BOZULMUŞ GLUKOZ TOLERANS HASTALARINDA MYOKARDİAL MİKROVASKÜLER DOLAŞIM BOZUKLUĞUNUN MANYETİK REZONANS GÖRÜNTÜLEME BULGULARI

Amaç: Bozulmuş glukoz toleransı (BGT) olan hastalarda manyetik rezonans görüntüleme (MRG) ile MRGperfüzyon ile miyokardiyal kan akımı değerlendirildi. Mikrovasküler obstrüksiyon varlığı ve iskemik kalp hastalığı sıklığı araştırıldı. Materyal ve Metot: Çalışmamıza IGT'li 20, tip 2 diabetes mellituslu (DM) 16 hasta ve normal MR bulguları olan 15 hasta dahil edildi. Tüm hastalar supin pozisyonda 1.5 Tesla MR ile vücut koili kullanılarak muayene edildi. İlk olarak, duvar hareketlerini görmek, duvar kütlesini ve sol ventrikül ejeksiyon fraksiyonunu hesaplamak için B-TFE sine sekansları elde edildi. Daha sonra diğer kardiyak miyokard hastalıklarını dışlamak için "siyah kan" T2 ağırlıklı ve STIR sekansları alındı. İlk geçiş perfüzyonunu değerlendirmek için 0.2 mmol/kg Gd-DTPA'nın intravenöz uygulanmasıyla bazal, midventriküler ve apikal kısa aks sekansları elde edildi. Ardından "inversiyon recovery GRE" sekansı ile enjeksiyondan 10 dakika sonra geç opaklanma bulguları elde edildi. Bulgular: Miyokard dokusunda ilk geçiş perfüzyonunda tepe kontrastlanma ve birikmiş kontrastlanma araştırıldığında, BGT ve tip 2 DM'li olgularda benzerlik saptandı. Ancak sağlıklı kontrol grubuna göre anlamlı farklılıklar tespit edildi. İlk geçiş perfüzyonunda; kontrast madde gelme zamanı ile miyokard dokusunda kontrast madde artışının tepe noktası karşılaştırıldığında, bu gruplar arasında fark görülmedi. Ayrıca sol ve sağ ventrikül sistolik fonksiyonları gruplar arasında benzerdi. Sonuç: BGT'li olgularda miyokardiyal mikrovasküler dolaşım bozuklukları koroner arter hastalığı olmaksızın erken evrelerde ortaya çıkabilir. Bu tür vakalarda kardiyak MRG önemli bir seçim olabilir.

THE MAGNETIC RESONANCE IMAGING FINDINGS OF MYOCARDIAL MICROVASCULAR CIRCULATORY DISORDER IN PATIENTS WITH IMPAIRED GLUCOSE TOLERANCE

Objectives: Myocardial blood flow was evaluated with magnetic resonance (MR) perfusion in the patients with impaired glucose tolerance (IGT), and the existence of microvascular obstruction and risk for cardiac diseases were researched. In addition, the wall motion, wall mass (gram), and viability of the left ventricle, and the systolic function of both ventricles were evaluated. Materials and Methods: Twenty patients with IGT, 16 patients with type 2 diabetes mellitus (DM) and 15 patients with normal MR findings were included in our study. All patients were examined in the supine position using a body coil with 1.5 Tesla MR. Firstly, images B-TFE cine sequences to see the wall motions, calculate the wall mass and the left ventricular ejection fraction. "Black blood" T2-weighted and STIR sequences were then taken to exclude other cardiac myocardial diseases. Basal, midventricular, and apical short-axis sequences were obtained by intravenous administration of 0.2 mmol/kg Gd-DTPA to evaluate first-pass perfusion. And late opacification findings were obtained 10 minutes after the injection with the "inversion recovery GRE" sequence. Results: When peak enhancement and accumulated enhancement in the first pass perfusion of myocardial tissue were investigated, the similarity was found in cases with IGT and type-2 DM. However, significant differences were found compared to the healthy control group. In the first pass perfusion; When contrast agent arrival time and the peak of contrast agent increase in myocardial tissue were compared, no difference was observed between these groups. In addition, left and right ventricular systolic functions were similar between groups. Conclusion: In the cases with IGT, myocardial microvascular circulation disorders can emerge in early phases without the presence of coronary artery disease. In these kinds of cases, cardiac MRI can be an important choice

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