中华小型猪心肌循环障碍综合影像学研究

【作者】 唐翔；

【导师】 吕滨； 蒋世良； 徐仲英；

【作者基本信息】 中国协和医科大学 ， 影像医学与核医学， 2009， 硕士

【摘要】 第一部分中华小型猪急性心肌缺血的综合影像学研究目的研究多层螺旋CT(Multi-Detector Row Computed Tomography,MDCT),磁共振(Magnetic Resonance Imaging,MRI),核素显像(Single Photon Emission ComputedTomography,SPECT)对中华小型实验猪急性心肌缺血模型的显示效果。材料与方法中华小型猪共6只,体重(21.6±1.2)kg,全部为雄性。所有实验猪接受MDCT扫描1次后结扎前降支中远段,在结扎后2h、4h、6h、8h内,每2h MDCT扫描1次。术后24h内进行MRI,SPECT及再次完成MDCT扫描各1次,最后处死动物病理检查。结果1只死于室颤,5只有结果。病理显示5只实验猪的心肌梗死大致范围为心尖部、左室前壁及室间隔,梗死主要为透壁心肌梗死。5只实验猪术后24hSPECT显示的灌注减低区域与病理染色梗死位置一致。术后24hMRI显示的首过灌注减低区域与病理染色梗死位置一致,4只猪延迟扫描出现灌注持续减低区域边缘的透壁延迟增强。术后2h、4h、6h、8h及术后24h的MDCT扫描动脉期减低区域与病理染色梗死位置一致,其中3只实验猪在4h～8h的扫描中出现了动脉期减低区域边缘的延迟强化,5只实验猪在术后24h均未出现延迟强化。术前至术后2h、4h、6h、8h及24h的动脉期减低区域的CT值均值依次为75.91HU、36.43HU、35.21HU、37.80HU、37.39HU、33.32HU,动脉期正常区域CT值依次为84.16HU、89.78HU、93.23HU、90.77HU、89.30HU、89.40HU。在p=0.05水平,重复测量资料的方差分析显示,随时间变化,灌注减低区域与灌注正常区域的心肌动脉期CT值有统计学差异(F=8.221,p＜0.001)。在p=0.05水平,使用单因素方差分析(One-Way ANOVA)显示,灌注减低区域CT值随时间变化不完全相同(F=33.649,p＜0.001),2h、4h、6h、8h及24h的动脉期CT值没有差别(p=0.792),术前的CT值与上述各时间段均有差别(p＜0.001)。术前、术后2h、4h、6h、8h的每搏输出量(Stroke Volume,SV)平均容积依次为21.7ml、11.9ml、10.3ml、11.4ml、12.3ml、12.6ml(F=22.349,p＜0.001);收缩末期(End-Systolic Volume,ESV)平均容积15.2ml、23.4ml、25.0ml、24.4ml、25.3ml、22.8ml(F=8.810,p＜0.001);舒张末期(End-Diastolic Volume,EDV)平均容积依次为37ml、35.4ml、35.0ml、35.7ml、37.6ml、37.5ml(F=2.339,p=0.079);射血分数(Ejection Fraction,EF)平均依次为58.9%、33.8%、29.0%、31.9%、32.6%、33.5%(F=27.240,p＜0.001)。EF、EDV变化没有统计学差异。SV、ESV变化有统计学差异。术后24hMRI心功能参数均值:SV9.8ml、ESV21.5ml、EDV22.8ml、EF33.8%。在p=0.05水平,术后24hMRI与MDCT心功能参数的配对t检验显示:SV(t=-2.474,p=0.069),ESV(t=-0.258,p=0.809),EDV(t=-1.379,p=0.240),EF(t=0.056,p=0.958),均没有统计学差异。5只实验猪测得的梗死面积占所测层面整个心肌比例分别为TTC:37.1%、58.7%、31.3%、26.8%、25.6%;MDCT:24.2%、63.3%、34.3%、47.0%、28.0%:MRI:38.2%、61.2%、32.6%、25.3%、21.5%。在p=0.05水平,配对t检验显示:TTC与MDCT(t=0.612,p=0.574),TTC与MRI(t=0.820,p=0.458),MDCT与MRI间(t=0.425,p=0.692)差别均没有统计学差异。结论MDCT动脉期、MRI首过灌注、SPECT均显示了急性心肌缺血后心尖部心肌灌注减低,与病理染色缺血部位一致。MDCT动脉期与MRI首过灌注显示的低灌注面积与病理染色梗死面积有很好地相关性。急性心肌缺血后8h内缺血心肌密度没有随时间变化,心功能没有随时间变化。第二部分中华小型猪慢性心肌缺血的综合影像学研究目的研究多层螺旋CT(Multi-Detector Row Computed Tomography,MDCT),磁共振(Magnetic Resonance Imaging,MRI),核素显像(Single Photon Emission ComputedTomography,SPECT)对中华小型猪慢性心肌缺血模型的显示效果。材料与方法中华小型猪共6只,全部为雄性,体重(22.7±1.4)kg.所有实验猪接受MDCT扫描1次后,在前降支近段放置Ameroid缩窄环,当日进行MDCT、MRI、SPECT。术后27d再次行核素显像,28d完成造影、MDCT、MRI,最后处死动物病理检查。结果2只实验猪饲养中死于心衰,4只有结果。病理显示3只实验猪有心内膜下梗死,1只无明显梗死。造影显示有梗死的3只实验猪前降支局限性狭窄程度均高于50%。MDCT显示了3只实验猪存在左室前壁动脉期灌注减低,均无延迟强化;MRI显示1只没有首过灌注减低或延迟强化,2只实验猪有左室前壁心内膜下首过灌注减低但无延迟强化,1只实验猪左室前壁心内膜下既有首过灌注减低又有延迟强化。SPECT在3只实验猪显示了左室前壁灌注减低,1只实验猪无灌注减低。MDCT显示3只实验猪冠状动脉前降支局限性50%以上狭窄,1只实验猪狭窄程度不足50%;3只实验猪有左室前壁动脉期低灌注区,均没有出现延迟强化。MDCT显示的术前、术后当日、术后28d心功能及SNK检验分别为:每搏输出量(Stroke Volume,SV)平均容积依次为20.5ml、22ml、15.2ml(F=3.330,p=0.106);收缩末期(End-SystolicVolume,ESV)平均容积15ml、17.2ml、26.2ml(F=10.820,p=0.010);舒张末期(End-Diastolic Volume,EDV)平均容积依次为38ml、39.2ml、41.4ml(F=1.132,p=0.383);射血分数(Eiection Fraction,EF)平均百分数依次为54.4%、53.1%、36.7%(p=2.802,F=0.138)。ESV的增加有统计学差异,其他参数均无统计学差异。