van Rugge F P, van der Wall E E, Spanjersberg S J, de Roos A, Matheijssen N A, Zwinderman A H, van Dijkman P R, Reiber J H, Bruschke A V
Department of Cardiology, University Hospital, Leiden, The Netherlands.
Circulation. 1994 Jul;90(1):127-38. doi: 10.1161/01.cir.90.1.127.
Quantitative measurement of wall motion is essential to assess objectively the functional significance of coronary artery disease. We developed a quantitative wall thickening analysis on stress magnetic resonance images. This study was designed to assess the clinical value of magnetic resonance imaging (MRI) during dobutamine stress for detection and localization of myocardial ischemia in patients with suspected coronary artery disease.
Thirty-nine consecutive patients with clinically suspected coronary artery disease referred for coronary arteriography and 10 normal volunteers underwent gradient-echo MRI at rest and during peak dobutamine stress (infusion rate, 20 micrograms.kg-1.min-1). MRI was performed in the short-axis plane at four adjacent levels. Display in a cine loop provided a qualitative impression of regional wall motion (cine MRI). A modification of the centerline method was applied for quantitative wall motion analysis by means of calculation of percent systolic wall thickening. Short-axis cine MRI images were analyzed at 100 equally spaced chords constructed perpendicular to a centerline drawn midway between the end-diastolic and end-systolic contours. Dobutamine MRI was considered positive for coronary artery disease if the percent systolic wall thickening of more than four adjacent chords was < 2 SD below the mean values obtained from the normal volunteers. The overall sensitivity of dobutamine MRI for the detection of significant coronary artery disease (diameter stenosis > or = 50%) was 91% (30 of 33), specificity was 80% (5 of 6), and accuracy was 90% (35 of 39). The sensitivity for identifying one-vessel disease was 88% (15 of 17), for two-vessel disease 91% (10 of 11), and for three-vessel disease 100% (5 of 5). The sensitivity for detection of individual coronary artery lesions was 75% for the left anterior descending coronary artery, 87% for the right coronary artery, and 63% for the left circumflex coronary artery.
Dobutamine MRI clearly identifies wall motion abnormalities by quantitative analysis using a modification of the centerline method. Dobutamine MRI is an accurate method for detection and localization of myocardial ischemia and may emerge as a new noninvasive approach for evaluation of patients with known or suspected coronary artery disease.
壁运动的定量测量对于客观评估冠状动脉疾病的功能意义至关重要。我们在应力磁共振图像上开发了一种定量壁增厚分析方法。本研究旨在评估多巴酚丁胺负荷试验期间磁共振成像（MRI）对疑似冠状动脉疾病患者心肌缺血的检测和定位的临床价值。
39例临床疑似冠状动脉疾病并接受冠状动脉造影的连续患者以及10名正常志愿者在静息状态和多巴酚丁胺负荷试验峰值（输注速率，20微克·千克⁻¹·分钟⁻¹）期间接受了梯度回波MRI检查。MRI在四个相邻层面的短轴平面上进行。电影环展示提供了区域壁运动的定性印象（电影MRI）。通过计算收缩期壁增厚百分比，应用中心线方法的一种改良方法进行定量壁运动分析。在垂直于舒张末期和收缩末期轮廓之间中点绘制的中心线构建的100个等间距弦上分析短轴电影MRI图像。如果超过四个相邻弦的收缩期壁增厚百分比低于从正常志愿者获得的平均值2个标准差，则多巴酚丁胺MRI被认为对冠状动脉疾病呈阳性。多巴酚丁胺MRI检测显著冠状动脉疾病（直径狭窄≥50%）的总体敏感性为91%（33例中的30例），特异性为80%（6例中的5例），准确性为90%（39例中的35例）。识别单支血管疾病的敏感性为88%（17例中的15例），双支血管疾病为91%（11例中的10例），三支血管疾病为100%（5例中的5例）。检测各冠状动脉病变的敏感性，左前降支冠状动脉为75%，右冠状动脉为87%，左旋支冠状动脉为63%。
多巴酚丁胺MRI通过使用中心线方法的改良进行定量分析，能清晰识别壁运动异常。多巴酚丁胺MRI是检测和定位心肌缺血的准确方法，可能成为评估已知或疑似冠状动脉疾病患者的一种新的非侵入性方法。
