Chen Zhiyong, Sun Bin, Duan Qing, Xue Yunjing, Chen Lianglong
Department of Radiology.
Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, People's Republic of China.
Medicine (Baltimore). 2018 Nov;97(45):e13138. doi: 10.1097/MD.0000000000013138.
To evaluate the accuracy of contrast-enhanced whole-heart magnetic resonance coronary angiography at 3.0T for assessing significant stenosis (≥50% lumen diameter reduction) in patients with myocardial infarction, by using conventional coronary artery angiography as the reference standard, and also test the performance of that for the detection and assessment of chronic myocardial infarction (MI), compared with standard delayed-enhancement coronary magnetic resonance (DE-CMR) for the determination of infarct size.We studied 42 consecutive patients (37 men, 5 women, mean age 58.5 ± 10.7 years) with MI scheduled for conventional coronary angiography. Contrast-enhanced whole-heart coronary magnetic resonance angiography (CMRA) was employed after sublingual nitroglycerin (NTG) with the abdominal banding rolled tightly along the side of ribs. Finally, a 3D phase-sensitive inversion-recovery gradient-echo (3D-PSIR-GRE) sequence was performed during free breathing. The assessment of MI sizes on WH-CMRA reconstructed images and 3D-PSIR-GRE images were compared using a paired student t test.The acquisition of CMRA was completed in 40 (95.2%) of 42 patients, with an imaging time averaged at 9.5 ± 3.1 minutes. The average navigator efficiency was 47%. The sensitivity, specificity, and positive and negative predictive values of whole-heart CMRA for the detection of significant lesions on a segment-by-segment analysis were 91.7% (95% confidence interval [CI] 83.8-96.1), 84.0% (95% CI 80.0-87.4), 57.9% (95% CI 50.0-65.8), 97.7% (95% CI 95.3-98.9), respectively, and on a patient-based analysis 93.5% (95% CI 77.2-98.9), 88.9% (95% CI 50.7-99.4), 96.7% (95% CI 80.9-99.8), and 80.0% (95% CI 44.2-96.5), respectively. Infarcts were generally higher on the CE-CMRA technique compared with the standard technique (18.0 ± 7.2 cm vs 16.1 ± 6.4 cm; P < .0001).Contrast-enhanced whole-heart CMRA with 3.0-T not only may permit reliable detection of significant obstructive coronary artery disease in patients with myocardial infarction, but also could identify and quantify the volume of myocardial infarction. This technique could be considered the preferred approach in patients who could not overcome longer scanning times or unable to hold their breath instead of delayed-enhancement magnetic resonance imaging for detection of infarcted myocardium. However, compared with standard imaging, the volume of myocardial infarction is slightly overestimated.
以传统冠状动脉造影为参考标准，评估3.0T对比增强全心磁共振冠状动脉造影在评估心肌梗死患者显著狭窄（管腔直径减少≥50%）方面的准确性，并与标准延迟增强冠状动脉磁共振（DE-CMR）测定梗死面积相比，测试其检测和评估慢性心肌梗死（MI）的性能。我们研究了42例计划进行传统冠状动脉造影的MI患者（37例男性，5例女性，平均年龄58.5±10.7岁）。舌下含服硝酸甘油（NTG）后，将腹带沿肋骨侧紧紧卷起，采用对比增强全心冠状动脉磁共振血管造影（CMRA）。最后，在自由呼吸期间进行三维相位敏感反转恢复梯度回波（3D-PSIR-GRE）序列。使用配对学生t检验比较WH-CMRA重建图像和3D-PSIR-GRE图像上MI大小的评估。42例患者中有40例（95.2%）完成了CMRA采集，平均成像时间为9.5±3.1分钟。平均导航效率为47%。全心CMRA在逐段分析中检测显著病变的敏感性、特异性、阳性和阴性预测值分别为91.7%（95%置信区间[CI]83.8 - 96.1）、84.0%（95%CI 80.0 - 87.4）、57.9%（95%CI 50.0 - 65.8）、97.7%（95%CI 95.3 - 98.9），在基于患者的分析中分别为93.5%（95%CI 77.2 - 98.9）、88.9%（95%CI 50.7 - 99.4）、96.7%（95%CI 80.9 - 99.8）和80.0%（95%CI 44.2 - 96.5）。与标准技术相比，CE-CMRA技术上梗死灶一般更高（18.
