对比增强磁共振对缺血性心脏病与原发性扩张型心肌病的临床鉴别研究

发布时间：2018-02-24 14:27

本文关键词： 对比增强磁共振缺血性心脏病扩张型心肌病延迟强化　出处：《北京协和医学院》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探讨对比增强磁共振(CE-CMR)在缺血性心脏病和原发性扩张型心肌病的临床鉴别诊断中的作用。方法：选取2008年1月至2012年8月于我院行对比剂增强磁共振检查和冠状动脉造影检查,伴有左室扩张和收缩功能减低的患者102例,分为两组：28例扩张型心肌病组与74例缺血性心脏病组,观察左室壁心肌延迟强化的部位、程度及范围。图像分析：由两位放射科医师行盲法共同观察分析,以意见一致为评判指标。左室心肌分段采用美国心脏协会(AHA)左室壁17节段分段标准。心肌强化程度采用5分法：0分,无强化；1分,1-25%左室壁厚度强化；2分,26-50%左室壁厚度强化；3分,51-75%左室壁厚度强化；4分,76-100%左室壁厚度强化。室壁增厚率在心脏短轴位上进行测量,以收缩末期心肌厚度减去舒张末期心肌厚度,以同层面病变部位对侧心肌为正常对照。数据统计：数据分析采用SPSS16.0统计分析软件。两组间的数据对比采用非配对t检验和卡方检验。P0.05被认为有统计学意义。结果：扩张型心肌病组对比剂增强磁共振扫描结果：8例患者可见左室壁延迟强化,其中1例为心内膜下强化,3例为肌壁间强化,3例为散在强化,1例为斑片状强化。缺血性心脏病组对比增强磁共振扫描结果：66例患者可见左室壁延迟强化,其中58例为透壁性强化,7例为心内膜下强化。两组间延迟强化的病例数有显著差异(8：66,P0.001)。对于102例患者总体而言,CMR检测到沿冠脉血管走行分布区域的典型的缺血性的透壁性或心内膜下的延迟强化敏感度达到89%,而特异性达到98.5%。结论：磁共振延迟增强是鉴别扩张型心脏病与缺血性心肌病的有效手段,与冠脉造影检查相结合为二者间的鉴别提供了重要的参考价值。
[Abstract]:Objective: to investigate the role of contrast-enhanced magnetic resonance imaging (CE-CMR) in the differential diagnosis of ischemic heart disease and primary dilated cardiomyopathy. And coronary angiography, 102 patients with left ventricular dilatation and decreased systolic function were divided into two groups: dilated cardiomyopathy group (n = 28) and ischemic heart disease group (n = 74). Extent and scope. Image analysis: blind observation and analysis by two radiologists, According to consensus, the left ventricular myocardial segment was divided by the American Heart Association (AHA), the left ventricular wall was divided into 17 segments, and the degree of myocardial enhancement was measured by 5 points method: 0 points. No enhancement; 1-25% enhancement of left ventricular wall thickness; 2min 26-50% enhancement of left ventricular wall thickness; 51-75% enhancement of left ventricular wall thickness; 76-100% enhancement of left ventricular wall thickness; Subtracting end-diastolic myocardial thickness from end-systolic myocardial thickness, The contralateral myocardium of the same lesion was taken as the normal control. Data statistics: the data analysis was performed with SPSS16.0 software. The data contrast between the two groups was considered to be statistically significant by using unpaired t test and chi-square test. Results: contrast enhanced magnetic resonance imaging in dilated cardiomyopathy group showed delayed enhancement of left ventricular wall in 8 patients with dilated cardiomyopathy. One case was subendocardial enhancement, 3 cases were intramural enhancement, 3 cases were scattered enhancement, 1 case was patch enhancement. Contrast enhanced MRI showed delayed enhancement of left ventricular wall in 66 cases in ischemic heart disease group. Among them, 58 cases were transmural enhancement and 7 cases were subendocardial enhancement. There was a significant difference between the two groups in the number of patients with delayed enhancement. The sensitivity of transmural or subendocardial delayed enhancement was 89 and the specificity was 98.5.Conclusion: Mr delayed enhancement is an effective method for differentiating dilated heart disease from ischemic cardiomyopathy. The combination of coronary angiography and coronary angiography provides an important reference value for the differential diagnosis between the two.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R541;R445.2;R542.2

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