MRI显示的术后当日、术后28d心功能与配对t检验分别为:SV平均容积依次为11.8ml、11.1ml(t=0.161,p=0.883);ESV平均容积13ml、27.3ml(t=-3.146,p=0.051);EDV平均容积依次为24.7ml、38.2ml(t=-19.817,p＜0.001);EF平均百分数依次为47.9%、30.2%(t=1.693,p=0.189)。EDV的增加有统计学差异,其他参数均无统计学差异。将MDCT与MRI心功能进行配对t检验,在p=0.05水平显示:SV(t=4.054,p=0.005),ESV(t=0.665,p=0.527),EDV(t=2.680,p＜0.032),EF(t=1.791,p=0.116)。MDCT的SV、EDV均高于MRI,但二者ESV与EF无统计学差异。在p=0.05水平,使用SNK检验分析CT值变化。术前、术后当日、术后28d左室前壁动脉期CT均值分别为75.60HU、80.66HU、46.73HU(F=10.274,p=0.011);室间隔CT均值分别为78.53HU、82.85HU、82.12HU(F=1.020,p=0.339);左室侧壁CT均值分别为73.34HU、76.92HU、67.08HU(F=4.233,p=0.070)。左室前壁的CT值有统计学差异。结论前降支局限性狭窄50%以上的实验猪,MDCT动脉期、MRI首过灌注、SPECT均显示了左室前壁灌注减低。MDCT、MRI分别显示了慢性心肌缺血ESV、EDV的增加有统计学差异。心肌慢性缺血的左室前壁动脉期CT值较未缺血时减低。第三部分中华小型实验猪心肌微循环障碍的综合影像学研究目的研究多层螺旋CT(Multi-Detector Row Computed Tomography,MDCT),磁共振(Magnetic Resonance Imaging,MRI),核素显像(Single Photon Emission ComputedTomography,SPECT)对中华小型猪微循环障碍的显示效果。材料与方法中华小型猪8只,全部为雄性,体重(22.8±0.9)kg。所有实验猪MDCT扫描1次后1周内于前降支中远段注射10~5直径约100μm微球,术后27d行SPECT,28d行造影,MDCT,MRI各1次,最后处死动物病理检查。结果3只实验猪死于室颤,1只实验猪因心衰死于饲养过程中,4只实验猪完成所有检查。病理大体染色未见梗死,模型的微循环障碍均为少量心肌的微循环障碍。在p=0.05水平使用配对t检验分析MDCT心功能变化,MDCT术前与术后28d的每搏输出量(Stroke Volume,SV)平均量分别为17.5ml、17.9ml(t=-0.329,p=0.746),二者无统计学差异;收缩末期容积(End-Systolic Volume,ESV)平均容积分别为16.4ml、16.8ml(t=-0.577,p=0.604),二者无统计学差异;舒张末期容积(End-DiastolicVolume,EDV)平均容积分别为33.9ml、34.9ml异(t=-1.190,p=0.320),二者无统计学差;射血分数(Ejection Fraction,EF)平均分别为51.8%、54.2%(t=-1.736,p=0.181),二者无统计学差异。术后28d的MRI心功能平均值分别为SV 14.8ml、ESV 15.5ml、EDV 30.6ml、EF 48.6%。在p=0.05水平,术后28d的MDCT心功能参数与MRI心功能参数进行配对t检验,SV(t=1.058,p=0.368);ESV(t=0.548,p=0.622);EDV(t=1.928,p=0.149);EF(t=1.513,p=0.227),均无统计学差异。在p=0.05水平,使用配对t检验分析MDCT的CT值变化。MDCT扫描左室前壁动脉期平均CT值术前术后分别为73.34HU、69.06HU(t=0.937,p=0.418),延迟1min注平均CT值术前术后分别为66.08HU、52.37HU(t=1.425,p=0.249),3min注平均CT值术前术后分别为73.34HU、69.06HU(t=0.937,p=0.418),5min注平均CT值术前术后分别为60.07HU、48.52HU(t=1.290,p=0.288),10min注平均CT值术前术后分别为54.00HU、55.96HU(t=2.313,p=0.314),均没有统计学差异。室间隔动脉期平均CT值术前术后分别为71.64HU、72.85HU(t=1.546,p=0.220),延迟1min注平均CT值术前术后分别为61.94HU、67.1HU(t=2.421,p=0.094),3min注平均CT值术前术后分别为68.52HU、53.17HU(t=0.069,p=0.950),5min注平均CT值术前术后分别为60.37HU、49.55HU(t=2.292,p=0.106),10min注平均CT值术前术后分别为46.84HU、46.26HU(t=0.125,p=0.909),均没有统计学差异。左室侧壁动脉期平均CT值术前术后分别为76.75HU、79.51HU(t=-0.812,p=0.735),延迟1min注平均CT值术前术后分别为71.36HU、77.56HU(t=2.421,p=0.476),3min注平均CT值术前术后分别为65.50HU、60.78HU(t=0.569,p=0.609),5min注平均CT值术前术后分别为54.41HU、54.35HU(t=0.013,p=0.991),10min注平均CT值术前术后分别为54.50HU、56.52HU(t=-0.327,p=0.765),均没有统计学差异。左室前壁、室间隔、左室侧壁在MDCT动脉期均没有异常灌注减低区域,延迟扫描也未出现强化;MRI均没有异常灌注减低区域,延迟扫描也未出现强化;SPECT均没有出现灌注减低区域。结论MDCT、MRI、SPECT对于没有明显病理染色梗死区域与心功能变化的微循环障碍显示是受限的。更多还原

【Abstract】 The First Part:Integrated imaging study of acute myocardial ischemia in Chinese mini-swine modelObjective To study the Multi-Detector Row Computed Tomography（MDCT）, Magnetic Resonance Imaging（MRI） and Single Photon Emission Computed Tomography（SPECT） detected acute myocardial ischemia in Chinese mini-swine model.Materials and Methods A total of six mini-pigs,body weight（21.6±1.2） kg,all male.MDCT scaned the pig first.Then distal segment of Left Anterior