本文關(guān)鍵詞： 對(duì)比增強(qiáng)磁共振 缺血性心臟病 擴(kuò)張型心肌病 延遲強(qiáng)化　出處：《北京協(xié)和醫(yī)學(xué)院》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討對(duì)比增強(qiáng)磁共振(CE-CMR)在缺血性心臟病和原發(fā)性擴(kuò)張型心肌病的臨床鑒別診斷中的作用。方法：選取2008年1月至2012年8月于我院行對(duì)比劑增強(qiáng)磁共振檢查和冠狀動(dòng)脈造影檢查,伴有左室擴(kuò)張和收縮功能減低的患者102例,分為兩組：28例擴(kuò)張型心肌病組與74例缺血性心臟病組,觀察左室壁心肌延遲強(qiáng)化的部位、程度及范圍。圖像分析：由兩位放射科醫(yī)師行盲法共同觀察分析,以意見一致為評(píng)判指標(biāo)。左室心肌分段采用美國心臟協(xié)會(huì)(AHA)左室壁17節(jié)段分段標(biāo)準(zhǔn)。心肌強(qiáng)化程度采用5分法：0分,無強(qiáng)化；1分,1-25%左室壁厚度強(qiáng)化；2分,26-50%左室壁厚度強(qiáng)化；3分,51-75%左室壁厚度強(qiáng)化；4分,76-100%左室壁厚度強(qiáng)化。室壁增厚率在心臟短軸位上進(jìn)行測(cè)量,以收縮末期心肌厚度減去舒張末期心肌厚度,以同層面病變部位對(duì)側(cè)心肌為正常對(duì)照。數(shù)據(jù)統(tǒng)計(jì)：數(shù)據(jù)分析采用SPSS16.0統(tǒng)計(jì)分析軟件。兩組間的數(shù)據(jù)對(duì)比采用非配對(duì)t檢驗(yàn)和卡方檢驗(yàn)。P0.05被認(rèn)為有統(tǒng)計(jì)學(xué)意義。結(jié)果：擴(kuò)張型心肌病組對(duì)比劑增強(qiáng)磁共振掃描結(jié)果：8例患者可見左室壁延遲強(qiáng)化,其中1例為心內(nèi)膜下強(qiáng)化,3例為肌壁間強(qiáng)化,3例為散在強(qiáng)化,1例為斑片狀強(qiáng)化。缺血性心臟病組對(duì)比增強(qiáng)磁共振掃描結(jié)果：66例患者可見左室壁延遲強(qiáng)化,其中58例為透壁性強(qiáng)化,7例為心內(nèi)膜下強(qiáng)化。兩組間延遲強(qiáng)化的病例數(shù)有顯著差異(8：66,P0.001)。對(duì)于102例患者總體而言,CMR檢測(cè)到沿冠脈血管走行分布區(qū)域的典型的缺血性的透壁性或心內(nèi)膜下的延遲強(qiáng)化敏感度達(dá)到89%,而特異性達(dá)到98.5%。結(jié)論：磁共振延遲增強(qiáng)是鑒別擴(kuò)張型心臟病與缺血性心肌病的有效手段,與冠脈造影檢查相結(jié)合為二者間的鑒別提供了重要的參考價(jià)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.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R541;R445.2;R542.2

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