中文摘要：

目的应用磁共振成像心肌灌注延迟显像（DE-MRI）所显示的高信号识别存活心肌和瘢痕组织，通过与^99Tc^m-甲氧基异丁基异腈（MIBI）单光子发射型计算机断层（SPECT）和^18F-脱氧葡萄糖（FDG）SPECT进行对比研究，评估其诊断的敏感性和特异性，并分析两种方法的一致性。方法34例临床确诊的心肌梗死患者，拟行再血管化手术治疗。男性29例，女性5例，年龄（58．0±9．8）岁，接受心脏MRI及SPECT灌注／代谢显像检查。两种方法各划分5个等级，依据17节段分析法，分析34例患者共578个节段，并对两种评价心肌存活的方法行一致性分析。结果DE-MRI判断存活心肌431段（74．6％），坏死心肌147段（25．4％）。SPECT灌注／代谢显像诊断正常心肌336段（58．1％），坏死心肌212段（36．7％），缺血心肌30段（5．2％）。两种方法半定量分析显示一致性较好，Kappa值为0．51（〉0．4）。以节段为单位，DE-MRI的敏感性为61．3％，特异性为95．4％。结论DE—MRI能够有效地识别存活心肌和瘢痕组织，并与^18F-FDG SPECT一致性较好。

英文摘要：

Objective The aim of this study was to investigate the feasibility and accuracy of delayed enhancement magnetic resonance imaging （DE-MRI） for the assessment of myocardial viability in patients with myocardial infarction in comparison with ^99Tc^m-scstamibi （MIBI） single photon emission computed tomagraphy（SPECT） and ^18F-fluoredeoxyglucosc （FDG） SPECT. Scar was defined as regionally increased MRI signal intensity 15 minutes after injection of 0. 2 mmoL/kg gadolinium-diethylenetriamine pentoacctic acid or reduced perfusion and glucose metabolism defined by SPECT. Methods A total of 34 patients with myocardial infarction （29 males, 58.0 ± 9. 8 years ） were imaged with MRI and SPECT. Results A total of 578 scgments were analyzed. DE-MRI and SPECT identified 431 and 336 viable segments respectively and SPECT also identified 30 ischcmic segments. Necrotic segments identified by DE- MRI and SPECT were 147 and 212 respectively. Sensitivity and specificity of DE-MRI in identifying segments with matched flow/metabolism defects （ scar tissues ） was 61.3% and 95.4% , respectively. Quantitatively assessed relative MRI infarct area correlated well with SPECT infarct size. The value of Kappa was 0. 51. Conclusion DE-MRI provides a good tool for differentiating viable myocardium from scar tissues and the detection accuracy is comparable between DE-MRI and SPECT.