Evaluation Of The Myocardial Ischemia And Myocardial Viability In Coronary Heart Disease With Magnetic Resonance And Color Doppler Ultrasound

Objective To assess the value in detecting myocardial ischemia and myocardial viability incoronary heart disease with MR myocardial perfusion,delayed enhancement scan andechocardiography.Material and Methods Twenty patients with coronary heart disease from2011.3to2012.2inthe hospital of Qinghai province.All the patients had cardiac magnetic resonance imaging andechocardiography.The time interval of the two examination is not more than two days.Echocardiography is focus to observe the movement of the left ventricular wall,in accordance with17paragraph of the the myocardial is recommended by the American Heart Association.Cardiacmagnetic resonance imaging1:morphological examination: FIESTA sequence imaging:the verticalventricular septal long axis, parallel to ventricular septal long axis,and the left ventricular shortaxis.Left ventricular short axis cardiac MRI cine imaging and assesthe each segmental wall motion.2: myocardial perfusion imaging: obtain the left ventricular short axis images with FIESTAsequence,perfuse scan with Gradient echo EPI sequence.After inject GD-DTPA through the cubitalvein (injection rate4ml/s, the total0.2mmol/kg),instantly cardiac short-axis imaging scan, slicethickness is8mm,each scan include5layer,continuous imaging of50phases that include the firstearly,early,middle,late,and post late period.3:Delayed enhancement scan:reverse fast gradient echosequence,re-injection of contrast agent5-10ml,delay5-10min,followed imaging of the leftventricular short axis,vertical long axis,parallel to the long axis with FGR sequence.Results The two examination were successfully conducted in all patients. Echocardiographydetected wall motion abnormalities in six cases, MRI detected in seven cases, two check were allpositive in five cases, seven cases were all negative, ultrasound positive and magnetic resonancenegative is in three cases, magnetic resonance positive and ultrasound negative is in one case. Two methods in detection of wall motion abnormalities was no significant difference. MRI first passperfusion imaging shows Myocardial signal reduced a total of11cases, pure myocardialendocardial ischemia in five cases,with myocardial infarction in six cases. Delayed enhancementin eight cases, of which only transmural enhancement of three cases,a simple non-transmuralenhancement three cases, Two cases show enhanced range is less than half of Myocardialfull-thickness, one case show enhanced range is more than half of Myocardial full-thickness,hybrid in two cases. Two cases show normal in perfusion imaging,but in delayed scanning imagingmyocardial shows signal enhancement. MRI examination is superior to conventionalechocardiography in the detection of ischemia and infarction paragraph section number, the twomethods was no statistical difference in the LV, IVS, LA measured values..Conclusion Echocardiography can judge the myocardial injury and the nature through theevaluation of abnormal myocardial segments the contractile function indirectly.but can not detectthe transmural extent of myocardial ischemia and infarction. Cardiac MRI can detect the viablemyocardium,delineate the location and the degree of myocardic necorosis,and demonstrate thewall motion of left ventricle. Combination of both methods can assess the myocardial viabilityaccurately, and provide an objective basis for clinical diagnosis, treatment and efficacy evaluation.