MR多技术扫描检测活性心肌及其和心肌声学造影对比的临床研究

目的 评价MR多技术扫描和心肌声学造影（MCE）在检测心肌灌注、判断心肌存活中的作用。资料与方法 应用MR多技术扫描对36例冠心病患者进行检查，并将结果与冠状动脉造影、MCE结果对照。结果 共有81支冠状动脉狭窄≥70％，狭窄的冠状动脉供血区域为334个（57．99％）节段。MR心肌灌注扫描见268个（46．53％）节段呈缺血改变，MR心肌活性扫描见83个（14．4l％）节段心肌梗死。以冠状动脉造影结果为标准，MR心肌灌注扫描的敏感性为80．2％，特异性为100％，总符合率为88．5％，Kappa值为0．773。定性MCE检查共有202个（35．07％）节段呈缺血改变。以冠状动脉造影结果为标准，定性MCE的敏感性为60．5％，特异性为100％，总符合率为77．1％，Kappa值为0．563。MR心肌灌注扫描所发现的缺血节段比狭窄冠状动脉的供血节段少但无统计学意义（P=0．468），MCE所发现的缺血节段比狭窄冠状动脉的供血节段少（P=0．000）；MR心肌灌注扫描检出缺血节段比MCE检出的多（P=0．000）。结论 MR多技术扫描可清晰显示心肌缺血或梗死的位置、程度，可重复性好，与冠状动脉造影结果的一致性较高。MCE为临床提供了元创、可重复地准确测定心肌缺血的新方法，但其评价方法具有一定主观性且低估心肌缺血的范围，检查者的经验和检查方法在一定程度上影响其准确性。

Multimodality MR Imaging Assessment in Determination of Myocardial Viability and Comparison with Myocardial Contrast Echocardiography

Objective To evaluate the effect of multimodality MR imaging and myocardial contrast echocardiography in determination of myocardial perfusion and decision of myocardial viability.Materials and Methods 36 patients with coronary artery disease were underwent with multimodality MR imaging, the result of MR scanning was compared with that of coronary artery angiography and myocardial contrast echocardiography.Results Coronary artery stenosis greater than 70% was 81 rami, the blood supply area of stenotic coronary artery was 334 (57.99%) segments, MR perfusion imaging detected 268 (46.53%) ischemic segments, MR delayed hyperenhancement was observed in 83 (14.41%) infarct segments. Using the result of coronary artery angiography as gold standard, the sensitivity, specificity and total coincidence of MR perfusion imaging was 80.2%,100% and 88.5%, respectively. Kappa value was 0.773. Qualitative myocardial contrast echocardiography detected 202 (35.07%) segments ischemic. Using the result of coronary artery angiography as standard, the sensitivity, specificity and total coincidence of qualitative MCE was 60.5%, 100% and 77.1%, respectively. Kappa value was 0.563. Ischemic segments detected by MR perfusion imaging were less than blood supply area of stenotic coronary artery but had no statistically significant (P=0.468). Ischemic segments detected by qualitative MCE significantly were less than blood supply area of stenotic coronary artery (P= 0.000). Ischemic segments detected by MR perfusion imaging were significantly higher than which detected by MCE (P= 0.000). Conclusion Multimodality MR imaging can delineate the location and extent of necrosis or ischemic myocardium, it has good repeatability and higher consistency with result of coronary artery angiography. MCE offers a noninvasive method to detect myocardial ischemic accurately and repeatability, which has a certain degree of subjective and significantly underestimate myocardial ischemic, experiment of examiner and means of examination effect its accuracy.