Descending Artery was ligated.In the 2h～8h after ligation,MDCT scan was given every 2h.MRI, SPECT and the last MDCT scan were given within 24 hours one after another.Finally pathological examination was given after pig got killed.Results One died of ventricular fibrillation,5 had the results.Pathological examination showed that myocardial infarction in 5 pigs generally range from apical,anterior and septal of left ventricular.Infarction model are transmural myocardial infarction most.Reduce perfusion regions of SPECT showed same location of infarct regions with pathology.Reduced first-pass perfusion regions in MRI showed same location of infarct regions with pathology.Delayed scanning of MRI did not show significantly delayed enhancement.Reduced first-pass perfusion regions in MDCT scan of 2h,4h,6h,8h and 24h all showed same location of infarct regions with pathology.Three pigs in the 4h～8h scan showed strengthened the edge of reduced perfusion regions in delayed scan.All 5 pigs showed no delayed enhancement at 24h scan.Mean value of the reduced first-pass perfusion region from preoperative to postoperative 2h～8h and 24h MDCT scan was followed bythe 75.91HU,36.43HU,35.21HU,37.8HU,37.39HU,33.32HU. Mean value of the normal first-pass perfusion region from preoperative to postoperative 2h～8h and 24h MDCT scan was followed by the values 84.16HU,89.78HU, 93.23HU,90.77HU,89.3HU,89.4HU.At p=0.05 level,repeated measures analysis of variance showed that over the time,first-pass perfusion CT values of reduced perfusion regions and normal perfusion regions are significantly different（F=8.221,p＜0.001）.At p=0.05 level,one-way ANOVA analysis showed that the value of the reduced first-pass perfusion region is not exactly the same over time（F=33.649,p＜0.001）,2h～8h and 24h had no difference between each other（p=0.792）,the value of preoperative MDCT scan was different（p＜0.001）.Preoperative and postoperative 2h～8h,24h average volume of SV（Stroke Volume） were 21.7ml, 11.9ml,10.3ml,11.4ml,12.3ml,12.6ml,respectively.Preoperative and postoperative 2h～8h,24h average volume of ESV（End-Systolic Volume） were 15.2ml,23.4ml,25.0ml,24.4ml,25.3ml,22.8ml,respectively.Preoperative and postoperative 2h～8h,24h average volume of EDV（End-Diastolic Volume） were 37ml,35.4ml,35.0ml,35.7ml,37.6ml,37.5mll,respectively.Peoperative and postoperative 2h～8h,24h average percentage of ejection fraction（Ejection FFraction EF） were 58.9%,33.8%,29.0%,31.9%,32.6%,33.5%.,respectively.EF（F =27.240,p＜0.001）,EDV（F=2.339,p=0.079） had no statistically significant change.SV（F=22.349,p＜0.001） ESV（F=8.810,p＜0.001） were statistically significant different.The mean parameters of MRI were SV9.8ml,ESV21.5ml, EDV22.8ml,EF33.8%.At p=0.05 level,paired-samples t test showed that SV（t=-2.474,p=0.069）,ESV（t=-0.258,p=0.809）,EDV（t=-1.379,p= 0.240）,EF（t=0.056,p=0.958）,no statistical difference between MRI and MDCT. Myocardial infarction rates of pathology in 5 pigs were 37.10%,58.70%,31.30%, 