陈旧性心肌梗塞MRI诊断及鉴别诊断研究和心脏大血管正常MRI所见及测量研究
摘要
(一) MRI扫描的方法学
本研究应用FONAR永磁型MRI扫描仪，场强0.3T。所有健康志愿者和研究病例均采用SE脉冲序列。ECG门控技术属交替层面选择方法，获取同一层面的收缩和舒张末期像。本文选用轴位及左、右斜位体层面，全面显示心脏结构，以便于今后的常规应用。所有检查对象均先作T1加权或T1、T2混合扫描，75％者还同时作了T2加权扫描。本文结合真正长、短轴位扫描，讨论了本方法的优缺点、及其临床应用意义和影响图像质量的因素。
(二) 中国人心脏MRI正常所见及测量研究
本文根据50例健康成人志愿者，分析了轴位和左、右斜位像的正常心脏MRI所见，测量了心脏及大血管的径线并与超声心动图检查结果进行了对比。
MRI可清楚显示心脏各部及其周围的形态结构，冠状动脉三主支开口部及近段的显示率相当高，右冠状动脉、左主干、左前降支和回旋支分别为80.4％、74.5％、78.7％和80.9％。心包为低信号，宽度1—2.5MM。本文提供了国人轴位及双斜位心腔及大血管的某些径线，左室壁和肌部室间隔厚度及收缩期增厚率，以及左室容积、射血分数、短轴缩短率等某些心功能指标的正常值。与超声心动图测量对照，两者各项指标均相关良好(r：0.3673-0.9951，P＜0.001)。这些正常值可作为心脏MRI诊断的基础，具有重要的临床意义。
(三) 陈旧心肌梗塞的MRI诊断研究
本文分析了50例陈旧心肌梗塞(DMI)和10例心室壁瘤的MRI所见，并同放射性核素(25例)和超声心动图(18例)检查结果进行了对比研究。在此基础上讨论了MRI对DMI和心室壁瘤的诊断价值和限度，探讨了MRI在影像学诊断中的地位。
DMI的MRI基本征象和诊断要点有：左室壁(包括室间隔)限局交薄，收缩期增厚率异常，病变部信号强度降低和节段性运动异常等。某些病例，可见左室腔内血流信号增强，左心房室增大和左室整体运动功能受损等征象。室壁局部显著变薄伴信号强度降低，并向腔外膨凸，为心室壁瘤的基本征象。收缩期增厚率消失，病变部多呈反向运动，以及左室整体运动功能多严重受损是常见的继发改变，上述基本征象及其继发性改变，反映了DMI和心室壁瘤的病理和病理生理改变。MRI检查能准确显示病变范围、程度，在一定程度上反映心肌组织特定，及继发的左
1.The Methodology of ECG-gated Cardiac Magnetic Resonance Imaging(MRI) FONAR MR: Scanner with a permanent magnet operating at 0.3 Tesla was in this study.In all subjects,both healthy volunteers and patients,spin-echo(SE)pulse se quences with ECC-gating technique were used,and the technique was of alternate s lice selection order style.So that end systolic and diastolic images on the same bodyplane slice could be obtained.The axial right and left oblique planes were chosen,which could be enable to delineate the structures of various parts of the heart clearly,as well as be used routinely in future.TI weighted or blending T1 and T2 images were obtained in all subjects,among them T2 weighted images also obtained in 75% of the subjects. Comparing with the "true"long and short axial i mages,the merits and demerits of the above-stated method and its clinical signif icance,as well as the factors affecting the quality of the images were discussed
本研究应用FONAR永磁型MRI扫描仪，场强0.3T。所有健康志愿者和研究病例均采用SE脉冲序列。ECG门控技术属交替层面选择方法，获取同一层面的收缩和舒张末期像。本文选用轴位及左、右斜位体层面，全面显示心脏结构，以便于今后的常规应用。所有检查对象均先作T1加权或T1、T2混合扫描，75％者还同时作了T2加权扫描。本文结合真正长、短轴位扫描，讨论了本方法的优缺点、及其临床应用意义和影响图像质量的因素。
(二) 中国人心脏MRI正常所见及测量研究
本文根据50例健康成人志愿者，分析了轴位和左、右斜位像的正常心脏MRI所见，测量了心脏及大血管的径线并与超声心动图检查结果进行了对比。
MRI可清楚显示心脏各部及其周围的形态结构，冠状动脉三主支开口部及近段的显示率相当高，右冠状动脉、左主干、左前降支和回旋支分别为80.4％、74.5％、78.7％和80.9％。心包为低信号，宽度1—2.5MM。本文提供了国人轴位及双斜位心腔及大血管的某些径线，左室壁和肌部室间隔厚度及收缩期增厚率，以及左室容积、射血分数、短轴缩短率等某些心功能指标的正常值。与超声心动图测量对照，两者各项指标均相关良好(r：0.3673-0.9951，P＜0.001)。这些正常值可作为心脏MRI诊断的基础，具有重要的临床意义。
(三) 陈旧心肌梗塞的MRI诊断研究
本文分析了50例陈旧心肌梗塞(DMI)和10例心室壁瘤的MRI所见，并同放射性核素(25例)和超声心动图(18例)检查结果进行了对比研究。在此基础上讨论了MRI对DMI和心室壁瘤的诊断价值和限度，探讨了MRI在影像学诊断中的地位。
