中文摘要：

目的 评价3.0T非增强全心冠状动脉MR血管成像（CMRA）诊断冠状动脉狭窄的临床价值.方法 对33例冠状动脉CT血管成像（CCTA）诊断冠状动脉有意义狭窄（＞50％）且拟行冠状动脉造影（CAG）的患者行冠状动脉MR血管成像（CMRA）检查.应用3.0T扫描仪及32通道成像线圈,采用非对比增强、心电门控触发、呼吸导航、T2预置脉冲以及脂肪抑制的三维梯度回波序列.利用美托洛尔降低心率至＜ 80次/min.采用配对样本Wilcoxon秩检验分析CMRA及CCTA在冠状动脉近中段及远段评分的差异性.以CAG结果为金标准,评价CMRA诊断冠状动脉近中段＞50％狭窄的准确性以及与CCTA的一致性.结果 33例患者中30例成功完成CMRA扫描,CMRA及CCTA 在冠状动脉近中段的评分相近[CMRA：（3.49±0.61）分,CCTA：（3.56±0.55）分,Z=-1.715,P＞0.05],CCTA评价冠状动脉远段明显优于CMRA[CMRA：（2.44±0.76）分,CCTA：（3.23±0.60）分,Z=-6.159,P＜0.05].CMRA及CCTA在以段为基础诊断冠状动脉近中段＞50％狭窄的一致性良好（Kappa=0.779,P＜0.05）.CMRA诊断的敏感度、特异度、阳性预测值及阴性预测值分别为84.1％ （37/44）、85.8％ （115/134）、66.1％（37/56）、94.3％ （115/122）,CCTA分别为88.6％ （39/44）、89.6％ （120/134）、73.6％ （39/53）、96.0％ （120/125）.结论 3.0T非增强全心CMRA及CCTA诊断冠状动脉近中段狭窄的准确性相似,但CMRA诊断冠状动脉远段的狭窄需进一步深入研究.

英文摘要：

Objective To evaluate the clinical value of non-contrast-enhanced whole-heart coronary magnetic resonance angiography （CMRA） at 3.0 T to diagnose coronary artery stenosis.Methods Thirtythree consecutive patients with significant coronary artery stenosis （〉 50%） on coronary computed tomographic angiography （CCTA） and who were scheduled for coronary angiography （CAG） were recruited for CMRA.CMRA was performed on a 3.0 T scanner with 32-element matrix coil.A non-contrastenhanced,ECG-triggered,navigator-gated,T2 prepared and fat-saturated 3-dimensional GRE sequence was employed.Using beta blockade to reduce the heart rate to less than 80 bpm.The quality at proximal-middle and distal segments of coronary artery between CMRA and CCTA was compared with Wilcoxon rank test.Using CAG as gold standard to evaluate the accuracy of CMRA to detect proximal-middle segments of coronary artery stenosis 〉 50% diagnosed and the agreement between CMRA and CCTA were calculated.Results Among the 33 patients,30 patients successfully finished CMRA.The score at proximal-middle segments of coronary artery evaluated by CMRA and CCTA was similar（CMRA：3.49 ± 0.61,CCTA：3.56 ±0.55,Z =-1.715,P 〉 0.05）,CCTA was better at evaluating the distal segment than CMRA （CMRA：2.44±0.76,CCTA：3.23 ±0.60,Z =-6.159,P 〈0.05）.CMRA and CCTA had good consistency on a segment-based analysis of diagnosing proximal-middle segments stenosis 〉 50% （Kappa =0.779,P 〈 0.05）.The sensitivity,specificity,positive predictive value and negative predictive value of CMRA were 84.1% （37/44）,85.8% （115/134）,66.1% （37/56）,94.3 % （115/122）,while corresponding values for CCTA were 88.6% （39/44）,89.6% （120/134）,73.6% （39/53）,96.0% （120/125）.Conclusions 3.0 T non-contrast whole-heart CMRA and CCTA have similar accuracy in detecting the proximal-middle segments of coronary artery stenosis.The ability of CMRA to diagnose distal segments of coronary artery stenosis needs to be further studied.