对比剂增强的磁共振显像检测陈旧性心肌梗死的坏死心肌

目的 通过动物实验和临床病例研究评价对比剂增强的磁共振显像(CE-MRI)检测陈旧性心肌梗死(OMI)坏死心肌的准确性。方法 采用导管介入球囊封堵冠脉的方法制作10头苏中猪心肌梗死模型，3周后行CE-MRI和病理学检查。选取OMI(Q波型或非Q波型)患者17例，行CE-MRI，判断梗死心肌的部位，与临床ECG和／或冠状动脉造影(CAG)检查比较。15例无心肌梗死者为对照组。结果10头苏中猪心脏磁共振检查均有心肌的延迟增强显像。病理TTC和HE染色证实，延迟增强区系坏死心肌。17例OMI患者均有心肌的延迟增强显像，且延迟增强区与临床ECG和／或冠状动脉造影判断的心肌梗死部位基本一致。对照组15例病人无一例出现延迟增强显像。结论CE-MRI能够较准确的判断OMI坏死心肌的存在及其范围。

Experimental and clinical study on the identification of necrotic myocardium in chronic myocardial infarction by contrast-enhanced magnetic resonance imaging

Objective To study the accuracy of contrast-enhanced magnetic resonance imaging for identifying necrotic myocardium in chronic myocardial infarction by experimental and clinical study.Methods The left anterior descending coronary artery was obstructed through catheter balloon,and the heart underwent contrast-enhanced magnetic resonance imaging and pathological examination three weeks later in 10 pigs.17 patients with chronic myocardial infarction(Q wave or non-Q wave) underwent contrast-enhanced magnetic resonance imaging,and another 15 patients without myocardial infarction were selected as control group.Results All 10 pigs showed delayed enhancement signal,which was confirmed to be necrotic myocardium pathologically by TTC or HE staining.Delayed enhancement signal was also seen in 17 patients with chronic myocardial infarction,and the region with enhancement signal was consistent with that identified by electrocardiography and/or coronary artery angiography,while no one in control group had delayed enhancement signal. Conclusion Contrast-enhanced magnetic resonance imaging can be used to identify the existence and the size of necrotic myocardium in chronic myocardial infarction.