Johnston D L, Mulvagh S L, Cashion R W, O'Neill P G, Roberts R, Rokey R
Department of Medicine, Baylor College of Medicine, Houston, Texas.
Am J Cardiol. 1989 Jul 15;64(3):172-9. doi: 10.1016/0002-9149(89)90452-9.
The present study was intended to establish the feasibility, safety and usefulness of conventional spin-echo nuclear magnetic resonance (NMR) imaging for the detection of acute myocardial infarction within 24 hours of the onset of chest pain. Monitoring facilities were established in the NMR imaging suite that provided the same level of reliability and safety found in a standard coronary care unit. An imaging protocol was developed that allowed the acquisition of a complete study in 30 minutes while providing useful information about mechanical function and myocardial tissue contrast. Eighteen postthrombolysis patients were imaged within 21 +/- 2 hours of chest pain onset. No patient developed recurrent chest pain or arrhythmias in the NMR imaging suite. Relatively T2-weighted spin-echo images (echo time = 60 ms; repetition time = heart rate) provided interpretable images in 16 patients. Fourteen normal subjects were imaged for comparison. Thirteen of 16 patients had an increase in signal intensity in the region of the infarction. Regional wall thickening was assessed using a floating endocardial centroid technique. Wall motion abnormalities detected by NMR corresponded to those noted by 2-dimensional echocardiography and contrast angiography. Sensitivity, specificity and accuracy for the detection of infarction were 93, 80 and 87%, respectively, when signal intensity and wall thickening abnormalities were combined. In summary, NMR imaging is feasible in patients with acute myocardial infarction within 24 hours of chest pain onset. The study can be conducted safely and it provides useful information about acute myocardial infarction.
本研究旨在确定常规自旋回波核磁共振（NMR）成像在胸痛发作24小时内检测急性心肌梗死的可行性、安全性和实用性。在NMR成像室建立了监测设施，其提供的可靠性和安全性与标准冠心病监护病房相同。制定了一种成像方案，该方案能在30分钟内完成完整检查，同时提供有关机械功能和心肌组织对比的有用信息。18名溶栓后患者在胸痛发作后21±2小时内接受了成像检查。在NMR成像室内，没有患者出现复发性胸痛或心律失常。相对T2加权自旋回波图像（回波时间=60毫秒；重复时间=心率）在16名患者中提供了可解读的图像。对14名正常受试者进行成像作为对照。16名患者中有13名梗死区域的信号强度增加。使用浮动心内膜质心技术评估局部室壁增厚。NMR检测到的室壁运动异常与二维超声心动图和对比血管造影所记录的异常一致。当结合信号强度和室壁增厚异常时，检测梗死的敏感性、特异性和准确性分别为93%、80%和87%。总之，NMR成像对于胸痛发作24小时内的急性心肌梗死患者是可行的。该检查可以安全进行，并能提供有关急性心肌梗死的有用信息。