26.80%,25.60%,respectively.Myocardial infarction rates of MDCT in 5pigs were 24.20%,63.30%,34.30%,47.00%,28.00%,respectively.Myocardial infarction rates of MRI in 5pigs were 38.20%,61.20%,32.60%,25.30%,21.50%, respectively.At p=0.05 level,paired-samples t test showed that no statistical difference between pathology and MDCT（t=0.612,p=0.574）,no statistical difference between pathology and MRI（t=0.820,p=0.458）,no statistical difference between MDCT and MRI（t=0.425,p=0.692）.Conclusions MDCT,MRI and SPECT were all able to show the myocardial infarction in acute myocardial ischemia model well.MDCT,MRI and pathology showed the infarct size well related between each other. The Second Part:Integrated imaging study of chronic myocardial ischemia in Chinese mini-swine modelObjective To study the Multi-Detector Row Computed Tomography（MDCT）, Magnetic Resonance Imaging（MRI） and Single Photon Emission Computed Tomography（SPECT） detected chronic myocardial ischemia in Chinese mini-swine model.Materials and Methods A total of six mini pigs,all male,body weight（22.7±1.4） kg.All pigs accepted MDCT scan first,then an Ameroid narrow ring was placed on Left Anterior Descending Artery within 1 week.MDCT,MRI and SPECT were given on the same day.The other SPECT was given on the 27^th day,then coronary angigraphy,MDCT,MRI were given on the 28^th day.Finally,killed animals and gave pathological examination.Results Two pigs died of heart failure during the process of rearing,4 had the results.Pathology showed 3 pigs had subendocardium infarction,1 had no infarction.Coronary Angiography showed anterior descending artery stenosis were higher than 50%in 3 pigs with infarction.MRI showed no reduced first-pass perfusion or delayed enhancement in 1 pig,reduced first-pass perfusion but no delayed enhancement in 2 pigs,reduced first-pass perfusion and delayed enhancement in 1 pig.SPECT in the 3 pigs showed reduced left ventricular anterior wall perfusion,1 pig had no reduced perfusion.MDCT showed stenosis of left anterior descending coronary arteryin is more than 50%in 3 pigs.Significant reduced first-pass perfusion regions could be seen in 3 pigs,but no delayed enhancement region was seen.Two pigs showed reduced first-pass perfusion regions but no delayed enhancement region.MDCT showed preoperative day,the 1^st postoperative day and the 28^th postoperative day of cardiac function.At p=0.05 level,SNK test were as follows:SV（Stroke Volume,） followed by the average volume of 20.5ml,22ml,15.2ml（F=3.330,p=0.106）;ESV （End-Systolic Volume） followed by the average volume of 15ml,17.2ml,26.2ml （F=10.820,p=0.010）;EDV（End-Diastolic Volume,） followed by the average volume of 38ml,39.2ml,41.4ml（F=1.132,p=0.383）;EF（Ejection FFraction） followed by the average percentage of 54.4%,53.1%,36.7%（p=2.802,F=0.138）. ESV increase was statistically significant,there was no statistical difference in other parameters.MRI showed the 1^st postoperative day and the 28^th postoperative day of cardiac