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Journal of Cardiovascular Magnetic Resonance：用定量心血管磁共振心肌灌注图表征左内乳冠状动脉搭桥术患者的心肌缺血

2021-06-19 MedSci原创 MedSci原创

定量心血管磁共振心肌灌注图左内乳冠状动脉搭桥术
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冠状动脉搭桥术后，尽管LIMA通畅，仍经常发现灌注不良，灌注不良可能反映真正的心肌血流减少，主要是由于与近端LAD相关的心肌灌注异常，而不是由于与移植物相关的造影剂延迟相关的技术限制。

尽管使用冠状动脉搭桥术(CABG)进行手术血运重建的结果有所改善，但很大比例的冠状动脉疾病(CAD)患者出现复发症状。传统的无创压力测试方法降低了冠脉搭桥术后缺血识别的准确性，导致图像解译的可信度降低，对临床管理的影响不一致。应力灌注心血管磁共振(Stress perfusion cardiovascular magnetic resonance, CMR)在血管CAD中检测心肌缺血具有较高的诊断准确性，但与其他无创检测方法类似，冠脉搭桥后定性解释降低了诊断准确性。定量灌注标测作为一种全自动、在线测量心肌血流的工具，正被越来越多地使用，可能提供更高的诊断准确性，并更好地了解功能血流限制的详细分布和严重程度。然而，它在左侧内乳动脉(LIMA)移植患者中的表现尚未被研究。

最近，Journal of Cardiovascular Magnetic Resonance杂志发表研究论文，利用心血管磁共振(CMR)定量心肌灌注图验证了冠状动脉疾病(CAD)心肌血流(MBF)评估。冠状动脉搭桥(CABG)手术后，左内乳动脉(LIMA)供血区域经常发现灌注不良，但它们的解释和随后的临床管理是多样的。

该研究对冠状动脉搭桥术后患者的首次灌注CMR进行了定性(目测)和定量(灌注标测)评估。

通过选择一组经血管造影证实为LIMA桥接左冠状动脉前降支(LAD)且LIMA - LAD区域内无梗死的患者, 评估决定这一区域心肌血流的因素，特别是LAD完全闭塞的影响。还评估了造影剂的动脉时间延迟，并评估了将最大延迟时间编程到自动灌注映射算法中对MBF定量的影响。

对38例既往行冠状动脉搭桥手术的患者采用定量CMR灌注标测评估心肌灌注，这些患者均经血管造影证实LIMA-左冠状动脉前降支(LAD)搭桥且LAD区域未发生梗死。评估了可能决定LIMA -LAD心肌区域内MBF的因素，包括通过LIMA延迟显影剂到达的影响。

患者左内乳动脉(LIMA)至左冠状动脉前降支(LAD)未受损伤，且有证据表明LAD区域存在可诱导灌注不良。从心底到心尖(从左到右)的短轴视图。上排(a):第一次通过腺苷加压灌注，定性显示LAD心底至中部(但不是心尖)灌注不良。中间行(b):灌注图显示这些区域心肌血流量峰值(MBF)定量减少。(如中前间隔的MBF为0.85 ml/g/min，心尖间隔的MBF为1.65 ml/g/min)。c美国心脏协会(AHA)各节段压力MBF的Bullseye图。最下面一行(d):晚期钆增强(LGE)图像显示无梗死。e, f冠状动脉造影显示LIMA桥血管未闭(e)，吻合部位(f)、远端流离良好。

箱式图显示了不同LAD状态下在LIMA-LAD区域(AHA 1,2,7,8,13,14)应力MBF。固有LAD的完全闭塞与应力MBF的显著减少相关。

27例(71%)患者的LIMA - LAD区域存在灌注不良，尽管LIMA移植血管通畅且LAD区域心肌未梗死。固有LAD慢性总闭塞(CTO)是应力MBF (B =−0.41,p = 0.014)和心肌灌注储备(MPR) (B =−0.56,p = 0.005)的强大独立预测因子，并与基础应力MBF的降低相关(1.47 vs 2.07 ml/g/min;P = 0.002)，但不影响心尖段(1.52 vs 1.87 ml/g/min;p = 0.057)。在定量灌注算法中延长最大动脉时间延迟，只导致估计的应力MBF小幅增加(3.4%)。

