成人孤立性心肌致密化不全的影像学诊断

目的：探讨成人孤立性心肌致密化不全（INVM）的影像学表现特征及其诊断价值。方法：回顾性分析20例INVM的影像学表现，超声心动图（ECG）诊断15例（15/20），心脏磁共振（CMR）诊断8例（8/8）。结果：20例INVM中，左心室单独受累18例，双心室受累2例。ECG表现：15例均为左心室单独受累。最常见的受累节段依次为15段（15例）、16段（15例）及17段（13例）。受累心肌肌小梁增多、增粗，肌小梁之间见深陷的隐窝，彩色多普勒示小梁隐窝有低速血流与心腔交通。多伴有心功能不全及房室瓣反流。CMR表现：左心室单独受累6例，双心室受累2例。最常见的受累节段依次为12段（7例）、13段（6例）、14段（6例）、15段（6例）及16段（6例）。受累心肌增厚并见分层：内层非致密心肌信号不均匀，由多发的肌小梁及小梁隐窝组成；外层致密心肌变薄，信号如常。延迟期左心室心肌强化3例28段，右心室心肌强化1例。结论：INVM的影像学表现具有特征性，磁共振判断INVM心肌受累范围及观察心肌灌注情况等方面比超声更具优势。

The imaging diagnosis of isolated noncompaction of ventricular myocardium in adults

Objective: To summarize the imaging features and investigate its diagnostic value to INVM in adults. Methods: Twenty cases of INVM were enrolled, 15 cases were detected by ECG, 8 cases were confirmed by CMR, and the imaging performances were retrospectively analyzed. Results: Eighteen cases of patients were of left ventricular, 2 cases were of left and right. Findings of ECG of 15 patients were shown as flows: All the patients were of left ventricular. The most impaired locations in sequence were 15 segment (n=15), 16 segment (n=15) and 17 segment (n=13). The INVM respected as prominent and excessive myocardial trabeculations and deep intratrabecular recesses. The Color Doppler flow imaging showed blood flowing into intertrabecular recesses with dim blood in them. Cardiac insufficiency and back-streaming of atrioventricular valve were found in most of patients. Findings of CMR of 18 patients were shown as flows: 6 cases were of left ventricular, 2 cases were of left and right. The most impaired locations in sequence were 12 segment (n=7), 13 segment (n=6), 14 segment (n=6), 15 segment (n=6) and 16 segment (n=6). The INVM mainly manifested as thickened myocardardium consisting of two layers: epicardial compacted thin myocardial and noncompacted thincked subendocardium, and the later expressed as prominent and excessive trabaculations and deep recesses. Enhancement of 28 segments of left ventricle was shown. Conclusion: The imaging of INVM is characteristic. CMR can clearly demonstrate the extent of abnormalities of myocardium as well as myocardial perfusion of INVM, which makes CMR better than ECG.