DMI的MRI基本征象和诊断要点有：左室壁(包括室间隔)限局交薄，收缩期增厚率异常，病变部信号强度降低和节段性运动异常等。某些病例，可见左室腔内血流信号增强，左心房室增大和左室整体运动功能受损等征象。室壁局部显著变薄伴信号强度降低，并向腔外膨凸，为心室壁瘤的基本征象。收缩期增厚率消失，病变部多呈反向运动，以及左室整体运动功能多严重受损是常见的继发改变，上述基本征象及其继发性改变，反映了DMI和心室壁瘤的病理和病理生理改变。MRI检查能准确显示病变范围、程度，在一定程度上反映心肌组织特定，及继发的左
1.The Methodology of ECG-gated Cardiac Magnetic Resonance Imaging(MRI) FONAR MR: Scanner with a permanent magnet operating at 0.3 Tesla was in this study.In all subjects,both healthy volunteers and patients,spin-echo(SE)pulse se quences with ECC-gating technique were used,and the technique was of alternate s lice selection order style.So that end systolic and diastolic images on the same bodyplane slice could be obtained.The axial right and left oblique planes were chosen,which could be enable to delineate the structures of various parts of the heart clearly,as well as be used routinely in future.TI weighted or blending T1 and T2 images were obtained in all subjects,among them T2 weighted images also obtained in 75% of the subjects. Comparing with the "true"long and short axial i mages,the merits and demerits of the above-stated method and its clinical signif icance,as well as the factors affecting the quality of the images were discussed
引文
1. FONAP., Operator Training Program; Cardiac Gating. FONAR Corporation 1986
2．代汝平等．左室及冠状动脉图像处理及定量研究(1)IA-87医学图像分析仪研制及临床应用的初步报告．中国循环杂志 1989；4：185
3．王新房、王加恩．超声心动图学．北京人民卫生出版社 1981；535
4. Higgins CB, Overview of MR of the heart—1986. AJR 1986; 146: 907
5. Higgins CB, et al. Imaging by neclear magnetic resonance in patients with??chronic ischemic heart disease. Circulatiln 1984;69:523
6. Higgins CB, et al. Magnetic Resonance Imaging of the Heart: A Review of the Experience in 172 Subjects. Radiology 1985;155:671
7. Tscholakoff D, et al. Gated MRI for Assessment of Cardiac Function and Myocardial infarction. RCNA 1985;23:449
8. McNamara MT, et al: Magnetic Resonance Imagingof Chronic Myolardial infarcts in man. AJR 1986; 146:315
9. Underwood SR, et al: Assessment of Regional left Ventricular Function by Magnetic Resonance.Br Heart J 1986; 56:334
10. Sechtem U, et al. Quantification of Cardiac Function by Conventional and Cine Magnetic Resonance Imaging. Cardiovasc Intervent Radiol 1987;10:356
11. Doom GC, et at. MR Imaging of Cardiac Tnrombi. J of Computer assist Tomogr 1986;10:415
12. von Schulthess GK, et al: Gated MR Imaging of the Heart: Intracardiac signals. in Patients and Healthy Subjecs. Radiology 1985;156:125
13. Revel D, et al. Magnetic Resonance Imaging of Ischemic Heart Disease. RCNA 1985;23:719
14. Dinsmore RE, et al:Magnetic Resonance Imaging of the Heart:Positioning and Gradient Angle Selection for Optional Imaging. AJR 1984; 143: 1135