在LIMA-LAD范围内的每个心肌水平(心底、中、尖)压力MBF。局部LAD的完全闭塞与心底和中部的MBF峰降低有关，但与心尖LAD段无关。

该研究证实，尽管LIMA-LAD血管通畅且未发生梗死，但LAD区域的灌注不良在行灌注CMR的患者中很常见，这些缺陷主要位于心底部和中部，而非心尖段，与固有血管CTO有关。最后，LIMA移植后动脉延迟时间可能较长(反映动脉通过时间)，导致对MBF轻微低估，但这并不足以解释血流减少的程度，从而造成灌注缺陷。

总之，这些发现表明冠状动脉搭桥术后，尽管LIMA通畅，仍经常发现灌注不良，灌注不良可能反映真正的心肌血流减少，主要是由于与近端LAD相关的心肌灌注异常，而不是由于与移植物相关的造影剂延迟相关的技术限制。

原文出处

Seraphim, A., Knott, K.D., Beirne, AM. et al. Use of quantitative cardiovascular magnetic resonance myocardial perfusion mapping for characterization of ischemia in patients with left internal mammary coronary artery bypass grafts. J Cardiovasc Magn Reson 23, 82 (2021). https://doi.org/10.1186/s12968-021-00763-y

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style='color:#2F92EE;'>#搭桥#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56917, encryptionId=03a35691e2e, topicName=搭桥)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=557f25711234, createdName=12498b3em16(暂无昵称), createdTime=Tue Sep 07 18:48:04 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1341728, encodeId=8fd11341e28d0, content=<a href='/topic/show?id=24b8e37529a' target=_blank style='color:#2F92EE;'>#磁共振#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73752, encryptionId=24b8e37529a, topicName=磁共振)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=24a22500182, createdName=1696533704_45270454, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1478193, encodeId=6d8a14e819394, content=<a href='/topic/show?id=8f9751881da' target=_blank style='color:#2F92EE;'>#心血管磁共振#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51881, encryptionId=8f9751881da, topicName=心血管磁共振)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1492397, encodeId=a209149239e0a, content=<a href='/topic/show?id=a251569194f' target=_blank style='color:#2F92EE;'>#搭桥术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56919, encryptionId=a251569194f, topicName=搭桥术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32a28924986, createdName=zzc2214, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1493306, encodeId=d3241493306f6, content=<a href='/topic/show?id=4223e0260a' target=_blank style='color:#2F92EE;'>#ESO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7026, encryptionId=4223e0260a, topicName=ESO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=30f59021057, createdName=hongbochen, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=)]
    2021-11-08 ms1065684921169360

    #vascular#

    0

  4. 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topicName=null, topicId=null, topicList=[TopicDto(id=2818, encryptionId=1c292818fd, topicName=ASC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Mon Apr 11 13:48:04 CST 2022, time=2022-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1734382, encodeId=30c81e3438237, content=<a href='/topic/show?id=d4f412668a4' target=_blank style='color:#2F92EE;'>#NET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12668, encryptionId=d4f412668a4, topicName=NET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7ea033781210, createdName=canlab, createdTime=Tue Oct 26 17:48:04 CST 2021, time=2021-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1663982, encodeId=80bc166398287, content=<a href='/topic/show?id=03a35691e2e' target=_blank 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createdBy=32a28924986, createdName=zzc2214, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1493306, encodeId=d3241493306f6, content=<a href='/topic/show?id=4223e0260a' target=_blank style='color:#2F92EE;'>#ESO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7026, encryptionId=4223e0260a, topicName=ESO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=30f59021057, createdName=hongbochen, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=)]
    2022-04-11 quxin068

    #ASC#

    0

  5. 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createdBy=32a28924986, createdName=zzc2214, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1493306, encodeId=d3241493306f6, content=<a href='/topic/show?id=4223e0260a' target=_blank style='color:#2F92EE;'>#ESO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7026, encryptionId=4223e0260a, topicName=ESO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=30f59021057, createdName=hongbochen, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=)]
    2021-10-26 canlab

    #NET#

    0

  6. 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GetPortalCommentsPageByObjectIdResponse(id=1478193, encodeId=6d8a14e819394, content=<a href='/topic/show?id=8f9751881da' target=_blank style='color:#2F92EE;'>#心血管磁共振#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51881, encryptionId=8f9751881da, topicName=心血管磁共振)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1492397, encodeId=a209149239e0a, content=<a href='/topic/show?id=a251569194f' target=_blank style='color:#2F92EE;'>#搭桥术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56919, encryptionId=a251569194f, topicName=搭桥术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32a28924986, createdName=zzc2214, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1493306, encodeId=d3241493306f6, content=<a href='/topic/show?id=4223e0260a' target=_blank style='color:#2F92EE;'>#ESO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7026, encryptionId=4223e0260a, topicName=ESO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=30f59021057, createdName=hongbochen, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=)]
    2021-09-07 12498b3em16(暂无昵称)

