心血管MRI延迟增强对心肌病变应用价值.docVIP

心血管MRI延迟增强对心肌病变应用价值 　　[摘要] 目的 探讨心血管MRI延迟增强对心肌病变的应用价值。 方法 收集心血管病变65例，均行心血管MRI延迟增强（LGE）检查，其中5例缺血性心肌病行冠脉CT检查。评估MR图像中LGE有无及LGE部位（心内膜下、透壁、壁间、心外膜下、弥漫粉尘样），同时评价LGE与心肌病变的关系。 结果 临床确诊的心肌病变病例47例，有LGE病例33例。LGE可以显示心肌病变（χ2=13.013，P0.01），其敏感度、特异度、阳性预测值、阴性预测值分别为70.2%、83.3%、91.6%、51.7%。缺血性心肌病LGE阳性占80%，透壁型占75%，心内膜下型占25%，且其分布与相应的冠状动脉灌注区域相匹配。肥厚型心肌病LGE阳性占75%，肌壁间型占77.8%，透壁型占22.2%，扩张型心肌病LGE阳性占66.7%，肌壁间线条状强化占75%，心内膜下型占25%。限制型心肌病为肌壁间斑片状强化，阳性占1/3。心肌致密化不全1例为肌壁间条状强化。高血压性心肌病为肌壁间斑片状或晕状强化，阳性占42.9%。心肌炎2例为肌壁间及心外膜下强化。心肌淀粉样变1例为弥漫粉尘样强化。 结论 LGE可以检测心肌病变，对各种心肌病变的诊断及鉴别诊断提供重要信息，是评价心肌病变的最佳选择。 　　[关键词] 心血管MRI；延迟增强；心肌病变 　　[中图分类号] R542.2 [文献标识码] B [文章编号] 1673-9701（2015）04-0092-04 　　[Abstract] Objective To explore clinical value of late gadolinium-enhanced cardiovascular magnetic resonance（LGE-CMR） images in myocardiopathy. Methods LGE-CMR images were obtained in 65 patients. LGE-CMR images were evaluated by radiologists. The relationship LGE and cardiomyopathy was performed. Results Myocardial lesions were found in 47 cases by clinical follow-up or pathology. LGE signs were observed in 33 cases. LGE-CMR well demonstrated myocardial lesions（χ2=13.013， P0.01） with a sensitivity， specificity， positive predictive value and negative predictive value of 70.2%，83.3%， 91.6% and 51.7%， respectively. Ischemic cardiomyopathy LGE positive（80%）， through the wall type （75%）， under the endocardium type （25%）， and its distribution match the corresponding area of the coronary artery perfusion hypertrophic cardiomyopathy LGE positive （75%）， muscle intramural type accounted for 77.8%， through the wall type （22.2%）， DCM LGE positive （66.7%）， muscle intramural line shape improved （75%）， under the endocardium type accounted for 25%. The LGE in restrictive cardiomyopathy （RCM） was situated in mid-wall sites （1/3）. In left ventricular noncompaction（LVNC），LGE sign was one in mid-wall sites. In hypertensive cardiomyopathy， LGE signs were in mid-wall sites （42.9%）. The LGE in inflammatory cardiomyopathy were 2 cases situated in mid-w