Anatomical evaluation of human coronary arteries by magnetic resonance, intravascular ultrasound and pathological anatomy "in vitro" / Avaliação anatômica de artérias coronárias humanas por ressonância magnética, ultra-som intravascular e anatomia patológica "in vitro"

AUTOR(ES)
DATA DE PUBLICAÇÃO

2008

RESUMO

INTRODUCTION: Numerous studies in the area of image have been conducted to evaluate the morphology of the coronary arteries. Major technical advances have provided better image quality that allows a reliable diagnosis of coronary lesions. For this, studies with cardiovascular magnetic resonance (CMR) and coronary intravascular ultrasound has been developed in an attempt to better measure and characterize coronary heart disease "in vivo". PURPOSE: To determine the capacity of CMR to detect changes in the lumen and the wall of the coronary arteries caused by atherosclerosis, using as references intravascular ultrasound (IVUS) and pathology measurements. METHODS: We examined 13 hearts of patients that died of myocardial infarction. The hearts were fixed with formalin solution to the 10% with constant pressure of 80 mmHg. Then the left anterior descending (LAD), left circumflex (LCx) and right coronary (RCA) arteries were dissected from the the aorta and epicardial fat and isolated as pathological specimens. The arteries were analyzed by CMR, IVUS and pathology and the images were subjected to analysis of the following parameters: total vessel area (TVA), lumen area (LA), major (MaVD) and minor vessel diameter (MiVD), minor (MiLD) and major lumen diameter (MaLD), minor (MiWT) and major wall thickness (MaWT). We analyzed the entire 355 arterial segments, using at least the first proximal 2 cm, in most cases 3 cm or more of each artery. In every centimeter we measured the parameters of the proximal, mid and distal segments. The measures obtained in the three methods were compared using Pearson correlation and the method of Bland and Altman plot. Comparisons among the three methods, by their respective averages and standard deviations, were carried out by analysis of variance with repeated measures. RESULTS: Measures in CMR,IVUS e PA were as follow respectively: TVA 15.46 ± 4.83, 13.86 ± 5.20 and 11.87 ± 4.57; MaVD 4.75 ± 0.84, 4.40 ± 0.87 and 4.18 ± 0.87; MeVD 4.23 ± 0.73, 3.75 ± 0.72 and 3.48 ± 0.70; LA 5.59 ± 2.93, 6.86 ± 3.18 and 5.57 ± 2.46; MiLD 2.54 ± 0.64, 2.55 ± 0.57 and 2.32 ± 0.52; MaLD 3.07 ± 0.65, 3.34 ± 0.76 and 3.04 ± 0.83; MiWT 0.76 ± 0.25, 0.38 ± 0.18 and 0.34 ± 0.17; MaWT 1.11 ± 0.39, 0.88 ± 0.37 and 0.90 ± 0.48.The best correlations were: 1. PAxCMR: TVA and LA (r=0.767 and r=0.805); 2. CMRxIVUS: TVA and LA (r=0.836 and r=0.770); 3. PAxIVUS: TVA and MiVD (r=0.89 and r=0.692). The variables that have shown the best correlations were TVA, MaVD, MiVD and LA in the 3 methods. The MiWT and MaWT had a weak correlation. The averages of variables MiLD and MaLD in the 3 three methods were very similar. CONCLUSION: CMR correlated well with IVUS for the majority of measures done and in especial for TVA, LA, MaVD, MiVD and MaLD. Measures in both methods had lower correlation with pathology that showed the lower values of all. As a perspective CMR may be a reliable method for measuring coronary artery dimensions, depending on new technical development for faster image acquirer

ASSUNTO(S)

histologia ultrasonography estudo comparativo ultra-sonografia histology comparative study coronary vessels/injuries imagem por ressonância magnética magnetic resonance imaging vasos coronários/lesões aterosclerose atherosclerosis

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