    #搭桥#

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1793277, encodeId=1aa71e9327788, content=<a href='/topic/show?id=0fe21535eca' target=_blank style='color:#2F92EE;'>#Resonance#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15357, encryptionId=0fe21535eca, topicName=Resonance)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7a5c2500147, createdName=12498bb3m90(暂无昵称), createdTime=Sun May 08 20:48:04 CST 2022, time=2022-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1642512, encodeId=b20016425128a, content=<a href='/topic/show?id=8210512940e' target=_blank style='color:#2F92EE;'>#心肌灌注#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51294, encryptionId=8210512940e, topicName=心肌灌注)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=754b22951372, createdName=12498e5fm19(暂无昵称), createdTime=Sun Mar 27 00:48:04 CST 2022, time=2022-03-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1763258, encodeId=1f3e1e632585e, content=<a href='/topic/show?id=f20f18290b8' target=_blank style='color:#2F92EE;'>#vascular#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18290, encryptionId=f20f18290b8, topicName=vascular)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=03b737453747, createdName=ms1065684921169360, createdTime=Mon Nov 08 20:48:04 CST 2021, time=2021-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1939220, encodeId=0fd319392205d, content=<a href='/topic/show?id=1c292818fd' target=_blank style='color:#2F92EE;'>#ASC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2818, encryptionId=1c292818fd, topicName=ASC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Mon Apr 11 13:48:04 CST 2022, time=2022-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1734382, encodeId=30c81e3438237, content=<a href='/topic/show?id=d4f412668a4' target=_blank style='color:#2F92EE;'>#NET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12668, encryptionId=d4f412668a4, topicName=NET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7ea033781210, createdName=canlab, createdTime=Tue Oct 26 17:48:04 CST 2021, time=2021-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1663982, encodeId=80bc166398287, content=<a href='/topic/show?id=03a35691e2e' target=_blank style='color:#2F92EE;'>#搭桥#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56917, encryptionId=03a35691e2e, topicName=搭桥)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=557f25711234, createdName=12498b3em16(暂无昵称), createdTime=Tue Sep 07 18:48:04 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1341728, encodeId=8fd11341e28d0, content=<a href='/topic/show?id=24b8e37529a' target=_blank style='color:#2F92EE;'>#磁共振#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73752, encryptionId=24b8e37529a, topicName=磁共振)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=24a22500182, createdName=1696533704_45270454, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1478193, encodeId=6d8a14e819394, content=<a href='/topic/show?id=8f9751881da' target=_blank style='color:#2F92EE;'>#心血管磁共振#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51881, encryptionId=8f9751881da, topicName=心血管磁共振)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1492397, encodeId=a209149239e0a, content=<a href='/topic/show?id=a251569194f' target=_blank style='color:#2F92EE;'>#搭桥术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56919, encryptionId=a251569194f, topicName=搭桥术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32a28924986, createdName=zzc2214, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1493306, encodeId=d3241493306f6, content=<a href='/topic/show?id=4223e0260a' target=_blank style='color:#2F92EE;'>#ESO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7026, encryptionId=4223e0260a, topicName=ESO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=30f59021057, createdName=hongbochen, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=)]
    2021-06-21 1696533704_45270454

