Rapid detection of myocardial infarction by subsecond, free-breathing delayed contrast-enhancement cardiovascular magnetic resonance
Rapid detection of myocardial infarction by subsecond, free-breathing delayed contrast-enhancement cardiovascular magnetic resonance
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DOI：
10.1161/circulationaha.106.635409
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发表时间：
2007-01-16
期刊：
影响因子：
37.8
通讯作者：
Kim, Raymond J.
中科院分区：
文献类型：
--
作者：
Sievers, Burkhard;Elliott, Michael D.;Kim, Raymond J.
背景 - 一种超快、延迟对比增强心血管磁共振技术，可以在自由呼吸（亚秒级）期间获取亚秒级“快照”图像，这种技术正在变得广泛应用。该技术可在 30 秒内提供完整左心室覆盖的心肌梗死 (MI) 成像。然而，该技术的准确性尚不清楚。方法和结果 - 我们在连续患者中前瞻性地将亚秒成像与常规屏气延迟对比增强心血管磁共振（标准）进行比较。预先指定了具有明确事实标准的两个队列：(1) 既往有心肌梗死记录的患者 (n = 135) 和 (2) 无心肌梗死且冠心病可能性较低的患者（最低弗雷明汉风险类别；n = 103）。扫描结果的评分掩盖了身份和临床信息。亚秒成像诊断 MI 的敏感性、特异性和准确性分别为 87%、96% 和 91%。与标准技术（98%、100%、99%）相比，亚秒技术的灵敏度略有降低（P = 0.0001），但特异性非常好。漏诊的梗塞通常较小或位于心内膜下（87%）。总体而言，梗塞评分的区域透壁程度高度一致（2083/2294；91%）；然而，通过标准技术，337 个区域中的 51 个区域 (15%) 被认为是主要梗塞区域（梗塞的透壁程度 > 50%）被认为是可行的（
Background - An ultrafast, delayed contrast-enhancement cardiovascular magnetic resonance technique that can acquire subsecond, "snapshot" images during free breathing ( subsecond) is becoming widely available. This technique provides myocardial infarction ( MI) imaging with complete left ventricular coverage in < 30 seconds. However, the accuracy of this technique is unknown.Methods and Results - We prospectively compared subsecond imaging with routine breath-hold delayed contrast-enhancement cardiovascular magnetic resonance ( standard) in consecutive patients. Two cohorts with unambiguous standards of truth were prespecified: ( 1) patients with documented prior MI ( n = 135) and ( 2) patients without MI and with low likelihood of coronary disease ( lowest Framingham risk category; n = 103). Scans were scored masked to identity and clinical information. Sensitivity, specificity, and accuracy of subsecond imaging for MI diagnosis were 87%, 96%, and 91%, respectively. Compared with the standard technique ( 98%, 100%, 99%), the subsecond technique had modestly reduced sensitivity ( P = 0.0001), but specificity was excellent. Missed infarcts were generally small or subendocardial ( 87%). Overall, regional transmural extent of infarction scores were highly concordant ( 2083/2294; 91%); however, 51 of 337 regions ( 15%) considered predominantly infarcted ( > 50% transmural extent of infarction) by the standard technique were considered viable (