超聲、磁共振、冠脈造影及核素掃描對(duì)心肌缺血和存活的臨床對(duì)比研究

1、超聲、磁共振、冠脈造影及核素掃描對(duì)心肌缺血和存活的臨床對(duì)比研究                  作者：劉慶華 田建明 趙寶珍 王莉 孔令山 王磊明 紀(jì)廣玉 王少雁【摘要】 目的  應(yīng)用超聲、磁共振、冠脈造影及核素掃描對(duì)冠心病患者心肌缺血和存活狀態(tài)進(jìn)行綜合研究，以利于臨床合理全面地評(píng)價(jià)各影像學(xué)檢查結(jié)果。 方法  12例超聲發(fā)現(xiàn)節(jié)段性室壁運(yùn)動(dòng)失?；颊撸啃泄诿}造影檢查。其中11例進(jìn)行多巴酚丁胺超聲心動(dòng)圖檢查

2、，10例進(jìn)行磁共振及核素掃描。根據(jù)左室短軸冠脈供血區(qū)域的不同劃分心肌運(yùn)動(dòng)節(jié)段。 結(jié)果  26個(gè)冠脈造影陽(yáng)性結(jié)果中，超聲發(fā)現(xiàn)其中16個(gè)供血區(qū)節(jié)段性室壁運(yùn)動(dòng)失常;有5處冠脈造影陰性，超聲發(fā)現(xiàn)運(yùn)動(dòng)異常。10例同時(shí)行磁共振和冠脈造影的患者中，20個(gè)冠脈造影陽(yáng)性，MRI檢出其中14個(gè)供血區(qū)異常;有4處冠脈造影陰性，MRI發(fā)現(xiàn)灌注異常。10例同時(shí)進(jìn)行核素掃描和冠脈造影的患者中，有18支血管造影異常，核素掃描顯示其中12個(gè)供血區(qū)充填缺損或放射性減低;核素掃描總共發(fā)現(xiàn)20個(gè)供血節(jié)段灌注異常，8個(gè)冠脈造影陰性，核素發(fā)現(xiàn)有灌注缺陷。同時(shí)進(jìn)行超聲和磁共振檢查的10例計(jì)30個(gè)供血區(qū)中，超聲、磁共振均發(fā)現(xiàn)異常

3、16處，兩者部位相符13處。均有3處磁共振發(fā)現(xiàn)灌注異常而超聲判斷運(yùn)動(dòng)正常，磁共振判斷灌注正常而超聲發(fā)現(xiàn)運(yùn)動(dòng)失常。9例行負(fù)荷試驗(yàn)的患者中，磁共振共發(fā)現(xiàn)低灌注區(qū)15處，有收縮儲(chǔ)備的9處，MRI判斷的存活性與超聲一致的有13處。10例中8例磁共振發(fā)現(xiàn)心內(nèi)膜有高信號(hào)的附壁血栓影，只有1例超聲隱約可見(jiàn)心內(nèi)膜面的強(qiáng)回聲光點(diǎn)。超聲發(fā)現(xiàn)室壁瘤4個(gè)，磁共振發(fā)現(xiàn)5個(gè)，核素掃描發(fā)現(xiàn)2個(gè)。 結(jié)論  在臨床實(shí)際應(yīng)用中，應(yīng)了解各影像學(xué)技術(shù)的原理及特點(diǎn)，全面合理的對(duì)冠心病的心肌狀態(tài)作出評(píng)價(jià)。    關(guān)鍵詞  超聲 磁共振 冠脈造影 核素掃描 心肌缺血 心肌存活 &

4、#160;  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.    Department of Ultrasound，Changhai Hospital，The Second Military Medical University，

5、Shanghai200433    【Abstract】 Objective To evaluate the examination results of medical imaging techniques comprehensively and rationally on myocardial ischemia and viability patients with coronary artery diseases，overall studies were per-formed by echocardiography，MRI，coronary angiogra

6、phy 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）and10of12cases by MRI and TI-SPECT.The myocardial segments were defined according to3-vess

7、el 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 findings.Of20positive findings of CAG，14perfusion defects were detected on M

8、RI.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 shown on the SPECT images，8perfusion defects were found without CAG positive f

9、indings.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.3seg-ments showing perfusion defects on MRI were normal on echocardiography.

10、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 coincident between MRI and e-chocardiography in judging myocardial viability.Thr

11、ombus 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 realize the principles and characterics of all these medical imaging techniqu

12、es to evaluate the situation of myocardium comprehensively and rationally.    Key words echocardiography MRI coronary angiography Tl-SPECT myocardial ischemia myocardial viability    由于超聲、磁共振、冠脈造影及核素掃描的成像原理不同，反映的心肌缺血和存活狀態(tài)有一定差異。本試驗(yàn)應(yīng)用上述影像學(xué)技術(shù)對(duì)冠心病患者心肌缺血和存活狀態(tài)進(jìn)行綜合研究，以利于臨床合理全面地評(píng)價(jià)各影像學(xué)檢查結(jié)果。     1 資料與方法     1.1 臨床資料    表1 患者的一般資料（略0    1.2 多巴酚丁胺負(fù)荷超聲心動(dòng)圖    1.3 磁共振檢查    圖1:心肌缺血患者，左室短軸位心肌灌注提示:左心室室間隔、左室前壁首次通過(guò)呈明顯低灌注區(qū)。左室短軸位心肌活性掃描顯示:左心室室間隔前部及前壁造影劑潴留呈高信號(hào)，為變性或壞死的心肌;其余在首過(guò)時(shí)呈低灌注區(qū)的