    #磁共振#

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1793277, encodeId=1aa71e9327788, content=<a href='/topic/show?id=0fe21535eca' target=_blank style='color:#2F92EE;'>#Resonance#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15357, encryptionId=0fe21535eca, topicName=Resonance)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7a5c2500147, createdName=12498bb3m90(暂无昵称), createdTime=Sun May 08 20:48:04 CST 2022, time=2022-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1642512, encodeId=b20016425128a, content=<a href='/topic/show?id=8210512940e' target=_blank style='color:#2F92EE;'>#心肌灌注#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51294, encryptionId=8210512940e, topicName=心肌灌注)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=754b22951372, createdName=12498e5fm19(暂无昵称), createdTime=Sun Mar 27 00:48:04 CST 2022, time=2022-03-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1763258, encodeId=1f3e1e632585e, content=<a href='/topic/show?id=f20f18290b8' target=_blank style='color:#2F92EE;'>#vascular#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18290, encryptionId=f20f18290b8, topicName=vascular)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=03b737453747, createdName=ms1065684921169360, createdTime=Mon Nov 08 20:48:04 CST 2021, time=2021-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1939220, encodeId=0fd319392205d, content=<a href='/topic/show?id=1c292818fd' target=_blank style='color:#2F92EE;'>#ASC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2818, encryptionId=1c292818fd, topicName=ASC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Mon Apr 11 13:48:04 CST 2022, time=2022-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1734382, encodeId=30c81e3438237, content=<a href='/topic/show?id=d4f412668a4' target=_blank style='color:#2F92EE;'>#NET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12668, encryptionId=d4f412668a4, topicName=NET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7ea033781210, createdName=canlab, createdTime=Tue Oct 26 17:48:04 CST 2021, time=2021-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1663982, encodeId=80bc166398287, content=<a href='/topic/show?id=03a35691e2e' target=_blank style='color:#2F92EE;'>#搭桥#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56917, encryptionId=03a35691e2e, topicName=搭桥)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=557f25711234, createdName=12498b3em16(暂无昵称), createdTime=Tue Sep 07 18:48:04 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1341728, encodeId=8fd11341e28d0, content=<a href='/topic/show?id=24b8e37529a' target=_blank style='color:#2F92EE;'>#磁共振#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73752, encryptionId=24b8e37529a, topicName=磁共振)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=24a22500182, createdName=1696533704_45270454, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1478193, encodeId=6d8a14e819394, content=<a href='/topic/show?id=8f9751881da' target=_blank style='color:#2F92EE;'>#心血管磁共振#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51881, encryptionId=8f9751881da, topicName=心血管磁共振)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1492397, encodeId=a209149239e0a, content=<a href='/topic/show?id=a251569194f' target=_blank style='color:#2F92EE;'>#搭桥术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56919, encryptionId=a251569194f, topicName=搭桥术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32a28924986, createdName=zzc2214, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1493306, encodeId=d3241493306f6, content=<a href='/topic/show?id=4223e0260a' target=_blank style='color:#2F92EE;'>#ESO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7026, encryptionId=4223e0260a, topicName=ESO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=30f59021057, createdName=hongbochen, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=)]
    2021-06-21 仁者大医

    #心血管磁共振#

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1793277, encodeId=1aa71e9327788, content=<a href='/topic/show?id=0fe21535eca' target=_blank style='color:#2F92EE;'>#Resonance#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15357, encryptionId=0fe21535eca, topicName=Resonance)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7a5c2500147, createdName=12498bb3m90(暂无昵称), createdTime=Sun May 08 20:48:04 CST 2022, time=2022-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1642512, encodeId=b20016425128a, content=<a href='/topic/show?id=8210512940e' target=_blank style='color:#2F92EE;'>#心肌灌注#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51294, encryptionId=8210512940e, topicName=心肌灌注)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=754b22951372, createdName=12498e5fm19(暂无昵称), createdTime=Sun Mar 27 00:48:04 CST 2022, time=2022-03-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1763258, encodeId=1f3e1e632585e, content=<a href='/topic/show?id=f20f18290b8' target=_blank style='color:#2F92EE;'>#vascular#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18290, encryptionId=f20f18290b8, topicName=vascular)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=03b737453747, createdName=ms1065684921169360, createdTime=Mon Nov 08 20:48:04 CST 2021, time=2021-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1939220, encodeId=0fd319392205d, content=<a href='/topic/show?id=1c292818fd' target=_blank style='color:#2F92EE;'>#ASC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2818, encryptionId=1c292818fd, topicName=ASC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Mon Apr 11 13:48:04 CST 2022, time=2022-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1734382, encodeId=30c81e3438237, content=<a href='/topic/show?id=d4f412668a4' target=_blank style='color:#2F92EE;'>#NET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12668, encryptionId=d4f412668a4, topicName=NET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7ea033781210, createdName=canlab, createdTime=Tue Oct 26 17:48:04 CST 2021, time=2021-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1663982, encodeId=80bc166398287, content=<a href='/topic/show?id=03a35691e2e' target=_blank style='color:#2F92EE;'>#搭桥#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56917, encryptionId=03a35691e2e, topicName=搭桥)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=557f25711234, createdName=12498b3em16(暂无昵称), createdTime=Tue Sep 07 18:48:04 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1341728, encodeId=8fd11341e28d0, content=<a href='/topic/show?id=24b8e37529a' target=_blank style='color:#2F92EE;'>#磁共振#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73752, encryptionId=24b8e37529a, topicName=磁共振)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=24a22500182, createdName=1696533704_45270454, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1478193, encodeId=6d8a14e819394, content=<a href='/topic/show?id=8f9751881da' target=_blank style='color:#2F92EE;'>#心血管磁共振#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51881, encryptionId=8f9751881da, topicName=心血管磁共振)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1492397, encodeId=a209149239e0a, content=<a href='/topic/show?id=a251569194f' target=_blank style='color:#2F92EE;'>#搭桥术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56919, encryptionId=a251569194f, topicName=搭桥术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32a28924986, createdName=zzc2214, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1493306, encodeId=d3241493306f6, content=<a href='/topic/show?id=4223e0260a' target=_blank style='color:#2F92EE;'>#ESO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7026, encryptionId=4223e0260a, topicName=ESO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=30f59021057, createdName=hongbochen, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=)]
    2021-06-21 zzc2214

