心脏磁共振技术在心肌肥厚性疾病中的诊断价值

发布时间：2019-06-02 01:37

【摘要】：目的对可疑心肌肥厚的患者行心脏磁共振(CMR)检查,明确有无心肌肥厚、心肌肥厚的原因、评估心肌纤维化损伤的出现,并对CMR检查的安全性进行评估。方法收集2014年7月—2016年2月在上海交通大学医学院附属仁济医院就诊,心脏彩色多普勒超声(以下简称心脏超声)检查发现心肌任何部位舒张末厚度11mm的可疑心肌肥厚的患者,行CMR检查明确有无心肌肥厚,心肌肥厚的原因,根据钆造影剂延迟强化阳性与否诊断患者是否存在心肌纤维化损伤,并对CMR检查的安全性进行评估。结果共收录216例可疑心肌肥厚患者。心脏超声检查与CMR检查对于心肌肥厚病因学诊断的符合率为82.4%(去除不明原因心肌肥厚患者)。心肌肥厚患者以高血压性心脏病和肥厚型心肌病(HCM)为主。CMR检查诊断为高血压性心脏病53例,HCM 117例,心肌淀粉样变3例,明确心肌肥厚病因的其他系统性疾病5例,不明原因心肌肥厚3例,明确诊断为其他疾病17例,明确无心肌肥厚18例。此外,CMR检查意外发现6例(2.8%)患者存在伴随病变。CMR检查确诊为心肌肥厚的患者中69.7%存在心肌纤维化,其中高血压性心脏病患者中38.9%存在心肌纤维化,显著低于HCM患者的82.1%(P0.05)。除1例(0.5%)患者注射造影剂后即刻出现恶心、呕吐外,未见其他CMR检查相关不良反应。结论 CMR检查无创、安全,可为心肌肥厚的明确诊断提供更多的线索,并从病因学诊断更多的疾病,同时可加深对心肌肥厚的组织学损伤的认识。
[Abstract]:Objective to determine whether there is myocardial hypertrophy and the causes of myocardial hypertrophy, to evaluate the occurrence of myocardial fibrosis injury and to evaluate the safety of CMR in patients with suspected myocardial hypertrophy. Methods from July 2014 to February 2016, he was admitted to Renji Hospital affiliated to Medical College of Shanghai Jiaotong University. Cardiac color Doppler ultrasound (hereinafter referred to as cardiac ultrasound) showed that patients with suspected myocardial hypertrophy with end diastolic thickness 11mm in any part of the myocardium were examined by CMR to determine whether there was myocardial hypertrophy and the causes of myocardial hypertrophy. The safety of CMR was evaluated according to the diagnosis of myocardial fibrosis injury according to the delayed enhancement positive of gadolinium contrast agent. Results 216 patients with suspected myocardial hypertrophy were collected. The coincidence rate of echocardiography and CMR in the etiological diagnosis of myocardial hypertrophy was 82.4% (removal of unexplained myocardial hypertrophy). The main causes of myocardial hypertrophy were hypertensive heart disease and hypertrophic cardiomyopathy (HCM). There were 53 cases of hypertensive heart disease, 117 cases of HCM, 3 cases of myocardial amyloidosis and 5 cases of other systemic diseases. There were 3 cases of unexplained myocardial hypertrophy, 17 cases of other diseases and 18 cases of unexplained cardiac hypertrophy. In addition, 6 patients (2.8%) were accidentally found to have accompanying lesions by CMR. 69.7% of the patients with myocardial hypertrophy diagnosed by CMR had myocardial fibrosis, and 38.9% of the patients with hypertensive heart disease had myocardial fibrosis. It was significantly lower than that of HCM patients (82.1%) (P 0.05). No other adverse reactions related to CMR were found except 1 patient (0.5%) who had nausea and vomiting immediately after injection of contrast agent. Conclusion CMR is noninvasive and safe, which can provide more clues for the definite diagnosis of myocardial hypertrophy, diagnose more diseases from etiology, and deepen the understanding of histologic injury of myocardial hypertrophy.
【作者单位】：上海交通大学医学院附属仁济医院心血管内科;上海交通大学医学院附属仁济医院放射科;
【基金】：国家自然科学基金(81270206、81470391) 上海交通大学医工交叉项目(YG2014MS49)资助
【分类号】：R542.2

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