【摘要】 目的评估钆剂延迟增强(LGE)对心肌病变的诊断价值。方法收集2010-01—2013-01具有完整心血管磁共振(CMR)图像病例51例,其中男32例。女19例,年龄17-79(49.8±16.0)岁。由2位影像诊断医师独立盲法评估CMR图像中LGE有无、LGE部位(心内膜下、透壁、壁间、心外膜下)及形态(斑点/斑片样、线条样、片状/片状),并行Kappa一致性检验,同时评价LGE与心肌病变的关系。结果临床确诊有心肌病变39例,2位影像诊断医师对LGE征象有无、部位、形态的判定一致性较好(Kappa=0.876、0.678、0.686,均P<0.01或0.05)。CMR-LGE可以显示心肌病变(X~2=13.226,P<0.05).其敏感度、特异度、阳性预测值、阴性预测值分别为79.5%、83.3%、93.9%、55.6%。其中缺血性心肌病LGE主要为心内膜下或透壁型,占81.8%(9/11),以片状强化多见72.7%(8/11)。炎性心肌病变主要位于心肌壁间75.0%(6/8)。强化形态多样,斑点/斑片样、线条样、片状均可见。而非缺血性心肌病中。LGE征象可出现于心内膜下、透壁、壁间,形态以斑点、斑片样多见。结论 LGE是CMR检查的一个重要组成部分。可以检测心肌病变的有无及范围,有助于临床医师识别与心脏有关的症状和病因。更多还原

【Abstract】 Objective To evaluate the application of late gadolinium-enhanced cardiovascular magnetic resonance(LGE-CMR) images in diagnosis of myocardiopathy.Methods Fifty one patients,including 32 males and 19 females aged17~79y received LGE-CMR examination during January 2010 and January 2013.The LGE-CMR images were evaluated by two radiologists independently,in terms of LGE locations(subendocardial,transmural,mid-wall,subepicardial) and LGE patterns(spot/spots,linear,patchy).Kappa test for consistency and X~2 for the relationship between LGE and cardiomyopathy were performed.Results Myocardial lesions were found in 39 cases by clinical follow-up or pathology.There was a good consistency in diagnosis,LGE location and pattern between 2 radiologists(Kappa=0.876,0.678,0.686,P<0.05 or 0.01).LGE-CMR well demonstrated myocardial lesions(X~2=13.226,P<0.05) with a sensitivity,specificity,positive predictive value and negative predictive value of 79.5%,83.3%,93.9% and 55.6%,respectively.The LGE in ischemic cardiomyopathy was mostly located in subendocardial or transmural(81.8%) sites,and patchy enhancement was common(72.7%).The LGE in inflammatory cardiomyopathy was mainly situated in mid-wall(75.0%),and spot/spots(3/8),linear(3/8),patchy(2/8) enhancements were all visible.In the non-ischemic cardiomyopathy,LGE signs were in subendocardial,transmural or mid-wall sites,and inclined to be spot/spots-like enhancement.Conclusion LGE-CMR is helpful in evaluation of cardiac lesions and its features in patients with cardiomyopathy.更多还原