    #搭桥术#

    0

  10. [GetPortalCommentsPageByObjectIdResponse(id=1793277, encodeId=1aa71e9327788, content=<a href='/topic/show?id=0fe21535eca' target=_blank style='color:#2F92EE;'>#Resonance#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15357, encryptionId=0fe21535eca, topicName=Resonance)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7a5c2500147, createdName=12498bb3m90(暂无昵称), createdTime=Sun May 08 20:48:04 CST 2022, time=2022-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1642512, encodeId=b20016425128a, content=<a href='/topic/show?id=8210512940e' target=_blank style='color:#2F92EE;'>#心肌灌注#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51294, encryptionId=8210512940e, topicName=心肌灌注)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=754b22951372, createdName=12498e5fm19(暂无昵称), createdTime=Sun Mar 27 00:48:04 CST 2022, time=2022-03-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1763258, encodeId=1f3e1e632585e, content=<a href='/topic/show?id=f20f18290b8' target=_blank style='color:#2F92EE;'>#vascular#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18290, encryptionId=f20f18290b8, topicName=vascular)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=03b737453747, createdName=ms1065684921169360, createdTime=Mon Nov 08 20:48:04 CST 2021, time=2021-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1939220, encodeId=0fd319392205d, content=<a href='/topic/show?id=1c292818fd' target=_blank style='color:#2F92EE;'>#ASC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2818, encryptionId=1c292818fd, topicName=ASC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Mon Apr 11 13:48:04 CST 2022, time=2022-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1734382, encodeId=30c81e3438237, content=<a href='/topic/show?id=d4f412668a4' target=_blank style='color:#2F92EE;'>#NET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12668, encryptionId=d4f412668a4, topicName=NET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7ea033781210, createdName=canlab, createdTime=Tue Oct 26 17:48:04 CST 2021, time=2021-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1663982, encodeId=80bc166398287, content=<a href='/topic/show?id=03a35691e2e' target=_blank style='color:#2F92EE;'>#搭桥#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56917, encryptionId=03a35691e2e, topicName=搭桥)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=557f25711234, createdName=12498b3em16(暂无昵称), createdTime=Tue Sep 07 18:48:04 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1341728, encodeId=8fd11341e28d0, content=<a href='/topic/show?id=24b8e37529a' target=_blank style='color:#2F92EE;'>#磁共振#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73752, encryptionId=24b8e37529a, topicName=磁共振)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=24a22500182, createdName=1696533704_45270454, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1478193, encodeId=6d8a14e819394, content=<a href='/topic/show?id=8f9751881da' target=_blank style='color:#2F92EE;'>#心血管磁共振#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51881, encryptionId=8f9751881da, topicName=心血管磁共振)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1492397, encodeId=a209149239e0a, content=<a href='/topic/show?id=a251569194f' target=_blank style='color:#2F92EE;'>#搭桥术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56919, encryptionId=a251569194f, topicName=搭桥术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32a28924986, createdName=zzc2214, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1493306, encodeId=d3241493306f6, content=<a href='/topic/show?id=4223e0260a' target=_blank style='color:#2F92EE;'>#ESO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7026, encryptionId=4223e0260a, topicName=ESO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=30f59021057, createdName=hongbochen, createdTime=Mon Jun 21 13:48:04 CST 2021, time=2021-06-21, status=1, ipAttribution=)]
    2021-06-21 hongbochen

    #ESO#

    0

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