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Rofo 2002; 174(2): 187-195
DOI: 10.1055/s-2002-20109
Herz
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Bestimmung der myokardialen Perfusionsreserve bei KHK-Patienten mit der kontrastmittelverstärkten MRT: Ein Vergleich zwischen semiquantitativer
und quantitativer Auswertung

Evaluation of myocardial perfusion reserve in patients with CAD using
Contrast-Enhanced MRI: A comparison between semiquantitative and
quantitative methodsM.  Schmitt1 , O.  K.  Mohrs1 , S.  E.  Petersen2 , K.-F.  Kreitner1 , T.  Voigtländer2 , T.  Wittlinger2 , G.  Horstick2 , S.  Ziegler2 , J.  Meyer2 , M.  Thelen1 , W.  G.  Schreiber1
  • 1Klinik und Poliklinik für Radiologie, Johannes Gutenberg-Universität, Mainz
  • 22. Medizinische Klinik und Poliklinik, Johannes Gutenberg-Universität, Mainz
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Publication History

Publication Date:
13 February 2002 (online)

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Zusammenfassung

Ziel: Vergleich zweier semiquantitativer Methoden und einer quantiativen Methode zur Bestimmung des myokardialen Blutflusses (MBF) und der myokardialen Perfusionsreserve (MPR) bei KHK-Patienten. Material und Methoden: Es wurden 9 Patienten mit Stenosen > 50 % mit einer EKG-getriggerten Saturation Recovery TurboFLASH Sequenz mit Gd-DTPA als Kontrastmittel (KM) untersucht. Die Messungen wurden sowohl unter Ruhebedingungen als auch unter pharmakologischer Belastung durch Adenosin durchgeführt. Die Steigungen der First-Pass-Kurven im Myokard und im linken Ventrikel (LV) wurden aus der mathematischen Anpassung einer Geraden bestimmt. Die MPR wurde aus den ursprünglichen Steigungen der myokardialen First-Pass-Kurven sowie aus den auf die Steigungen der LV First-Pass-Kurven normierten Steigungen berechnet. Für die Quantifizierung des MBF wurde das physiologische Modell MMID 4 verwendet. Ergebnisse: Die MPR war bei allen drei Methoden in den hochgradig ischämischen Myokardregionen (Stenosen ≥ 70 %) vermindert. Der Unterschied war mit der normalisierten Steigungsmethode und der Absolutquantifizierung signifikant. Schlussfolgerungen: Die normalisierte Steigungsmethode und die Quantifizierung sind sensitivere Methoden zur Differenzierung zwischen nicht-ischämischen und ischämischen Regionen als die nicht normalisierte Steigungsmethode.

Abstract

Objective: Comparison between two semiquantitative methods and a quantitative evaluation of myocardial blood flow (MBF) for assessment of myocardial perfusion reserve (MPR) in patients with CAD. Material and Methods: 9 patients with coronary stenoses > 50 % were examined with an ECG-gated Saturation Recovery Turbo FLASH sequence by using Gd-DTPA as contrast agent (CA). The entive measurements were performed both during rest and hyperemia induced by adenosine. The up-slopes of the signal-time S(t) curves in the myocardium and left ventricular (LV) cavity were evaluated by a linear fit. MPR was calculated from the original up-slopes of the myocardial S(t) curves and from the up-slopes, which were normalized to the up-slopes of the LV S(t) curves, respectively. For quantification of MBF values, the mathematical model MMID 4 was used and MPR was evaluated from the MBF values. Results: With all tested methods, MPR was reduced in myocardial regions subtended by arteries with stenoses ≥ 70 % compared with remote regions. With MMID 4 and the normalized up-slope method, differences between severe ischemic and remote regions were statistically significant. Conclusion: The up-slope method with normalization and quantification with MMID 4 are more sensitive methods to differentiate between remote and ischemic myocardium than the up-slope method without normalization.

Schlüsselwörter

Myokardperfusion - Magnet-Resonanz-Tomographie - KHK - Quantifizierung

Key words

Perfusion - Myocardium - Magnetic Resonance Imaging - CAD - Quantification

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Dipl.-Phys. Melanie Schmitt

Klinik und Poliklinik für Radiologie
Johannes Gutenberg-Universität

Langenbeckstr. 1

55131 Mainz

Phone: 06131/17-6882

Fax: 06131/17-475285

Email: schmitt@radiologie.klinik.uni-mainz.de