超声、磁共振、冠脉造影及核素扫描对心肌缺血和存活的临床对比研究

1、超声、磁共振、冠脉造影及核素扫描对心肌缺血和存活的临床对比研究         08-08-13 09:17:00     编辑：studa20              作者：刘庆华 田建明 赵宝珍 王莉 孔令山 王磊明 纪广玉 王少雁【摘要】 目的  应用超声、磁共振、冠脉造影及核素扫描对冠心病患者心肌缺血和存活状态进行综合研究，以利

2、于临床合理全面地评价各影像学检查结果。 方法  12例超声发现节段性室壁运动失常患者，全部行冠脉造影检查。其中11例进行多巴酚丁胺超声心动图检查，10例进行磁共振及核素扫描。根据左室短轴冠脉供血区域的不同划分心肌运动节段。 结果  26个冠脉造影阳性结果中，超声发现其中16个供血区节段性室壁运动失常;有5处冠脉造影阴性，超声发现运动异常。10例同时行磁共振和冠脉造影的患者中，20个冠脉造影阳性，MRI检出其中14个供血区异常;有4处冠脉造影阴性，MRI发现灌注异常。10例同时进行核素扫描和冠脉造影的患者中，有18支血管造影异常，核素扫描显示其中12个供血区充填缺损或放射性减

3、低;核素扫描总共发现20个供血节段灌注异常，8个冠脉造影阴性，核素发现有灌注缺陷。同时进行超声和磁共振检查的10例计30个供血区中，超声、磁共振均发现异常16处，两者部位相符13处。均有3处磁共振发现灌注异常而超声判断运动正常，磁共振判断灌注正常而超声发现运动失常。9例行负荷试验的患者中，磁共振共发现低灌注区15处，有收缩储备的9处，MRI判断的存活性与超声一致的有13处。10例中8例磁共振发现心内膜有高信号的附壁血栓影，只有1例超声隐约可见心内膜面的强回声光点。超声发现室壁瘤4个，磁共振发现5个，核素扫描发现2个。 结论  在临床实际应用中，应了解各影像学技术的原理及特点，全面合理

4、的对冠心病的心肌状态作出评价。    关键词  超声 磁共振 冠脉造影 核素扫描 心肌缺血 心肌存活    The clinic comparative study of echocardiography，coronary angiography，MRI and TI-SPECT in myocardial ischemia and viability    Liu Qinghua，Tian Jianming，Zhao Baozhen，et al.    Depar

5、tment of Ultrasound，Changhai Hospital，The Second Military Medical University，Shanghai200433    【Abstract】 Objective To evaluate the examination results of medical imaging techniques comprehensively and rationally on myocardial ischemia and viability patients with coronary artery disea

6、ses，overall studies were per-formed by echocardiography，MRI，coronary angiography and TI-SPECT.Methods 12patients with regional wall motion abnormalities found by echocardiography underwent coronary angiography（CAG）examination.11of12were studied by dobutamine stress echocardiography（DSE）and10of12case

7、s by MRI and TI-SPECT.The myocardial segments were defined according to3-vessel territories at short-axis view（mid-papillary level）.Results Of26positive findings of CAG，16dysfunctional segments were found by echocardiography.5dysfunctional segments were found by echocardiography without positive CAG

8、 findings.Of20positive findings of CAG，14perfusion defects were detected on MRI.4perfusion defects were found byMRI without positive CAG findings.In18positive results of CAG，TI-SPECT were found perfusion defects in12segments，other6segments were normal on the SPECT images.Of20perfusion defects were s

9、hown on the SPECT images，8perfusion defects were found without CAG positive findings.Of10patients both undergoing MRI and echocardiography examination，16dysfunctional segments and perfusion defects were displayed on MRI and echocardiography，respectively.13segments were accordant in these two methods

10、.3seg-ments showing perfusion defects on MRI were normal on echocardiography.Other3dysfunctional segments on the e-chocardiography image displayed normal perfusion on MRI.In9patients undergoing DSE，15hypoperfusion area were found by MRI，9of15had response to dobutamine stimulation.13segments were coi

11、ncident between MRI and e-chocardiography in judging myocardial viability.Thrombus were detected by MRI in8of10patients，only1patient was found thrombus by echocardiography.4，5and2aneurysms were found by echocardiography，MRI and SPECT re-spectively.Conclusion In clinic application，it is important to

12、realize the principles and characterics of all these medical imaging techniques to evaluate the situation of myocardium comprehensively and rationally.    Key words echocardiography MRI coronary angiography Tl-SPECT myocardial ischemia myocardial viability    由于超声、磁共振、冠

13、脉造影及核素扫描的成像原理不同，反映的心肌缺血和存活状态有一定差异。本试验应用上述影像学技术对冠心病患者心肌缺血和存活状态进行综合研究，以利于临床合理全面地评价各影像学检查结果。     1 资料与方法     1.1 临床资料    表1 患者的一般资料（略0    1.2 多巴酚丁胺负荷超声心动图    1.3 磁共振检查    图1:心肌缺血患者，左室短轴位心肌灌注提示:左心室室间隔、左室前壁首次通过呈明显低灌注区。左室短轴位心肌活性扫描显示:左心室室间隔前部及前壁造影剂潴留呈高信号，为变性或坏死的心肌;其余在首过时呈低