Clinical value of cardiac magnetic resonance myocardial perfusion imaging in coronary artery lesion and microcirculation obstruction in coronary heart disease patients
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摘要:
目的 探讨心脏磁共振（CMR）心肌灌注成像在冠心病冠状动脉病变及微循环梗阻（MVO）中的临床应用价值。 方法 选取2020年1月~2022年12月我院收治的106例冠心病患者，均在经皮冠状动脉介入治疗前和治疗后行CMR心肌灌注成像。以冠状动脉造影诊断结果为金标准，对比经皮冠状动脉介入治疗前CMR心肌灌注成像中延迟强化透壁局部室壁异常运动及病变区与正常心肌区CMR心肌灌注成像参数。分析CMR心肌灌注成像对冠心病冠状动脉病变的诊断效能。经皮冠状动脉介入治疗后根据患者是否存在MVO将其分为MVO组（n=29）和无MVO组（n=77），对比两组CMR心肌灌注成像参数，并采用ROC曲线分析CMR心肌灌注成像参数对MVO的诊断价值。 结果 106例患者中的1802个心肌节段被纳入评价。CMR心肌灌注成像显示106例患者共有147个延迟强化的心肌节段（每个患者至少有1个心肌节段延迟强化），其中68个透壁强化，79个非透壁强化。病变心肌首过灌注时间、首过灌注最大上升斜率（Slopemax）、心肌延迟强化信号值与正常心肌间对比有统计学差异（P < 0.05）。以冠状动脉造影结果为金标准，CMR心肌灌注成像对左前降支、右冠状动脉、左回旋支病变的诊断敏感度分别为94.12%、88.64%、88.89%，特异性分别为95.00%、96.55%、94.74%，准确度分别为94.66%、93.89%、93.13%。经皮冠状动脉介入治疗后有MVO者29例，无MVO者77例。MVO组中首过灌注时间、Slopemax、心肌延迟强化信号值与无MVO组的差异有统计学意义（P < 0.05）。ROC曲线显示，CMR心肌灌注成像参数中首过灌注时间、Slopemax、心肌延迟强化信号值对冠心病患者MVO诊断的曲线下面积分别为0.803、0.718、0.851，敏感度分别为82.76%、72.41%、86.21%，特异性分别为66.23%、68.83%、67.53%，准确度分别为70.75%、69.81%、72.64%。 结论 CMR心肌灌注成像可显示冠心病心血管病变区域的变化，对诊断冠心病冠状动脉病变及MVO情况有较高的诊断价值。 Abstract:Objective To explore the clinical value of cardiac magnetic resonance (CMR) myocardial perfusion imaging in coronary artery disease and microcirculation obstruction (MVO). Methods 106 patients with coronary heart disease admitted to our hospital from January 2020 to December 2022 were selected to undergo CMR myocardial perfusion imaging before and after percutaneous coronary intervention. Using the diagnostic results of coronary angiography as the gold standard, the parameters of delayed enhanced transmural regional wall abnormal motion and CMR myocardial perfusion imaging in the diseased and normal myocardial areas in CMR myocardial perfusion imaging before percutaneous coronary intervention were compared. To analyze the diagnostic efficacy of CMR myocardial perfusion imaging in coronary artery disease. After percutaneous coronary intervention, the patients were divided into MVO group (n=29)and non-MVO group (n=77)according to whether there was MVO. The parameters of CMR myocardial perfusion imaging were compared between the two groups, and the diagnostic value of CMR myocardial perfusion imaging parameters to MVO was analyzed by ROC curve. Results 1802 myocardial segments in 106 patients were included in the evaluation. CMR myocardial perfusion imaging showed that there were 147 myocardial segments with delayed enhancement in 106 patients (at least one myocardial segment with delayed enhancement in each patient), including 68 transmural enhancement and 79 non-transmural enhancement. There were significant differences in the first pass perfusion time, the maximum slope of first pass perfusion (Slopemax) and the delayed enhancement signal value between the diseased myocardium and the normal myocardium (P < 0.05). Based on the results of coronary angiography as the gold standard, the sensitivity of CMR myocardial perfusion imaging in the diagnosis of left anterior descending artery, right coronary artery and left circumflex artery lesions was 94.12%, 88.64% and 88.89% respectively, the specificity was 95.00%, 96.55% and 94.74% respectively, and the accuracy was 94.66%, 93.89% and 93.13% respectively. After