中文摘要：

目的 观察慢性肺源性心脏病（简称肺心病）患者心脏MRI（CMRI）心肌增强成像特征.方法 前瞻性纳入确诊为慢性肺心病患者21例,包括18例慢性血栓栓塞性肺动脉高压及3例特发性肺动脉高压患者.所有患者均行CMRI,采用回顾性心电门控真实稳态自由进动梯度回波序列获得从心尖至心底8-10层心室短轴两腔心电影图像,采用前瞻性时间调整敏感度编码梯度回波序列获得心肌首过灌注图像,采用相位敏感反转恢复（PSIR）T1WI序列获得心肌延迟增强显像.采用Argus软件测定延迟期强化心肌体积与右心室功能参数,采用Spearman相关分析评价延迟期强化心肌体积与右心室功能参数的相关关系.结果 21例肺心病患者CMRI均显示不同程度右心房及右心室扩大,室间隔向左心室膨隆,左心房及左心室受压缩小.CMRI测定脊柱室间隔夹角为（70±11）.,右心室舒张末期容积为（205±48）ml,收缩末期容积为（141±33）ml,每搏输出量为（64±21）ml,射血分数为（32±11）％,心肌质量为（100±37）g.心肌首过灌注增强成像显示心肌均匀增强,未见局限性异常灌注区.21例患者延迟强化,均在右心室游离壁与室间隔移行带（IP）部心肌中层出现三角形延迟强化灶,1例除IP部出现延迟强化外,室间隔中层心肌出现线状延迟强化,心肌延迟强化病灶体积为（13±3） ml.Spearman相关分析显示延迟强化心肌体积与脊柱室间隔夹角（r=0.419,P=0.033）、收缩末期容积（r=0.598,P=0.001）、右心室心肌质量（r=0.441,P=0.024）呈正相关,与右心室射血分数呈负相关（r=-0.709,P=0.001）.结论 肺心病CMRI首过灌注期左、右心室心肌呈均匀灌注,延迟期强化期在右心室游离壁与室间隔移行带（IP部）出现延迟强化,位于心肌中层,同时延迟强化心肌体积可作为评价右心功能的指标.

英文摘要：

Objective To determine the characteristics of contrast enhanced-cardiovascular magnetic resonance imaging （CE-CMRI） in patients with cor pulmonale.Methods Twenty-one patients with cor pulmonale were prospectively included and underwent CMRI.Short-axis cine images of the heart were obtained for ventricular function assessment using a steady-state free precession sequence.For first-pass perfusion,a Turbo FLASH was performed after intravenous administration of 0.2 mmol/kg Gadopentetate dimeglumine.For delayed contrast enhancement （DCE）,a short-axis phase-sensitive inversion recovery sequence was performed.Right ventricular function and myocardial contrasted volume in DCE were measured with Argus software.Spearman correlation analysis was conducted to examine the association between myocardial contrasted volume and right ventricular function.Results CMRI showed the enlarged right atrium and ventricle,bowing ventricular septum in 21 patients.Septal angle was （70± 11）＆#176;,Right ventricular end diastolic volume （RVEDV）and end systolic volume RVESV respectively were （205 ± 48） and （141±33） ml,stroke volume（RVSV） was （64±21） ml and ejection fraction RVEF was （32± 11）%.Average RV myocardial mass was （100±37） g.No abnormal lesions were observed in the first-pass perfusion imaging.All patients showed triangular DCE in the insertion points （IP） of the right ventricular free wall to the interventricular septum and one in middle layer of interventricular septum.The DCE myocardial volume was （13±3） ml.Spearman correlation showed DCE myocardial volume correlated with septal angle （r=0.419,P=0.033）,RVESV （r=0.598,P=0.001）,RVEF （r=-0.709,P=0.001）and average RV myocardial mass （r=0.441,P=0.024）.Conclusions Negative first-pass perfusion and positive DCE are mainly present in patients with cor pulmonale.DCE is mainly present within the insertion points of the right ventricular free wall to the interventricular septum.DCE extent correlates with RV function.