15. White RD, et al. Segmental eveluation of left ventricular wall motion after myocardial Infarction: Magnetic resonance imaging versus echocardiography. Am Heart J 1988; 115: 1661. Friedman BJ,et al.Camparison of Magnetic Resonance Imaging and Echocardiography in Determination of Cardiac Dimensions in Normal Subjects.J Am coll Cardiol 1985; 5:1363.
2. Kaul S,et al.Measurement of Normal Left Heart Dimensions Using Optimally Oriented MR Images AJR 1986:146:75.
3. Dinsmore RE.Quantitation of Cardiac Dimensions from ECG-Synchronized MRI Studies.Cardiovasc Intervent Radiol 1987; 10:356.
4. Fisher MR,et al.Multiphasic Cardiac Magnetic Resonance Imaging:Normal Regional Left Ventricular wall thickening.AJR 1985;145:27.
5. ByrdⅢ BF, et al.Normal Cardiac Dimensions by Magnetic Resonance Imaging. Am J Cardiol 1985; 55: 1440.6. Higgins CB, et al. Magnetic Resonance Imaging of the Heart: A Review of the Experience in 172 Subjects. Radiology 1985; 155:671.
7．张雪林等．心电门控磁共振成像(ELG-MRI)技术在心脏的应用研究．中华医学会第三次全国中青年医学学术交流会论文汇编．1988；55．
8．王新房、王加恩．超声心动图学，北京人民卫生出版社第二版．1985；130、569、535．
9．张楚武．超声心动图诊断学，乌鲁木齐，新疆人民出版社第一版．1978；35、43．
10. White RD, dt al. Segmental evaluation of left ventricuLar wall motion after myocardial infarction: Magnetic resonance inaging versus echocardiography.Am Heart J 1988;115:166.1．刘力生．高血压病的治疗．阜外医院内部资料 1989；5
2. McNamara MR, et al. Magnetic Resonate Imaging of Chronic Myocardial Infarction in Man. AJR. 1986; 146: 315
3. Higgins CB, et al. Imaging by neclear magnetic resonance in patients with chronic ischemic heart disease. Circulation 1984; 69:523
4. Higgins CB, et el. Magnetic Resonance Imaging ot the Heart: A Rewiew of the Experience in 172 Subjects. Radiology 1985; 155: 671
5. Wagner GS. Myocardial Infarction Measurement and Intervention. Martinus Nijhaff Publishers 1982; 4-7
6. Sechtem U, et al. Regional Left Ventricular Wall Thickening by Magnetic Res onance Imaging :Evaluation in Normal Person and Patients with Global and Resional Desfunction. Am J Cardiol 1987; 59: 145
7. Filipchuk NG, et al. Detection and Locatization of Recent Myocardial Infarction by Magnetic Resonance Imaging. Am J Cardiol 1986; 58: 214
8. von Schulthess GK, et al. Gated MR Imaging of the Heart: Intracardiac Signals in Patients adn Healthy Subjects. Radiology 1985; 156: 125
9．代汝平等．心室壁瘤59例造影诊断分析．中华放射学杂志 1985；22：65
10．吴遐等．23例室壁瘤临床病理探讨．中华心血管病杂志 1982；10：278
11. Von Rossum AC, et al. Evaluation of Magnetic Resonance Imaging for Determination of left Ventricular Ejection Fraction and Comparison with Angiography. Am J Cardiol 1988;62:628