function.At p=0.05 level,the sample-paired t test were as follows:SV followed by the average volume of 11.8ml,11.1ml（t=0.161,p=0.883）;ESV the average volume of 13ml,27.3ml（t=-3.146,p=0.051）;EDV were the average volume of 24.7ml,38.2ml（t=-19.817,p＜0.001）;EF were the average percentage of 47.9%,30.2%（t=1.693,p=0.189）.The increase in EDV was statistically significant,there was no statistical difference in other parameters.MDCT and MRI were compared by sample-paired t test at the level of p=0.05:SV（t=4.054,p= 0.005）,ESV（t=0.665,p=0.527）,EDV（t=2.680,p＜0.032）,EF （t=1.791,p=0.116）.MDCT of the SV,EDV were higher than MRI,but both ESV and EF was no statistical difference.At p=0.05 level,using the SNK test to analyze the changes of mean first-pass perfusion CT value on preoperative day,the 1^st postoperative day and the 28^th postoperative day.Mean ventricular anterior wall value were 75.6HU,80.66HU,46.73HU（F=10.274,p=0.011）;mean septal mean CT were 78.53HU,82.85HU,82.12HU（F=1.020,p=0.339）;mean left ventricular wall CT mean,respectively 73.34HU,76.92HU,67.08 HU（F=4.233, p=0.070）.CT value of Left ventricular anterior wall were statistical difference.Conclusions MDCT,MRI and SPECT could show the region of chronic myocardial ischemia.They were all limited to show little subendocardium infarction. The Third Part:Integrated imaging study of myocardial microcirculation disturbance in Chinese mini-swine modelObjective To study the Multi-Detector Row Computed Tomography（MDCT）, Magnetic Resonance Imaging（MRI） and Single Photon Emission Computed Tomography（SPECT） detected myocardial microcirculation disturbance in Chinese mini-swine model.Materials and Methods Eight Chinese mini pigs,all male,body weight（22.8±0.9） kg.All pigs got MDCT scan first,then 10⁵ microspheres （100μm） were injected in the middle piece of left anterior descending artery in 1 week.SPECT was given 27 days later.Coronary angigraphy,MDCT,MRI were given on the 28^th day.Finally,animals were killed and pathological examination was given. Results Three pigs died of ventricular fibrillation,one pig died due to heart failure in the rearing process,four pigs got all inspections.No pathological staining infarction was found.All models got microcirculation disturbance of little myocardial.Using sample-paired t test to analyse changes in MDCT cardiac function at p=0.05 level.SV （Stroke Volume） of MDCT preoperative and 28th day were the average amount of 17.5ml,17.9ml,no statistical difference between the two（t=-0.329,p=0.746）.The average volume of ESV（End-Systolic Volume） of MDCT preoperative and 28th day were the average amount of 16.4ml,16.8ml,no statistical difference between the two （t=-0.577,p=0.604）.EDV（End-Diastolic Volume） of MDCT preoperative and 28th day were the average amount of 33.9ml,34.9ml,no statistical difference between the two（t=-1.190,p=0.320）.EF（Ejection Fraction） of MDCT preoperative and 28th day were the average amount of 51.8%,54.2%,no statistical difference between the