况下可能会有所帮助，例如在那些具有典型 MI 特征但冠状动脉造影未显示罪犯病变的患者中。即使在 MI 诊断确立后，CMR 也可以通过识别残余存活、微血管损伤、顿抑和右心室梗死来提供有临床意义的信息。此外，还可以轻松识别 MI 后的后遗症，包括左心室血栓形成和心包炎。鉴于 DE-CMR 定量梗死面积的高度可重复性，与替代方法相比，该技术可能为临床试验提供有用的替代终点，显著减少样本量。
