做不做心脏旁路手术？核磁共振增强扫描说了算
http://www.100md.com
2001年1月17日
路透社纽约健康消息 根据最近发表在《新英格兰医学杂志》上的报告，一种独特的影像技术可以准确预测哪些心脏病人最适合做动脉清扫血管成形术或心脏旁路手术。这项技术先给病人注射一种增强的造影剂，然后再做核磁共振(MRI)。它可以有效地预测病人心肌的损害程度，以及动脉清扫或心脏旁路手术能否恢复心肌的血流灌注。
芝加哥伊利诺斯州西北医科大学非音贝格心血管研究所的罗伯特蒙·朱迪博士说，新技术与其他成像技术不同之处是提供了一个可以透视整个心壁的视角，而不是仅仅只能看到心壁的最外面部份。如果在心肌的某个区域见到有增强的或白色的区域，那么即使是旁路手术或者血管成形术，也不能挽救这个区域心肌的功能。事实上这部份区域在手术治疗后得到改善的机会只有2%。
研究人员让50名准备接受心脏旁路手术或动脉清扫血管成形术的病人在术前做这种核磁共振增强扫描。结果发现，图象上显示90%的心肌死亡表明实际上有51%到75%心肌受损，这种病人手术后并不能恢复。血管成形和旁路手术都有一定的风险，因此这种核磁共振技术有助于判断病人是否值得冒险去做手术。
, http://www.100md.com
维吉尼亚大学的乔治亚·贝勒博士认为，在冠心病患者中，心脏某些区域仍有健康心肌组织的病人接受动脉清扫治疗的效果要比心肌组织已经广泛受损的病人要好得多。将来要把研究重点放在检测这种核磁共振增强扫描技术的价值和成本问题。
Who Will Benefit From Heart Bypass? New MRI Can Tell
NEW YORK (Reuters Health) - A specialized imaging technique appears to accurately predict which heart disease patients will benefit the most from artery-clearing angioplasty or a heart bypass operation, researchers report.
In the technique, patients are injected with a contrast-enhancing dye, and then undergo magnetic resonance imaging (MRI). The technique appears to be effective at predicting whether people with heart disease have heart muscle damage that is so severe, they may not benefit from angioplasty or bypass surgery to restore blood flow to the muscle. The report is published in the November 16th issue of The New England Journal of Medicine (news - web sites).
, 百拇医药
In the study, 50 people who were already scheduled to undergo bypass surgery or angioplasty first underwent a contrast-enhanced MRI. The screen was highly accurate at predicting which hearts were too damaged to benefit from treatment. In fact, 90% of heart regions that appeared dead on the MRI--51% to 75% damaged--did not recover after treatment, the report indicates.
Unlike other imaging techniques, this type of MRI provides a view of the entire thickness of the heart wall, not just the outer portions, according to study co-author Dr. Robert M. Judd, of the Feinberg Cardiovascular Research Institute at Northwestern University Medical School in Chicago, Illinois.
, 百拇医药
``If an area of the heart was hyperenhanced or bright, that area would not improve‘‘ after surgery or angioplasty, Judd told Reuters Health. He noted that bright sections had only a 2% chance of improving after such treatments.
Since angioplasty and bypass surgery are not risk-free, the MRI scan may help identify people for whom the risks of treatment outweigh the benefits, Judd explained.
The results of the study demonstrate that people with coronary heart disease who still have substantial areas of healthy heart tissue are much more likely to benefit from artery-clearing treatments than those whose hearts are extensively damaged, according to Dr. George A. Beller, of the University of Virginia Health System in Charlottesville.
In an editorial that accompanies the study, Beller emphasizes the need for future studies to test the value and cost effectiveness of using the contrast-enhanced MRI., 百拇医药
芝加哥伊利诺斯州西北医科大学非音贝格心血管研究所的罗伯特蒙·朱迪博士说，新技术与其他成像技术不同之处是提供了一个可以透视整个心壁的视角，而不是仅仅只能看到心壁的最外面部份。如果在心肌的某个区域见到有增强的或白色的区域，那么即使是旁路手术或者血管成形术，也不能挽救这个区域心肌的功能。事实上这部份区域在手术治疗后得到改善的机会只有2%。
研究人员让50名准备接受心脏旁路手术或动脉清扫血管成形术的病人在术前做这种核磁共振增强扫描。结果发现，图象上显示90%的心肌死亡表明实际上有51%到75%心肌受损，这种病人手术后并不能恢复。血管成形和旁路手术都有一定的风险，因此这种核磁共振技术有助于判断病人是否值得冒险去做手术。
, http://www.100md.com
维吉尼亚大学的乔治亚·贝勒博士认为，在冠心病患者中，心脏某些区域仍有健康心肌组织的病人接受动脉清扫治疗的效果要比心肌组织已经广泛受损的病人要好得多。将来要把研究重点放在检测这种核磁共振增强扫描技术的价值和成本问题。
Who Will Benefit From Heart Bypass? New MRI Can Tell
NEW YORK (Reuters Health) - A specialized imaging technique appears to accurately predict which heart disease patients will benefit the most from artery-clearing angioplasty or a heart bypass operation, researchers report.
In the technique, patients are injected with a contrast-enhancing dye, and then undergo magnetic resonance imaging (MRI). The technique appears to be effective at predicting whether people with heart disease have heart muscle damage that is so severe, they may not benefit from angioplasty or bypass surgery to restore blood flow to the muscle. The report is published in the November 16th issue of The New England Journal of Medicine (news - web sites).
, 百拇医药
In the study, 50 people who were already scheduled to undergo bypass surgery or angioplasty first underwent a contrast-enhanced MRI. The screen was highly accurate at predicting which hearts were too damaged to benefit from treatment. In fact, 90% of heart regions that appeared dead on the MRI--51% to 75% damaged--did not recover after treatment, the report indicates.
Unlike other imaging techniques, this type of MRI provides a view of the entire thickness of the heart wall, not just the outer portions, according to study co-author Dr. Robert M. Judd, of the Feinberg Cardiovascular Research Institute at Northwestern University Medical School in Chicago, Illinois.
, 百拇医药
``If an area of the heart was hyperenhanced or bright, that area would not improve‘‘ after surgery or angioplasty, Judd told Reuters Health. He noted that bright sections had only a 2% chance of improving after such treatments.
Since angioplasty and bypass surgery are not risk-free, the MRI scan may help identify people for whom the risks of treatment outweigh the benefits, Judd explained.
The results of the study demonstrate that people with coronary heart disease who still have substantial areas of healthy heart tissue are much more likely to benefit from artery-clearing treatments than those whose hearts are extensively damaged, according to Dr. George A. Beller, of the University of Virginia Health System in Charlottesville.
In an editorial that accompanies the study, Beller emphasizes the need for future studies to test the value and cost effectiveness of using the contrast-enhanced MRI., 百拇医药