two（t=-1.736,p=0.181）.The average amount of SV of MRI on the 28^th day was 14.8ml,The average amount of ESV of MRI on the 28^th day was 15.5ml,The average amount of EDV of MRI on the 28^th day was 30.6ml,The average amount of EF of MRI on the 28^th day was 48.6%.At p=0.05,comparing MDCT and MRI parameters of cardiac function by sample-paired t test.SV（t=1.058,p=0.368）,ESV（t=0.548, p=0.622）,EDV（t=1.928,p=0.149）,EF（t=1.513,p=0.227）,there were no statistical difference.At p=0.05 to analyse the CT value changes of MDCTin the use of sample-paired t test.MDCT scan of left ventricular anterior wall first-pass perfusion CT values of the average before and after operation were 73.34HU,69.06HU （t=0.937,p=0.418）,delayed 1min note the value of the average preoperative and postoperative CT were 66.08HU,52.37HU（t=1.425,p=0.249）,3min note the average value of preoperative and postoperative CT were 73.34HU,69.06HU（t= 0.937,p=0.418）,5min note the average value of preoperative and postoperative CT were 60.07HU,48.52HU（t=1.290,p=0.288）,10min note the average preoperative and postoperative CT values were 54.00HU,55.96HU（t=2.313,p= 0.314）,no statistical difference were found.Ventricular septal average first-pass perfusion CT values of preoperative and postoperative 71.64HU,72.85HU（t=1.546, p=0.220）,delayed injection 1min average preoperative and postoperative CT values were 61.94HU,67.1HU（t=2.421,p=0.094）,3min note the average value of preoperative and postoperative CT were 68.52HU,53.17HU（t=0.069,p=0.950）, 5min note the average value of preoperative and postoperative CT were 60.37HU, 49.55HU（t=2.292,p=0.106）,10min note the average preoperative and postoperative CT values were 46.84HU,46.26HU（t=0.125,p=0.909）,no statistical difference were found.Left ventricular wall first-pass perfusion CT values of the average before and after operation were 76.75HU,79.51HU（t=-0.812,p= 0.735）,delayed lmin Note the value of the average preoperative and postoperative CT were 71.36HU,77.56HU（t=2.421,p=0.476）,3min note the average value of preoperative and postoperative CT were 65.50HU,60.78HU（t=0.569,p=0.609）, 5min note the average value of preoperative and postoperative CT were 54.41HU,54.35 HU（t=0.013,p=0.991）,10min note the average preoperative and postoperative CT values were 54.50HU,56.52HU（t=-0.327,p=0.765）,no statistical difference were found.MDCT showed no reduce the first-pass perfusion region in Left ventricular anterior wall,interventricular septum,left ventricular wall,no delayed enhancement was found either.MRI showed no reduce the first-pass perfusion region in Left ventricular anterior wall,interventricular septum,left ventricular wall,no delayed enhancement was found either.SPECT are not reduce regional perfusion.SPECT showed no reduced perfusion region in Left ventricular anterior wall,interventricular septum, left ventricular wall.Conclusions MDCT,MRI,SPECT detected microcirculation disturbance of little myocardial on Chinese mini-pigs are limited.更多还原