心臓MRI検査の必要性
Contents
1. MRI 7 750 000 MRI T whole heart LGE KI LGE matrix LGE partial volume effect BEN siice e 6 50 CAG LAD 6 1002. CMR 2008 4 4 SPECT 64 x 64 128 x 128 MRI perfusion image 5 128 x 96 3 0 1 5 MRI perfusion image LGE slice slice LGE partial volume effect parallel imaging perfusion image CMR CMR
3. BREEDER A EDIR L MRI TIWI T2WI T2 WL PDWI diffusion WI steady state free precession SSFP CMR TIWI late gadolinium enhancement LGE vessel wall imaging VWI quantitative flow image T2WI VWI T2 microvascular obstruction MO T1WI perfusion image balanced TFE Philips SSEP cine MRI whole heart coronary MRA WHC MRA tagging image 1
4. T2WI STIR black blood T2WI T wash out LGE T2 WI black blood T2 WI B TEB cine MRI WHC MRA CMR 2 survey transverse line 2 2
5. 2 2 line N 2 OO LE HR LAZO BR e SAlineD 2 2 2 FERRA OR Hine 2 2 2 L line L 2 line 2 TOER A 3 3 ARE CMRO 32 AAA e a a a Y e A A T 1
6. CAG WHC MRA volume rendering threshold HEEE maximum intensity projection MIP slab real time sliding MIP 12 WHC MRA MIP LAD 6 JEDES NTA T1WI SPIR black blood MRI 39 To A A A A a A A A A A e T A a E a gt ii w E Em E E Eh e iE pe E i e a a FL r AA i e ao e rE i Cal serlo e a e A A AA E a e a ae Ts Bo i e e a E AR y a TG a a AA q e r 4 E ir ma p A Te a z E m
7. T2 WI black bed T2WI STIR black blood o 2 LGE or a MO D T2 WI MO LGE BIE LAO ENE MO L cine MRI 8 9 60 CAGE LAD 7 100 LCX 13 90 dual SPECT I BMIPP 7 Versus A e A a e a a a e a a m E a T a A a SSA post PCI TI CL On CMR LGE Wh BD DAL SPECT 5110 11 LAD 412 HEBREO DECO A WHC MRA
8. E 7 a dis Le Versus vssel wall image gt CMR MRI CMR LT CMR 1 Rogers WJ Jr Kramer CM Geskin G et al Early contrast enhanced MRI predicts late functional recovery after rep erfused myocardial infarction Circulation 99 744 750 1999 2 Ishida N Sakuma H Motoyasu M et al Noninfarct myo cardium correlation between dynamic first pass contrast enhanced myocarial MR imaging and quantitative coronary angiography Radiology 229 1 209 216 2003 3 Wagner A Mahrhold H Holly TA et al Contrast en hanced MRI and routine single photon emission computed tomography SPECT perfusion imaging for detection of subendocardial myocardial infarcts an imaging study Lan cet 361 374 379 2003 4 Kitagawa K Sakuma H Hirano T et al Acute myocardial infarction myocardial
9. 25 MRI sensitivity specificity MRI SPECT LGBE 35 I 7 Versus UA y A a T A A A e a E A a sa r a i s a A a an E T Te m L 5 a AA pr ee B Sgr A e a PP ia e pi e e e E H qa AA A e jm m moa ae c am n GAE A e A E a LaF mel a i a a 5 E a E 7 n Wal a a ap z p e 3 EE gt Ea e qe a AA pa mE jm mm E a mk a E m km E a A j m a m A tm A Ra m a i a F s di a E A a b E A _ ER E i z e xr E gt a P A A a i Bae ia dt a a i Aa ls gs a Me 2 E a a e A a Bag AA a E i e E e a nu t E y mr pm a A gt we Ti m a a A Jr Fm T y P I TE i MRI 5 128 x 96 1 5T stress perfusion 256x208 3 0T 208 x 192 1
10. CMR one stop shop perfusion image cine MRI LGE WHC MRA 1 30 CORR CT CT CT WHC MRA LGE AMI T2WI STIR black blood T2 WI black blood cine MRI perfusion rest LGB OMI AMI routine T2 WI black blood 33 Em a r S a TTP de E A a E E A a SA A T A AS pr Ja A 5 mi r E PA a e e E H PERA AA Mi n a MAA AZ A a EH 3 AN a mm pu W da Ie A jm m gt e E z ppe gt yj j a mr a A E gt a i a FT pi _ i B i ea e ma mr Psi 2 Ya T2WI STIR bl
11. A A A A A A O a ATA Versus _ l MRI IMPAR FS Perfusion MRI MRI cardiovascular magnetic resonance CMR CMR Versus CMR CMR CMR
12. navi e E 5 Er i A A A A E a E ll z m Cas ser Mi j z i Gan m A a m E a E aA a a un P mk a E m a ka E a La i vm re E mi mE i E E 7 E 2 E e E SS E _ Bi a Y A Bi a a En T Eag m E m ae nd E 3 7 gator echo DO 57 by navigator echo RF pulse gating window accept data L gating win dow vector VCG VCG 4 retrospective prospectiv