12. Tscholakoff D, et al. Gated Magnetic Resonance Imaging for Assesment of Cadiac Funciton and Myocardial Infarction. RCNA 1985; 23: 449
13. Just H, et al: Estimation of left ventricular volume and mass by Magnetic Resonance Imaging: Comparison with Quantitative Biplane Angiography. Cardiovasc Intervent Radiol 1987; 10: 1
14. Bucdwalter KA, et al: Gated Cardiac MRI: Ejection-Fraction Determination Using the Right Anterior Oblique View. AJR 1986; 7: 101615. Mogeovang J, et al: Evaluation of Left Ventricular Volumes Measured By Magnetic Resonance Imaging. Europear. Heart Journal 1986; 7: 1046.
16. Underwood SR, et al: Left Ventricular volumermeasured rapidly by magnetic resonance imgaing. Br Heart J 1988; 60:188
17. Edelman RR, et al. Cardiac Function: Evaluation with. Fast-Echo MR Imaging Radiolgy 1987; 162: 611
18. Utz Ja, et al. Cine MR Determination of Left ventricular Ejection Fraction AJR 1987; 162: 611
19．代瑞鸿．心肌梗塞．上海．上海科学技术出版社 1987；67，117，121，137
20．石毓澍，张鸿修．冠心病．天津．天津科学技术出版社 1981；158，84
21．王新房，王加恩．超声心动图学．北京．人民卫生出版社第二版 1985；2971. Germain par P, et al. Interet de I'IRM dans les Myocardiopathies dilatees. Arch Mal Coeur 1987; 80:1753
2. Higgins CB, et al. Magnetic Resonance Imaging of the Body. New York. U.S.A.Reven Press, Ltd. 1987; 249
3．刘玉清等．原发性心肌病的诊断—着重讨论放射学检查的价值和限度．中华放射学杂志，1983；17：314
4．赵锋．原发性扩张型心肌病的X线诊断(附85例临床分析)．白求恩医科大学学报．1988；14：441. de Roos A, et al: AJR 1988; 150: 531
2. Fisher MR, et al: AJR 1987; 148: 247
3. Filipchuk, NG et el: Am J Cardiol 1986; 58: 214
4. Revel D et al: RCNA 1985; 23:719
5. Johnston DJ, et al: Am J Cardiol 1989; 64:172
6. Sechtem U, et al: Am J Cardiol 1987; 59: 145
7. McNamara MT, et al: AJR 1986; 146: 315
8. Akins EW, et al: Am J Cardiol 1987; 59: 24
9. Been M, et al: Br Heart J 1988; 59: 1
10. Higgins CB, et al: Circulation 1984; 69: 523
11. Underwood SR, et al: Br Heart J 1986; 56: 334
12. White RD, et al: Am J Cardiol 1988; 115: 166
13. Eichstaedt HW, et al: Clin Cardiol 1986; 9: 527
14. de Roos A, et al: Radiology 1989: 172: 717
2．代汝平等．左室及冠状动脉图像处理及定量研究(1)IA-87医学图像分析仪研制及临床应用的初步报告．中国循环杂志 1989；4：185
3．王新房、王加恩．超声心动图学．北京人民卫生出版社 1981；535
4. Higgins CB, Overview of MR of the heart—1986. AJR 1986; 146: 907
5. Higgins CB, et al. Imaging by neclear magnetic resonance in patients with??chronic ischemic heart disease. Circulatiln 1984;69:523
6. Higgins CB, et al. Magnetic Resonance Imaging of the Heart: A Review of the Experience in 172 Subjects. Radiology 1985;155:671
7. Tscholakoff D, et al. Gated MRI for Assessment of Cardiac Function and Myocardial infarction. RCNA 1985;23:449
8. McNamara MT, et al: Magnetic Resonance Imagingof Chronic Myolardial infarcts in man. AJR 1986; 146:315
