CT_MR在评价缺血性心脏病中的作用.ppt

n MRI nonviable, infarcted tissue is most commonly detected using a technique called “delayed enhancement” or “delayed hyperenhancement.” The main advantage of MRI delayed enhancement is its spatial resolution of 1 to 2 mm, compared with about 10 mm with Tc99m-sestamibi SPECT scanning. Ibrahim et al. (17) compared MRI with SPECT in 78 patients with acute MI. Using troponin elevation as the reference standard for MI, they found that MRI was significantly more sensitive than SPECT for the detection of small infarcts (troponin 3.0 ng/ml; 92% vs. 69%; p = 0.03), and infarction in nonanterior location (98% vs. 84%; p = 0.03) (Figure 2 and Figure 3). Given the excellent prognosis of patients with no infarction by SPECT, future studies will be required to see whether patients with such small infarcts, detectable by MRI and not SPECT, have an adverse prognosis. Full-size image (72K) - Opens new window Full-size image (72K) Figure 2. MRI Compared With SPECT for Detection of Small Infarcts (A) Short-axis magnetic resonance imaging (MRI) delayed-enhancement images show a small subendocardial infarct in the lateral wall (arrowhead). The corresponding short axis Tc99m sestamibi single-photon emission computed tomography (SPECT) images do not show a definite abnormality in this area (arrowhead). (B) Short axis delayed-enhancement MRI image in a different patient shows a small focus of transmural delayed enhancement in the inferolateral wall. The corresponding short axis Tc99m sestamibi SPECT images do not show a definite abnormality in this area (arrowhead). Figure used with permission from Ibrahim et al. (17). View Within Article Full-size image (44K) - Opens new window Full-size image (44K) Figure 3. MRI and SPECT Compared With Troponin Levels Sensitivity of delayed enhancement contrast-enhanced magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT) for the detection of acute myocardial infarction based on the peak troponin T levels