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目的评价磁共振心肌灌注成像(MRMPI)检测心肌梗死存活心肌的作用。方法选择心肌梗死患者51例。采用1.5T MR扫描仪,反转恢复快速小角度激励(IR-turbo FLASH)序列,全部患者均在静脉注射钆喷替酸葡甲胺(Gd-DTPA)0.1mmol/kg、MRMPI首过期及5～30min延迟期成像。21例行静息、负荷99锝单光子发射计算机体层摄影术(single photon emission computed tomography,SPECT)进行对照研究。首过期行短轴面成像,延迟期行短轴面及长轴面成像。结果51例心肌梗死患者,42例(82.3%)首过期显示灌注减低;50例(98%)延迟增强。在21例168个心肌段SPECT诊断无活性心肌段48个,MRMPI示梗死区均有延迟增强,SPECT诊断存活心肌段120个,MRMPI示97段无延迟增强。以静息、负荷99m锝SPECT作为参考标准,MRMPI的敏感度、特异度分别为100%、80.8%。结论MRMPI可有效地检测心肌梗死的存活和非存活心肌,以及其程度和范围。
Objective To evaluate the effect of magnetic resonance myocardial perfusion imaging (MRMPI) on the detection of viable myocardium in myocardial infarction. Methods Fifty-one patients with myocardial infarction were selected. All patients were injected intravenously with Gd-DTPA (0.1mmol / kg), MRMPI first phase and 5 (superscript TM) MRT with 1.5T MR scanner and IR-turbo FLASH sequence. ~ 30min delayed imaging. Twenty-one patients underwent resting, single-load 99 technetium single photon emission computed tomography (SPECT) for control study. The first staging line short axis imaging, delayed phase short axis and long axis imaging. Results 51 patients with myocardial infarction, 42 patients (82.3%) showed the first phase of perfusion decreased perfusion; 50 patients (98%) delayed enhancement. There were 48 inactive myocardial segments diagnosed by SPECT in 168 myocardial segments of 21 cases. MRMPI showed delayed enhancement of infarct zone, SPECT diagnosis of 120 myocardial segments, MRMPI showed 97 segments without delay enhancement. With resting, 99mTc SPECT as the reference standard, the sensitivity and specificity of MRMPI were 100% and 80.8% respectively. Conclusion MRMPI can effectively detect myocardial infarction survival and non-viable myocardium, as well as the extent and scope.