早期对比增强 CMRI 成像中急性心肌梗死患者的梗死周边区。

Peri-infarct zone on early contrast-enhanced CMR imaging in patients with acute myocardial infarction.

机构信息

Cardiovascular Center, Rakuwakai Otowa Hospital, Kyoto, Japan.

出版信息

JACC Cardiovasc Imaging. 2011 Jun;4(6):610-8. doi: 10.1016/j.jcmg.2011.03.015.

DOI:10.1016/j.jcmg.2011.03.015

PMID:21679895

Abstract

OBJECTIVES

The aims of this study were to evaluate hyperenhanced regions on contrast-enhanced cardiovascular magnetic resonance (CE-CMR) imaging in patients with acute myocardial infarction (AMI) between early contrast-enhanced cardiovascular magnetic resonance (ECE) (2 min) and late contrast-enhanced cardiovascular magnetic resonance (LCE) (10 to 15 min) after gadolinium administration, and to compare the CE-CMR images with area at risk (AAR) derived from T2-weighted (T2W) CMR.

BACKGROUND

Although CE-CMR imaging can demarcate the infarcted myocardium, the value of hyperenhancement in AMI is still in dispute. The size of hyperenhanced regions may vary with time, and overestimation can be often observed with early acquisition.

METHODS

Thirty-four patients with successfully reperfused AMI underwent CMR within 4 days after the event. Myocardial regions as percentage of left ventricular (LV) myocardium were quantified on CE and T2W images. Relative peri-infarct zone was calculated as the difference in hyperenhanced regions between ECE and LCE, normalized to the individual infarct size.

RESULTS

Both ECE and LCE images revealed hyperenhancement in the territory of the infarct-related artery in all patients. The hyperenhanced region on ECE extended transmurally and was consistently larger than that on LCE (39 ± 12% vs. 27 ± 12% of LV myocardium, p<0.001). The relative peri-infarct zone was inversely correlated with the transmurality of infarction (r=-0.59, p<0.001) and the time from symptom to reperfusion (r=-0.46, p<0.01). The hyperenhanced region on ECE was correlated with the T2W CMR-derived AAR (r=0.86, p<0.001) with the average difference of -0.8% and the limits of agreement of ±11.9%.

CONCLUSIONS

ECE depicts ischemically injured but salvaged myocardium, as well as infarcted myocardium in patients with AMI. The myocardium at risk and infarcted myocardium after reperfusion can be retrospectively assessed by the combination of ECE and LCE.

摘要

目的

本研究旨在评估急性心肌梗死（AMI）患者在钆对比增强心血管磁共振（CE-CMR）成像中，早期对比增强（ECE）（2 分钟）和晚期对比增强（LCE）（10-15 分钟）后增强区域的变化，并将 CE-CMR 图像与 T2 加权（T2W）CMR 得出的危险区（AAR）进行比较。

背景

尽管 CE-CMR 成像可以描绘梗死心肌，但 AMI 中增强的价值仍存在争议。增强区域的大小可能随时间而变化，并且早期采集时通常会出现高估。

方法

34 例成功再灌注的 AMI 患者在事件发生后 4 天内行 CMR 检查。通过 CE 和 T2W 图像对左心室（LV）心肌的心肌区域进行量化。相对梗死周边区通过 ECE 和 LCE 之间的增强区域差异计算得出，并与个体梗死大小进行归一化。

结果

所有患者的梗死相关动脉区域在 ECE 和 LCE 图像上均显示增强。ECE 上的增强区域呈透壁性延伸，且始终大于 LCE（39±12%比 27±12%的 LV 心肌，p<0.001）。相对梗死周边区与梗死的透壁程度（r=-0.59，p<0.001）和症状至再灌注时间（r=-0.46，p<0.01）呈负相关。ECE 上的增强区域与 T2W CMR 得出的 AAR 相关（r=0.86，p<0.001），平均差异为-0.8%，一致性界限为±11.9%。