13. O CMR SPECT Q CMR SPECT CMR CMR perfusion imaging PCI AMI rest perfusion stress perfusion sensitivity MRI 94 SPECT 82 T SPECT stress perfusion LGB SPECT CATE RORE E JE 76 100 MRI SPECT
14. 9 WHC MRA LAD 6 0 37 B i a F mi i rest perfusion y y de j i i L D A T f w PCI 2day dual SPECT 7 LAD 6100 PCI SPECT CMR PCI 6days 3 0T PCI 3months 1 5T 8 LAD 6 100 AMI 1 5T 3 0T CMR 38 A A a a E J a AAA a ar o gr a T a e E ls Ea a E a a AI a z rr p s ER eS kai ae A E ar a a E r A A ar E y gF ar a p E AS z a EA E i i Ar E amy a in am a p a el mm A A al A Pora tr A a m I 9 LAD 7 100 LCX 413 90 AMI 2 L BMIPP TI1 CL dual HH PP LAD RI viability CMR Trest perfusion T2WI STIR black blood P
15. a pt el mi de m E rm Lo a A A a e pF A A e HE ga a E u iim m r nio m a E a s j a gt i z a A e A A A O A ma A A DAA a a a J r n e i m E F y na t i 5 An PF A ME eS ya e s ae T a A T Rs E F ms ee ml F A a mmm J En 1 ae r m Eim a aE le e A r ye z O my WW 66 4 39 al gt ersus E B i 1 7 V i a z F p E m z t gt a a E o e a Ar ma o sm e a E p E al pm RE a A a a E a a Ce b m Ci jo a E e d TN r a AAA a a post PCI A E inversion recovery thin slice LGE inversion time null 0 WHC MRA fusion
16. a 7 a pa ji a i z Bem am A E i e I ai m a m i E e y E E i m A ee i m meg pe 3 F i a r E Fat my i ee a A z i a A i a Bpm gs i a E A a Mi g i a a mr a a ma mm ee T A ma E B J e a A STRESS FBP 6 AID ILBMIPP REST_FBP PCI 2day dual SPECT 10 LAD 7 100 LCX 13 90 PCI SPECT CMR 11 CAG WHC MRA volume rendering n a r E E ii TA E a a a a JP a a A E a E a a pa mi gt SmE z T u e li a r m a a m a A PE A a Pa Tie m i r Ez T i hm E z ya e r A dl zi z z a mE E um Za dl r a T Y 0 2 mm 1 mE 12 vessel wall image IVUS X El CT one stop shop ss MRI E
17. viability assessment in patients early thereafter comparison of contrast enhanced MR imaging with resting 201 TI SPECT Single photon emission com puted tomography Radiology 226 138 144 2003 5 Kim RJ Wu E Rafael A et al The use of contrast en hanced magnetic resonance imaging to identify reversible myocardial dysfunction N Engl J Med 343 20 1445 1453 2000 6 Kim RJ Fleno DS Parrish TB et al Relationship of MRI delayed contrast enhancement to irreversible injury infarct age and contractile function Circulation 100 1992 2002 1999 41
18. 5T Tc99m TF stress 5 288 x 256 1 5T LGE 15 min 352x336 3 0T 320 x 256 1 5T Tc99m TF rest Navigator Display WHCAJNAVI navigator x E 15 EA gating window y MUA EN Ls a i E E pem E sampling data HE m ho a Magrerohydrod mane a 1 Anila y Laad mv u Lead mA 5 navigator echo VCG 36 pre PCI 6 LAD 6 100 AMI S0 25 Y LGE PCI percutaneous coronary intervention LGE ZE rea AA r n D i a TN AP A a um AS E A Y e e e PU a ie A E e A a N a E a T i
19. ack blood cine MRI perfusion LGB 10 LGE 30 CMR CMR navigator echo navigator echo 5 MRI MRI 5 navigator echo
20. e trigger E 72 MRI trade off data sampling msec msec WHC MRA MRI 34 i Y nn nm E Ti e al T P pim a T m B E 3 CMR 3 MRI A TRBUIIDA RN
21. i r AA AN AAA E a a MA AAA A A A a nn le jar Ar A N jaiii A A a mk m a g de mh E g PL ba T lt Eu mm a ai mia ba e gt PL r pn i PH r 3 a e a a I a o ig cc y A er E a e s e a e La A e A a a i a a A T E APA E de e e Ln mr Fm E Er e Ta e SR i a ol LS p il i m da a Ln n L T A A C E nit mi ad Za a ME e _ Si Sile zi A ae ar gt gt Er A ps ee x Pa a AS rs po 5 gt mn a a A aa _ E T T zi ar a a dl a i y a E p E pm r i gt y A A a a ae q a n n a E qim a T E i a rM 8 al E Aa m r ba r e PE ee Ea P z Tj an EE an Bi T2WI STIR black blood LGE T2 WI black blood MRCA 1 CMR
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