CAJ | 학술논문

目的观察慢性肺源性心脏病(简称肺心病)患者心脏MRI(CMRI)心肌增强成像特征.方法前瞻性纳入确诊为慢性肺心病患者21例,包括18例慢性血栓栓塞性肺动脉高压及3例特发性肺动脉高压患者.所有患者均行CMRI,采用回顾性心电门控真实稳态自由进动梯度回波序列获得从心尖至心底8～10层心室短轴两腔心电影图像,采用前瞻性时间调整敏感度编码梯度回波序列获得心肌首过灌注图像,采用相位敏感反转恢复(PSIR)T1WI序列获得心肌延迟增强显像.采用Argus软件测定延迟期强化心肌体积与右心室功能参数,采用Spearman相关分析评价延迟期强化心肌体积与右心室功能参数的相关关系.结果 21例肺心病患者CMRI均显示不同程度右心房及右心室扩大,室间隔向左心室膨隆,左心房及左心室受压缩小.CMRI测定脊柱室间隔夹角为(70±11).,右心室舒张末期容积为(205±48)ml,收缩末期容积为(141±33)ml,每搏输出量为(64±21)ml,射血分数为(32±11)％,心肌质量为(100±37)g.心肌首过灌注增强成像显示心肌均匀增强,未见局限性异常灌注区.21例患者延迟强化,均在右心室游离壁与室间隔移行带(IP)部心肌中层出现三角形延迟强化灶,1例除IP部出现延迟强化外,室间隔中层心肌出现线状延迟强化,心肌延迟强化病灶体积为(13±3) ml.Spearman相关分析显示延迟强化心肌体积与脊柱室间隔夹角(r=0.419,P=0.033)、收缩末期容积(r=0.598,P=0.001)、右心室心肌质量(r=0.441,P=0.024)呈正相关,与右心室射血分数呈负相关(r=-0.709,P=0.001).结论肺心病CMRI首过灌注期左、右心室心肌呈均匀灌注,延迟期强化期在右心室游离壁与室间隔移行带(IP部)出现延迟强化,位于心肌中层,同时延迟强化心肌体积可作为评价右心功能的指标.
목적 관찰만성폐원성심장병(간칭폐심병)환자심장MRI(CMRI)심기증강성상특정.방법 전첨성납입학진위만성폐심병환자21례,포괄18례만성혈전전새성폐동맥고압급3례특발성폐동맥고압환자.소유환자균행CMRI,채용회고성심전문공진실은태자유진동제도회파서렬획득종심첨지심저8～10층심실단축량강심전영도상,채용전첨성시간조정민감도편마제도회파서렬획득심기수과관주도상,채용상위민감반전회복(PSIR)T1WI서렬획득심기연지증강현상.채용Argus연건측정연지기강화심기체적여우심실공능삼수,채용Spearman상관분석평개연지기강화심기체적여우심실공능삼수적상관관계.결과 21례폐심병환자CMRI균현시불동정도우심방급우심실확대,실간격향좌심실팽륭,좌심방급좌심실수압축소.CMRI측정척주실간격협각위(70±11).,우심실서장말기용적위(205±48)ml,수축말기용적위(141±33)ml,매박수출량위(64±21)ml,사혈분수위(32±11)％,심기질량위(100±37)g.심기수과관주증강성상현시심기균균증강,미견국한성이상관주구.21례환자연지강화,균재우심실유리벽여실간격이행대(IP)부심기중층출현삼각형연지강화조,1례제IP부출현연지강화외,실간격중층심기출현선상연지강화,심기연지강화병조체적위(13±3) ml.Spearman상관분석현시연지강화심기체적여척주실간격협각(r=0.419,P=0.033)、수축말기용적(r=0.598,P=0.001)、우심실심기질량(r=0.441,P=0.024)정정상관,여우심실사혈분수정부상관(r=-0.709,P=0.001).결론 폐심병CMRI수과관주기좌、우심실심기정균균관주,연지기강화기재우심실유리벽여실간격이행대(IP부)출현연지강화,위우심기중층,동시연지강화심기체적가작위평개우심공능적지표.
Objective To determine the characteristics of contrast enhanced-cardiovascular magnetic resonance imaging (CE-CMRI) in patients with cor pulmonale.Methods Twenty-one patients with cor pulmonale were prospectively included and underwent CMRI.Short-axis cine images of the heart were obtained for ventricular function assessment using a steady-state free precession sequence.For first-pass perfusion,a Turbo FLASH was performed after intravenous administration of 0.2 mmol/kg Gadopentetate dimeglumine.For delayed contrast enhancement (DCE),a short-axis phase-sensitive inversion recovery sequence was performed.Right ventricular function and myocardial contrasted volume in DCE were measured with Argus software.Spearman correlation analysis was conducted to examine the association between myocardial contrasted volume and right ventricular function.Results CMRI showed the enlarged right atrium and ventricle,bowing ventricular septum in 21 patients.Septal angle was (70± 11)°,Right ventricular end diastolic volume (RVEDV)and end systolic volume RVESV respectively were (205 ± 48) and (141±33) ml,stroke volume(RVSV) was (64±21) ml and ejection fraction RVEF was (32± 11)％.Average RV myocardial mass was (100±37) g.No abnormal lesions were observed in the first-pass perfusion imaging.All patients showed triangular DCE in the insertion points (IP) of the right ventricular free wall to the interventricular septum and one in middle layer of interventricular septum.The DCE myocardial volume was (13±3) ml.Spearman correlation showed DCE myocardial volume correlated with septal angle (r=0.419,P=0.033),RVESV (r=0.598,P=0.001),RVEF (r=-0.709,P=0.001)and average RV myocardial mass (r=0.441,P=0.024).Conclusions Negative first-pass perfusion and positive DCE are mainly present in patients with cor pulmonale.DCE is mainly present within the insertion points of the right ventricular free wall to the interventricular septum.DCE extent correlates with RV function.