9. Underwood SR, et al: Assessment of Regional left Ventricular Function by Magnetic Resonance.Br Heart J 1986; 56:334
10. Sechtem U, et al. Quantification of Cardiac Function by Conventional and Cine Magnetic Resonance Imaging. Cardiovasc Intervent Radiol 1987;10:356
11. Doom GC, et at. MR Imaging of Cardiac Tnrombi. J of Computer assist Tomogr 1986;10:415
12. von Schulthess GK, et al: Gated MR Imaging of the Heart: Intracardiac signals. in Patients and Healthy Subjecs. Radiology 1985;156:125
13. Revel D, et al. Magnetic Resonance Imaging of Ischemic Heart Disease. RCNA 1985;23:719
14. Dinsmore RE, et al:Magnetic Resonance Imaging of the Heart:Positioning and Gradient Angle Selection for Optional Imaging. AJR 1984; 143: 1135
15. White RD, et al. Segmental eveluation of left ventricular wall motion after myocardial Infarction: Magnetic resonance imaging versus echocardiography. Am Heart J 1988; 115: 1661. Friedman BJ,et al.Camparison of Magnetic Resonance Imaging and Echocardiography in Determination of Cardiac Dimensions in Normal Subjects.J Am coll Cardiol 1985; 5:1363.
2. Kaul S,et al.Measurement of Normal Left Heart Dimensions Using Optimally Oriented MR Images AJR 1986:146:75.
3. Dinsmore RE.Quantitation of Cardiac Dimensions from ECG-Synchronized MRI Studies.Cardiovasc Intervent Radiol 1987; 10:356.
4. Fisher MR,et al.Multiphasic Cardiac Magnetic Resonance Imaging:Normal Regional Left Ventricular wall thickening.AJR 1985;145:27.
5. ByrdⅢ BF, et al.Normal Cardiac Dimensions by Magnetic Resonance Imaging. Am J Cardiol 1985; 55: 1440.6. Higgins CB, et al. Magnetic Resonance Imaging of the Heart: A Review of the Experience in 172 Subjects. Radiology 1985; 155:671.
7．张雪林等．心电门控磁共振成像(ELG-MRI)技术在心脏的应用研究．中华医学会第三次全国中青年医学学术交流会论文汇编．1988；55．
8．王新房、王加恩．超声心动图学，北京人民卫生出版社第二版．1985；130、569、535．
9．张楚武．超声心动图诊断学，乌鲁木齐，新疆人民出版社第一版．1978；35、43．
10. White RD, dt al. Segmental evaluation of left ventricuLar wall motion after myocardial infarction: Magnetic resonance inaging versus echocardiography.Am Heart J 1988;115:166.1．刘力生．高血压病的治疗．阜外医院内部资料 1989；5
2. McNamara MR, et al. Magnetic Resonate Imaging of Chronic Myocardial Infarction in Man. AJR. 1986; 146: 315
3. Higgins CB, et al. Imaging by neclear magnetic resonance in patients with chronic ischemic heart disease. Circulation 1984; 69:523
4. Higgins CB, et el. Magnetic Resonance Imaging ot the Heart: A Rewiew of the Experience in 172 Subjects. Radiology 1985; 155: 671
5. Wagner GS. Myocardial Infarction Measurement and Intervention. Martinus Nijhaff Publishers 1982; 4-7
6. Sechtem U, et al. Regional Left Ventricular Wall Thickening by Magnetic Res onance Imaging :Evaluation in Normal Person and Patients with Global and Resional Desfunction. Am J Cardiol 1987; 59: 145
