磁共振钆剂延迟增强在冠状动脉疾病心肌评估中的应用价值

目的：探讨心血管磁共振钆剂延迟增强（LGE-CMR）在冠状动脉疾病（CAD）中的应用价值。方法：收集我院自2010年1月-2013年3月期间确诊为CAD且有LGE—CMR图像病例共19例（男15例，女4例，年龄范围36-79岁，中位年龄57岁），冠状动脉粥样硬化5例，冠状动脉硬化性心脏病14例，其中5例合并急性心肌梗死，5例患者有陈旧心肌梗死。由2位影像学诊断医生独立盲法评估心血管磁共振（CMR）图像中钆剂延迟增强（LGE）征象的有无、部位（心内膜下、透壁、壁间）及形态（斑点／斑片样、线条样、条片／片状），并行Kappa一致性检验。结果：2位影像诊断医生对LGE征象的有无、部位、形态的判定一致性较好（Kappa=0．908、0．733、0．724，均P〈0．05）。84．2％（16／19）CAD患者CMR可见LGE征象，且LGE主要位于心内膜下（7／16）和透壁（6／16），占81．25％（13／16）；条片／片状强化占43．75％（7／16）、线条样强化占31．25％（5／16）、斑点／斑片占25．00％（4／16）。结论：LGE-CMR可以显示CAD患者心肌损害的有无及范围，可为临床医生提供心肌层面影像学信息。

The application of late gadolinium enhancement in coronary artery disease

Objective： To explore the application in coronary artery disease with the use of late gadolinium enhancement on cardiovascular magnetic resonance （LGE-CMR） images. Methods： A total of 19 cases diagnosed as coronary artery disease （CAD） with LGE-CMR images in our hospital between January 2010 to March 2013. were accepted （15 men, 4 women, ages range from 36 to 79 years, median age 57 years）, including 5 cases of coronary atherosclerosis, 14 cases of coronary atherosclerotic heart disease. There were 5 patients with acute myocardial infarction and 5 patients with chronic myocardial infarction in the group of coronary atherosclerotic heart disease. 2 radiologists evaluated whether LGE or not, LGE localizations （subendocardial, transmural, mid- wall） and LGE morphology （spot/spots, linear, patchy） independently and blindly, Kappa test for consistency. Results： LGE present/absent, LGE localization and morphology had a good consistency （Kappa=0.908, 0.733, 0.724, P all 〈0.05） between 2 radiologists. LGE signs were observed in 84.2% （16/19） CAD cases, and 81.25%（13/ 16） located in subendocardial （7/16） or transmural （6/16）. 43.75% （7/16） patchy, 31.25% （5/16） lines and 25. 00% （4/16） spot/spots enhancement were seen. Conclusion： LGE-CMR is helpful to detect cardiac lesion and its range on CAD patients and also useful to identify the extent of myocardial lesions.