Hartnell G, Cerel A, Kamalesh M, Finn J P, Hill T, Cohen M, Tello R, Lewis S
Department of Radiological Sciences, Deaconess Hospital, Harvard Medical School, Boston, MA 02215.
AJR Am J Roentgenol. 1994 Nov;163(5):1061-7. doi: 10.2214/ajr.163.5.7976875.
Established noninvasive methods for assessing myocardial ischemia have limitations that might be overcome by MR imaging. We investigated MR myocardial perfusion imaging and MR ventriculography, before and after dipyridamole-induced stress, to determine whether the superior spatial and temporal resolution of MR imaging has advantages for the evaluation of myocardial ischemia.
Eighteen patients with symptoms suggestive of myocardial ischemia were examined by use of MR perfusion imaging and MR cineangiography before and during dipyridamole-induced stress. Multiplanar gradient-echo MR cineangiography and cardiac gated fast low-angle shot (turbo-FLASH) MR imaging during injection of gadopentetate dimeglumine were used. Results were compared with findings from perfusion scintigraphy and coronary arteriography.
The accuracy of the combination MR technique for detecting myocardial ischemia was similar to that of scintigraphy. No significant difference was found between the MR technique and scintigraphy for detecting segments of myocardium supplied by stenosed coronary arteries (> 70% reduction in diameter, as determined by coronary arteriography). The sensitivity of the combination MR technique for angiographically detecting significant coronary artery narrowing was 92%, and the specificity was 100%. For scintigraphy, the sensitivity was also 92% and the specificity was 100%.
Initial results indicate that a combination of stress MR myocardial perfusion imaging and MR ventriculography is feasible and that this technique can detect myocardial ischemia with an accuracy similar to that of scintigraphy. This technique may make more complete noninvasive assessment of myocardial ischemia possible.
已有的评估心肌缺血的非侵入性方法存在局限性，而磁共振成像（MR）或许可以克服这些局限。我们研究了双嘧达莫诱发应激前后的MR心肌灌注成像和MR心室造影，以确定MR成像卓越的空间和时间分辨率在评估心肌缺血方面是否具有优势。
对18例有心肌缺血症状提示的患者在双嘧达莫诱发应激前及应激期间进行MR灌注成像和MR电影血管造影检查。使用多平面梯度回波MR电影血管造影和注射钆喷酸葡胺期间的心脏门控快速低角度激发（turbo-FLASH）MR成像。将结果与灌注闪烁显像和冠状动脉造影的结果进行比较。
联合MR技术检测心肌缺血的准确性与闪烁显像相似。在检测由狭窄冠状动脉供血的心肌节段方面（冠状动脉造影显示直径减少>70%），MR技术与闪烁显像之间未发现显著差异。联合MR技术血管造影检测冠状动脉明显狭窄的敏感性为92%，特异性为100%。对于闪烁显像，敏感性也是92%，特异性为100%。
初步结果表明，应激MR心肌灌注成像和MR心室造影相结合是可行的，并且该技术检测心肌缺血的准确性与闪烁显像相似。该技术可能使对心肌缺血进行更全面的非侵入性评估成为可能。