7. Filipchuk NG, et al. Detection and Locatization of Recent Myocardial Infarction by Magnetic Resonance Imaging. Am J Cardiol 1986; 58: 214
8. von Schulthess GK, et al. Gated MR Imaging of the Heart: Intracardiac Signals in Patients adn Healthy Subjects. Radiology 1985; 156: 125
9．代汝平等．心室壁瘤59例造影诊断分析．中华放射学杂志 1985；22：65
10．吴遐等．23例室壁瘤临床病理探讨．中华心血管病杂志 1982；10：278
11. Von Rossum AC, et al. Evaluation of Magnetic Resonance Imaging for Determination of left Ventricular Ejection Fraction and Comparison with Angiography. Am J Cardiol 1988;62:628
12. Tscholakoff D, et al. Gated Magnetic Resonance Imaging for Assesment of Cadiac Funciton and Myocardial Infarction. RCNA 1985; 23: 449
13. Just H, et al: Estimation of left ventricular volume and mass by Magnetic Resonance Imaging: Comparison with Quantitative Biplane Angiography. Cardiovasc Intervent Radiol 1987; 10: 1
14. Bucdwalter KA, et al: Gated Cardiac MRI: Ejection-Fraction Determination Using the Right Anterior Oblique View. AJR 1986; 7: 101615. Mogeovang J, et al: Evaluation of Left Ventricular Volumes Measured By Magnetic Resonance Imaging. Europear. Heart Journal 1986; 7: 1046.
16. Underwood SR, et al: Left Ventricular volumermeasured rapidly by magnetic resonance imgaing. Br Heart J 1988; 60:188
17. Edelman RR, et al. Cardiac Function: Evaluation with. Fast-Echo MR Imaging Radiolgy 1987; 162: 611
18. Utz Ja, et al. Cine MR Determination of Left ventricular Ejection Fraction AJR 1987; 162: 611
19．代瑞鸿．心肌梗塞．上海．上海科学技术出版社 1987；67，117，121，137
20．石毓澍，张鸿修．冠心病．天津．天津科学技术出版社 1981；158，84
21．王新房，王加恩．超声心动图学．北京．人民卫生出版社第二版 1985；2971. Germain par P, et al. Interet de I'IRM dans les Myocardiopathies dilatees. Arch Mal Coeur 1987; 80:1753
2. Higgins CB, et al. Magnetic Resonance Imaging of the Body. New York. U.S.A.Reven Press, Ltd. 1987; 249
3．刘玉清等．原发性心肌病的诊断—着重讨论放射学检查的价值和限度．中华放射学杂志，1983；17：314
4．赵锋．原发性扩张型心肌病的X线诊断(附85例临床分析)．白求恩医科大学学报．1988；14：441. de Roos A, et al: AJR 1988; 150: 531
2. Fisher MR, et al: AJR 1987; 148: 247
3. Filipchuk, NG et el: Am J Cardiol 1986; 58: 214
4. Revel D et al: RCNA 1985; 23:719
5. Johnston DJ, et al: Am J Cardiol 1989; 64:172
6. Sechtem U, et al: Am J Cardiol 1987; 59: 145
7. McNamara MT, et al: AJR 1986; 146: 315
8. Akins EW, et al: Am J Cardiol 1987; 59: 24
9. Been M, et al: Br Heart J 1988; 59: 1
10. Higgins CB, et al: Circulation 1984; 69: 523
11. Underwood SR, et al: Br Heart J 1986; 56: 334
12. White RD, et al: Am J Cardiol 1988; 115: 166
13. Eichstaedt HW, et al: Clin Cardiol 1986; 9: 527
14. de Roos A, et al: Radiology 1989: 172: 717