黃博昭2006-07-262018-07-112006-07-262018-07-112003http://ntur.lib.ntu.edu.tw//handle/246246/23598慢性冠心病為心臟衰竭及死亡的重要原因，正確的評估心肌存活，對病人之 治療及預後非常重要。新近研發之磁振造影儀具極佳的解析力，可評估心肌存 活。本研究之目的，乃利用新型磁振造影測定心肌存活，並與多保他命超音波心 圖與鉈－201 斷層造影所得比較之。 研究對象包括14 位慢性冠心病者，經心導管證實其冠狀動脈有≥70%的狹 窄，並有左心室功能異常。所有病人均於一個月內接受心肌磁振造影、多保他命 超音波心圖與鉈－201 斷層造影等檢查。 心肌磁振造影乃利用顯影劑（gadolinium-DTPA ）注射後心肌出現延遲性顯 影可測定心肌存活與否，以0 至4 分定量之（≥2 分為壞死心肌）。鉈－201 之顯 現≤50%則該節段心肌為壞死；多保他命超音波心圖則以多保他命注射前後的心 室壁無運動被認定為壞死。每個人左心室均以17 個節段分析之。 結果顯示，磁振造影的延遲性顯影和鉈－201 顯像及多保他命心肌存活之相 關性相當強。磁振造影和鉈－201 斷層造影於評估心肌存活之一致性為74.4%。 三種檢查的一致性為65.5%.。結論：以磁振造影測定心肌存活和鉈－201 顯像、 多保他命超音波的相關性不錯，但以何種檢查最能判斷存活心肌（預測接受血管 再造術後心室壁之復原），則需進一步的研究。Chronic coronary artery disease (CAD) is the leading cause of congestive heart failure and cardiac mortality. Functional recovery depends on accurate identification of reversible, viable myocardium. We evaluated the value of contrast-enhanced magnetic resonance imaging (MRI) in the assessment of myocardial viability. The study population consisted of 14 patients with angiographically significant CAD (≧70% diameter stenosis) and left ventricular (LV) dysfunction. Each patient underwent simultaneous dobutamine stress echocardiography (DSE), thallium-201 ( 201 Tl) SPECT, contrast-enhanced MRI and coronary angiography within one month. MRI and 201 Tl images were semiquantitatively interpreted using a 17-segment model. For 201 Tl SPECT, segment with a severe (≦50% of peak uptake), fixed perfusion defect was considered as scar. In gadolinium-enhanced MRI, hyperenhacement score ≧ 2 was defined as nonviability. The amount of viable tissue in MRI correlated positively with 201 Tl uptake and DSE (p ＜0.0001, each). The concordance rate of MRI and 201 Tl SPECT in detecting myocardial viability was 74.4%. Complete agreement of the 3 tests was 65.5%. In conclusion, there is a good correlation between the amount of viable tissue on MRI and 201 Tl uptake and also between these and contractile reserve detected by DSE. However, further study of a larger number of patients with revascularization is needed to explore which modality is superior in predicting functional recovery after intervention.application/pdf37486 bytesapplication/pdfzh-TW國立臺灣大學醫學院內科reporthttp://ntur.lib.ntu.edu.tw/bitstream/246246/23598/1/912314B002272.pdf