The Magnetic Resonance Imaging Findings of Myocardial Microvascular Circulatory Disorder in Patients with Impaired Glucose Tolerance

INTRODUCTION: 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.
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.
DISCUSSION AND 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.

Bozulmuþ Glukoz Tolerans Hastalarýnda Myokardial Mikrovasküler Dolaþým Bozukluðunun Manyetik Rezonans Görüntüleme Bulgularý

GÝRÝÞ ve AMAÇ: Bozulmuþ glukoz toleransý (BGT) olan hastalarda manyetik rezonans görüntüleme (MRG) ile MRG-perfüzyon ile miyokardiyal kan akýmý deðerlendirildi. Mikrovasküler obstrüksiyon varlýðý ve iskemik kalp hastalýðý sýklýðý araþtýrýldý.
YÖNTEM ve GEREÇLER: Çalýþmamýza IGT'li 20, tip 2 diabetes mellituslu (DM) 16 hasta ve normal MR bulgularý olan 15 hasta dahil edildi. Tüm hastalar supin pozisyonda 1.5 Tesla MR ile vücut koili kullanýlarak muayene edildi. Ýlk olarak, duvar hareketlerini görmek, duvar kütlesini ve sol ventrikül ejeksiyon fraksiyonunu hesaplamak için B-TFE sine sekanslarý elde edildi. Daha sonra diðer kardiyak miyokard hastalýklarýný dýþlamak için "siyah kan" T2 aðýrlýklý ve STIR sekanslarý alýndý. Ýlk geçiþ perfüzyonunu deðerlendirmek için 0.2 mmol/kg Gd-DTPA'nýn intravenöz uygulanmasýyla bazal, midventriküler ve apikal kýsa aks sekanslarý elde edildi. Ardýndan "inversiyon recovery GRE" sekansý ile enjeksiyondan 10 dakika sonra geç opaklanma bulgularý elde edildi.
BULGULAR: Miyokard dokusunda ilk geçiþ perfüzyonunda tepe kontrastlanma ve birikmiþ kontrastlanma araþtýrýldýðýnda, BGT ve tip 2 DM'li olgularda benzerlik saptandý. Ancak saðlýklý kontrol grubuna göre anlamlý farklýlýklar tespit edildi. Ýlk geçiþ perfüzyonunda; kontrast madde gelme zamaný ile miyokard dokusunda kontrast madde artýþýnýn tepe noktasý karþýlaþtýrýldýðýnda, bu gruplar arasýnda fark görülmedi. Ayrýca sol ve sað ventrikül sistolik fonksiyonlarý gruplar arasýnda benzerdi.
TARTIÞMA ve SONUÇ: BGT'li olgularda miyokardiyal mikrovasküler dolaþým bozukluklarý koroner arter hastalýðý olmaksýzýn erken evrelerde ortaya çýkabilir. Bu tür vakalarda kardiyak MRG önemli bir seçim olabilir.