Bottomley P A, Weiss R G
Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.
Lancet. 1998 Mar 7;351(9104):714-8. doi: 10.1016/S0140-6736(97)06402-7.
Preserved energy metabolism is essential for myocardial viability and the creatine kinase reaction is central to energy production and reserve. Although the appearance of myocardial creatine kinase enzyme in the blood is widely used to diagnose cardiac necrosis, there are no non-invasive ways to measure local creatine concentrations in the healthy and diseased human heart.
We measured total myocardial creatine by spatially-localised, water-suppressed hydrogen magnetic-resonance spectroscopy (1H-MRS) on a clinical (1.5 T) magnetic-resonance-imaging system in ten healthy volunteers (controls) and ten patients with a history of myocardial infarction. We validated this technique by comparison of 1H-MRS values of creatine with biopsy assays in an animal model of infarction.
Total creatine was measured in the posterior and anterior left ventricle and septum, and was significantly lower in regions of infarction (10 [9] SD micromol/g wet weight) than in non-infarcted regions (26 [11] micromol/g, p=0.001) of myocardium in patients or in the myocardium of healthy controls (28 [6] micromol/g, p<0.0001).
Spatially localised 1H-MRS can be used to measure total creatine non-invasively throughout the human heart. The detection of regional creatine depletion may provide a metabolic means to distinguish healthy from infarcted non-viable myocardium.
维持能量代谢对心肌存活至关重要，而肌酸激酶反应是能量产生和储备的核心。尽管血液中心肌肌酸激酶酶的出现被广泛用于诊断心脏坏死，但尚无无创方法可测量健康和患病人类心脏中的局部肌酸浓度。
我们在临床（1.5T）磁共振成像系统上，通过空间定位、水抑制氢磁共振波谱（1H-MRS）对10名健康志愿者（对照组）和10名有心肌梗死病史的患者测量了心肌总肌酸。我们通过在梗死动物模型中将肌酸的1H-MRS值与活检测定结果进行比较来验证该技术。
测量了左心室后壁、前壁和室间隔的总肌酸，患者梗死区域（10[9]标准差微摩尔/克湿重）的总肌酸明显低于非梗死区域（26[11]微摩尔/克，p=0.001）或健康对照者心肌（28[6]微摩尔/克，p<0.0001）。
空间定位的1H-MRS可用于在整个人类心脏中无创测量总肌酸。检测区域肌酸消耗可为区分健康与梗死的无活力心肌提供一种代谢方法。
