实时心肌超声造影与磁共振心肌灌注延迟增强检测存活心肌的比较

摘要

Objective To review the clinical values of real-time myocardial contrast echocardiography (RT-MCE) and delayed-enhancement magnetic resonance imaging (DE-MRI) in detection survival myocardium. Methods The patients with coronary heart disease (CHD,n=27, male 16, female 11 and average age, 62.5) were chosen from July 2012 to Dec. 2013. All patients were given treatment of RT-MCE, DE-MRI, coronary angiography (CAG) and percutaneous coronary intervention (PCI). The images of RT-MCE were analyszed by using visual semi-quantitative method for deciding survival myocardium. DE-MRI was graded and survival status of myocardium was adjuged according to the grading results. All patients were given reexamination of RT-MCE after 1 m, 3 m and 6 m respectively. The improvement of ventricular segment systolic function after coronary revascularization was taken as the gold standard for deciding survival myocardium.Results The sensitivity, specificity and accuracy of semi-quantitative RT-MCE were, respectively, 70.9%, 85.7% and 76.3% and those of DE-MRI were, respectively, 72.7%, 76.2% and 74.0%. RT-MCE had higher specificity than DE-MRI (76.2%vs. 85.7%,P<0.05). The correlation between RT-MCE and DE-MRI was good.Conclusion RT-MCE and DE-MRI all have higher clinical value, and RT-MCE has higher specificity.%目的：评价实时心肌超声造影（RT-MCE）与磁共振心肌灌注延迟增强（DE-MRI）检测存活心肌的临床价值。方法入选2012年7月至2013年12月徐州矿务集团总医院（徐州医学院第二附属医院）心内科收治入院的冠状动脉粥样硬化性心脏病（冠心病）患者27例，男性16例，女性11例，平均年龄62.5岁。所有患者行RT-MCE、DE-MRI、冠状动脉造影（CAG）及冠状动脉介入治疗（PCI）。对患者的RT-MCE图像分析采用目测半定量法，判定存活心肌；对心肌灌注延迟增强情况进行分级，根据分级结果对心肌存活情况进行判定。术后1、3、6月时复查心脏超声，以冠状动脉血运重建后室壁节段收缩功能改善为判断存活心肌的金标准。结果 RT-MCE目测半定量法检测存活心肌的灵敏性、特异性及准确度分别是70.9%、85.7%、76.3%；DE-MRI法检测存活心肌的灵敏性、特异性及准确度分别是72.7%、76.2%、74.0%，RT-MCE目测半定量法检测存活心肌较DE-MRI法具有较高的特异度（76.2%vs.85.7%， P＜0.05）。两种检测方法的相关性良好。结论 RT-MCE目测半定量法与DE-MRI法检测存活心肌具有较高的临床价值，RT-MCE目测半定量法具有更高的特异性。