3.0T磁共振全心冠状动脉成像在诊断冠状动脉狭窄中的临床价值

目的 探讨3.0T磁共振全心冠状动脉成像在冠状动脉狭窄诊断中的临床应用价值.方法 应用3.0T MR自由呼吸三维导航快速梯度回波序列,对30例临床怀疑为冠心病患者进行MR全心冠状动脉成像检查,完成MR检查的27例中有19例进行了行冠状动脉造影检查,以血管造影为"金标准",初步估价3.0T磁共振全心冠脉成像诊断冠状动脉狭窄(>50%)的敏感性、特异性、准确度、阳性预测值及阴性预测值.结果 30例进行MR全心冠状动脉成像的患者中,27例获得了满意的检查结果(84.5%),MR全心冠状动脉成像检查在进行了冠状动脉造影检查的患者中共发现24支冠状动脉显著狭窄.与冠状动脉造影结果对照,MR全心冠状动脉成像诊断冠状动脉显著性狭窄敏感性为73.91%,特异性为82.29%,准确度为77.19%,阳性预测值为70.83%,阴性预测值为87.88%.结论 3.0T磁共振全心冠脉成像能够无创性地进行冠状动脉成像,初步评价冠状动脉主干及近、中段狭窄.冠状动脉MRA表现了较高的阴性预测值,对排除冠状动脉狭窄具有较高的临床应用价值.

Clinical application of whole-heart coronary MR angiography at 3.0T in the diagnosis of coronary artery stenosis

Objective To evaluate the applied value in clinics of the whole heart magnetic resonance coronary angiography at 3.0T diagnostic accuracy in determining coronary artery stenosis. Methods By using a three dimensional segmented K-space gradient echo imaging sequence (turbo field echo) with free breath, the whole-heart MRCA were performed in 30 patients suspected with coronary artery disease, 19 of them undergo elective coronary angiography. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for detection of significant stenosis (50%) using CAG as reference and gold standard. Results Whole-heart coronary MRA was completed in 27 (84.5%) of 30 patients, 19 of them undergo elective coronary angiography. Sensitivity, specificity, positive predictive value, and negative predictive value of MRA in detecting significant stenosis were 73.91%, 82.29%, 70.83%, 87.88% using CAG as reference and gold standard. Conclusion Whole heart coronary MR angiography allows for the accurate detection of coronary artery stenosis noinvasively. MRA showed high negative predictive value, which is useful for excluding coronary stenosis in symptomatic patients.