作　　者： (殷亮）; (徐海燕）; (郑穗生）; (肖江喜）; (喻思思）; (邹倩）; (周伟）; (龚良庚）;

机构地区： 北京大学第一医院医学影像科,100034

出　　处： 《中华放射学杂志》 2017年第8期577-582,共6页

摘　　要： 目的 利用3.0 T MR心肌首过灌注成像和延迟增强成像定量评估肥厚型心肌病（HCM）患者冠状动脉微循环功能障碍.方法 回顾性分析2010年3月至2015年10月南昌大学第二附属医院收治的47例HCM患者（HCM组）和21名健康志愿者（对照组）.所有患者均接受心脏MR检查,包括左心室短轴电影成像、心肌首过灌注成像和延迟增强成像,测量各心肌节段峰值时间（tpeak）、最大上升斜率（Slopemax）、峰值信号强度（SIpeak）和心肌延迟强化（LGE）程度.将HCM按有无强化分为无心肌节段强化组、有心肌节段强化组,将有心肌节段强化组按照强化程度分为轻、中、重度强化组.采用单因素方差分析和非参数检验（Kruskal-Wallis检验）比较多组间SIpeak、Slopemax和tpeak等参数.检验心肌节段的灌注参数和延迟强化程度的相关关系采用Spearman相关性分析.结果 无心肌节段强化组（527段）、有心肌节段强化组（225段）及对照组（336段）tpeak分别为（67.0±27.4）、（79.4±27.4）、（59.7±21.6）s,Slopemax分别为17.2±7.0、16.4±7.4、20.4±6.3,SIpeak分别为442.7±143.2、465.1±138.4、521.9±146.7.无心肌节段强化组、有心肌节段强化组较对照组tpeak升高,而Slopemax及SIpeak降低（P值均＜0.01）,其中有心肌节段强化组较无心肌节段强化组tpeak升高更为显著（P＜0.01）,而Slopemax和SIpeak在两组之间差异无统计学意义;在轻、中、重度强化节段中,tpeak及SIpeak呈上升趋势,差异有统计学意义（P＜0.01）.Slopemax在不同强化程度的心肌节段之间差异无统计学意义.tpeak与LGE呈正相关（r=0.237,P＜0.01）.结论 3.0 T MR心肌灌注成像能可靠显示出无强化心肌节段的微循环功能异常,具有早期显示HCM患者冠脉微循环障碍的能力. Objective To evaluate the coronary microvascular dysfunction in patients with hypertrophic cardiomyopathy（HCM） by MR first-pass perfusion and late gadolinium enhancement. Methods From January 2011 to May 2015, 47 cases with HCM （HCM group） from the second affiliated hospital of Nanchang University were retrospectively analyzed. Additionally, 21 healthy volunteers were recruited as the control group. HCM group and control group underwent cardiac MR examinations at rest, including short axial cine, first-pass myocardial perfusion and late gadolinium enhancement scanning. Time to peak（tpeak）, maximal upslope of time-intensity curve（Slopemax）, peak signal intensity（SIpeak）, myocardial thickening, and late myocardial gadolinium enhancement（LGE） were assessed for each myocardial segment. HCM group were divided into LGE segments group and non-LGE segments group. LGE segments group were divided into mild, moderate and severe LGE segments group. The SIpeak, Slopemax and tpeak in multiple groups were compared by one-way ANOVA and Kruskal-Wallis test. Spearman correlation tests were used to determine the relationships between perfusion parameter and LGE. Results The average values of tpeak in non-LGE segments group （527 segments）, LGE segments group （225 segments） and control group （336 segments） were （67.0 ± 27.4）, （79.4 ± 27.4）, （59.7 ± 21.6）s, respectively. The average values of Slopemax in the three groups were 17.2±7.0, 16.4±7.4, 20.4±6.3, respectively. The average values of SIpeak in the three groups were 442.7 ± 143.2, 465.1 ± 138.4, 521.9 ± 146.7, respectively. Compared to the control group, tpeak increased and Slopemax, SIpeak decreased in non-LGE segments group and LGE segments group （P〈0.01）, while tpeak increased more significantly in LGE segments group. The Slopemax and SIpeak showed no statistically significant differences between non-LGE segments group and LGE segments group （P〉0.05）. There were significant differences among LGE segments gro

关 键 词： 心肌病 肥厚性 心肌灌注显像 微循环