percutaneous coronary intervention, there were 29 cases with MVO and 77 cases without MVO. In MVO group, the first perfusion time, Slopemax and delayed myocardial enhancement signal value were significantly different from those without MVO group (P < 0.05). The ROC curve analysis showed that AUC of the first perfusion time, Slopemax, and delayed myocardial enhancement signal value of CMR myocardial perfusion imaging parameters for the diagnosis of MVO in patients with coronary heart disease were 0.803, 0.718 and 0.851, respectively, with sensitivity of 82.76%, 72.41% and 86.21%, specificity of 66.23%, 68.83%, and 67.53%, and accuracy of 70.75%, 69.81% and 72.64%. Conclusion CMR myocardial perfusion imaging can display the changes of the cardiovascular disease area of coronary heart disease, and has high diagnostic value for diagnosing coronary artery disease and MVO. -
图 1 CMR心肌灌注成像参数对冠心病患者MVO诊断的ROC曲线
Figure 1. ROC curve of CMR myocardial perfusion imaging parameters in the diagnosis of MVO in patients with coronary heart disease.
图 2 灌注扫描心尖部前壁及侧壁、中间部前间壁、前壁信号减低
Figure 2. The signal of the anterior wall and lateral wall of the apex, the anterior septum wall and the anterior wall of the middle part were decreased.
图 3 延迟扫描心尖部前壁及侧壁、中间部前间壁、前壁见片状强化，部分为透壁强化
Figure 3. Delayed scan showed patchy enhancement in the anterior and lateral walls of the apex, the anterior septal wall and the anterior wall of the middle part, and partial transmural enhancement.
表 1 病变心肌与正常心肌CMR心肌灌注成像参数比较
Table 1. Comparison of CMR myocardial perfusion imaging parameters between diseased myocardium and normal myocardium (Mean±SD)
Groups First pass perfusion time (s) Slopemax Myocardial delayed enhancement signal value Myocardial lesions (n=147) 4.69±1.07 25.83±4.06 68.35±14.72 Normal myocardial (n=1655) 3.17±0.92 30.11±5.19 21.43±5.48 t 18.928 9.736 81.118 P < 0.001 < 0.001 < 0.001 
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表 2 CMR心肌灌注成像对冠状动脉病变的诊断价值
Table 2. Diagnostic value of CMR myocardial perfusion imaging in coronary artery disease (n)
Checkout procedure CAG Footing LAD RCA LCX CMR myocardial perfusion imaging LAD 48 2 2 52 RCA 1 39 2 42 LCX 2 3 32 37 Footing 51 44 36 CAG: Coronary angiography; LAD: Left anterior descending artery; RCA: Right coronary artery; LCX: Left circumflex artery.
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表 3 MVO组与无MVO组CMR心肌灌注成像参数比较
Table 3. Comparison of CMR myocardial perfusion imaging parameters between MVO group and non-MVO group (Mean±SD)
Group First pass perfusion time（s） Slopemax Myocardial delayed enhancement signal value MVO group(n=29) 4.28±1.01 27.36±3.15 56.14±13.29 Non-MVO group (n=77) 3.46±0.89 29.57±3.40 28.32±7.35 t 4.074 3.042 13.687 P < 0.001 0.003 < 0.001 MVO: Microcirculation obstruction.
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表 4 CMR心肌灌注成像参数对冠心病患者MVO的诊断价值
Table 4. Diagnostic value of CMR myocardial perfusion imaging parameters for MVO in patients with coronary heart disease
Index AUC 95% CI Sensitivity（%） Specificity（%） Accuracy（%） First pass perfusion time 0.803 0.705-0.901 82.76 66.23 70.75 Slopemax 0.718 0.601-0.835 72.41 68.83 69.81 Myocardial delayed enhancement signal value 0.851 0.764-0.938 86.21 67.53 72.64
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