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目的 评价MR肺灌注成像(MRPP)对肺动脉栓塞治疗疗效的可行性及在随访中的作用.方法 60例可疑肺栓塞患者,将MRPP作为常规检查,其中27例同时进行了放射性核素肺通气-灌注显像扫描.将放射性核素肺通气-灌注显像与MRPP进行一致性检验,验证MRPP诊断肺栓塞的可行性.所有患者中有22例抗凝或溶栓治疗后3 d至1个月内进行了MRPP复查,通过分析治疗前后MRPP中肺实质的信号强度变化率(TROS),时间-峰值曲线以及肺动脉主干的相关参数(血流峰值、平均流速、单位时间内流量等),对MR增强肺灌注成像在肺动脉栓塞治疗疗效评价方面的可行性及准确性进行评估.获得的数据采用t检验、秩和检验进行统计学分析.结果 MRPP与放射性核素肺通气-灌注显像具有很好的一致性(以患者为研究对象时Kappa值为0.705,而肺叶、段及亚段的一致性分别为0.7632、0.8280、0.7344).两种方法比较,治疗前后MRPP肺实质强化率分别为(2.86±2.48)和(6.72±2.54)倍(t=3.370,P＜0.01),峰值时间分别为(13.98±5.60)和(12.33±3.63)s(t=3.930,P＜0.01),肺动脉干血流峰值分别为(60.39±15.17)和(69.93±13.22)cm/s(t=2.930,P=0.01),平均流速分别为(11.68±5.46)和(13.54±4.18)cm/s(t=2.380,P＜0.05),差异均有统计学意义,而单位时间内的流量分别为(80.57±24.87)和(85.48±11.81)ml/s,差异无统计学意义(t=0.860,P＞0.05).结论 MRPP与放射性核素肺通气-灌注显像具有很好的一致性.MRPP具有更高的空间分辨率和时间分辨率,并能够对肺血流进行半定量分析.对肺栓塞的诊断和治疗后的评估具有重要的临床意义.

Objective To investigate the feasibility and accuracy of enhanced magnetic resonance pulmonary perfusion imaging(MRPP) in the diagnosis and follow-up of pulmonary embolism(PE). Methods Sixty patients suspected of PE underwent MRPP. Twenty-seven patients also underwent radionuclide perfusion imaging. 22 patients repeated MRPP examination after 3 day to 1 month anticoagulation or thrombolytic therapy. The feasibility and accuracy of MRPP in the diagnosis and follow-up of PE were evaluated according to the transformation rate of signal (TROS), time-signal curve and some parameters of main pulmonary artery(such as peak value of flow,mean flow velocity and flow rate). The t test and rank sum test were used for the statistics. Results MRPP showed a high agreement with radionuclide perfusion imaging. TROS was (2. 86 ± 2. 48 ) vs ( 6. 72 ± 2. 54) ( t = 3. 370, P ＜ 0. 01 ), the peak time was ( 13.98 ±5.60) vs ( 12. 33 ± 3.63 ) s ( t = 3. 930, P ＜ 0. 01 ), the peak value of main pulmonary blood flow was (60.39 ± 15. 17) vs (69.93±13.22) cm/s(t=2.930, P＜0. 01) and mean flow velocity (11.68±5.46) vs ( 13.54 ± 4. 18 ) cm/s ( t = 2. 380, P ＜ 0. 05 ) before and after anticoagulation or thrombolytic therapy. The flow rate per unit was (80. 57 ± 24. 87) vs ( 85.48 ± 11.81 ) ml/s ( t = 0. 86,P ＞ 0. 05 ) . Conclusion MRPP shows a high agreement with radionuclide perfusion imaging and is a useful method for the diagnosis and follow-up of PE.