MRI诊断双侧先天性视盘缺损一例

眼球先天性视盘缺损病例临床不多见,常规Ｘ线平片检查对本病诊断没有帮助,而ＭＲＩ和ＣＴ能较好地显示眼球形态的改变。本文报道１例经ＭＲＩ检查的病例。患者　男,３８岁。右眼视力较差。７年前,左眼曾被柴板击伤,１９９６年４月来我院诊治。眼科检查：右眼瞳孔膜闭合,右眼鼻侧上方视网膜剥离隆起。ＭＲＩ检查：横断面Ｔ１加权（图１）：双眼球后极部球壁均有缺损,右侧为著,缺损区向后呈球形凸出,玻璃体向后极部疝出达１５ｍｍ×１５ｍｍ,左侧眼球后极部呈漏斗形扩大,玻璃体向后疝出达８ｍｍ×７ｍｍ,缺损区与眼内容物呈均一的…     

马凡综合征心血管病变的MRI诊断

目的：评价ＭＲＩ对马凡综合征心血管病变的诊断价值和限度，明确ＭＲＩ在制定手术方案中的作用。材料和方法：３５例患者行ＭＲＩ自旋回波和电影扫描，马凡综合征的诊断由心血管、肌肉骨骼或眼的异常改变和家族史确立。ＭＲＩ的结果与５０例正常志愿者和５０例高血压病者进行对比。结果：马凡综合征的主要ＭＲＩ征象如下：（１）主动脉窦和升主动脉根部瘤样扩张（１００．０％），在左斜和（或）冠、矢状断面上呈大蒜头样（７４．３％）。（２）左心房受压变扁（８８．６％）。（３）左心室扩大（６０．０％）和左室壁增厚（３４．３％）。（４）电影ＭＲＩ准确显示主动脉瓣关闭不全。（５）可见马凡综合征的并发症，包括主动脉夹层（４例）、心包积液（３例）和胸腔积液（１例）。１４例患者未行Ｘ线血管造影检查，根据ＭＲＩ所见成功施行了手术，全部患者存活。结论：马凡综合征的ＭＲＩ所见有特征性，ＭＲＩ能取代Ｘ线血管造影制定手术方案。     

肺包虫病的X线及MRI的诊断与对照分析

目的 探讨肺包虫病的Ｘ线及磁共振成像（ＭＲＩ）的诊断特征。材料与方法 本组７例均经Ｘ线及ＭＲＩ检查,并经手术及病理证实,对其作回顾性对照分析。结果 根据本组资料,Ｘ线平片对一般肺包虫病多能作出正确诊断,但对于肺包虫破裂感染等复杂病例易与其他疾病混淆,而ＭＲＩ无１例误诊。结论 ＭＲＩ对此病诊断有如优势：定位、定位准确,结构观察清晰,解剖空间关系显示佳,有很高诊断价值。     

15例单心室磁共振诊断

作者报告１５例单心室ＭＲＩ，均经心血管造影（ＣＡＧ）检查证实，５例经手术证实。１１例左室型单心室ＭＲＩ表现为主腔肌小梁纤细，８例有流出小腔，２例为右侧房室瓣部分骑跨流出腔。４例右室型单心室ＭＲＩ表现为主腔肌小梁粗大，半月瓣下有圆锥肌。１５例单心室主要合并畸形有单心房结构５例，肺动脉狭窄８例，房耳并列１例。经与ＣＡＧ和超声心动图（ＵＣＧ）比较，作者认为：对单心室的诊断，ＭＲＩ优于ＵＣＧ，基本达到ＣＡ     

股骨头缺血性坏死的影像学诊断与临床分析

目的：评价Ｘ线与ＭＲＩ对股骨头缺血性坏死（ＡＮＦＨ）的诊断价值。方法：对５０例怀疑为ＡＮＦＨ患者进行Ｘ线检查，其中１０例进行了ＭＲＩ检查，且作了Ｘ线与ＭＲＩ征象的对照观察，并与同期临床症状比较。结果：５０例经Ｘ线检查诊断为ＡＮＦＨ者共４５例６７髋，其中１０例（包括５例Ｘ线平片阴性者）进行了ＭＲＩ检查均证实为ＡＮＦＨ共１０例１４髋。统计结果表明：ＡＮＦＨ的Ｘ线与ＭＲＩ表现与其临床功能无显著相关性（Ｐ＞０．０５）。结论：Ｘ线平片难以显示ＡＮＦＨ的早期表现，ＭＲＩ不仅能发现其早期病变，且能反映病变的确切范围和程度，对早期治疗及预后都有积极意义。     

眼内异物MRI临床应用研究

目的：通过分析４２例５５枚眼内异物的ＭＲＩ表现，并与ＣＴ和Ｘ线平片比较，探讨了ＭＲＩ对眼内异物的诊断价值。材料与方法：男３３例，女９例，年龄５～４５岁。５５枚眼内异物中非磁性异物５３枚，铁磁性异物２枚。每例均在术前１个月内完成Ｘ线平片、ＣＴ和ＭＲＩ检查。结果：（１）ＭＲＩ对５５枚眼内异物检出率（９４％）和ＣＴ（９１％）相仿（Ｐ＞０．２５），均明显高于Ｘ线平片（４２％）（Ｐ＜０．００５）；（２）ＭＲＩ对眼内异物相关并发症的显示优于ＣＴ，而其对巩膜异物的显示差于ＣＴ；（３）ＳＥ序列Ｔ２ＷＩ和ＰＤＷＩ（质子密度加权成像）是检出眼内异物的优选序列；（４）非磁性异物ＭＲＩ呈信号缺失区，无伪迹产生；而铁磁性异物产生大量伪迹，并可致眼部额外损伤。结论：ＭＲＩ是检出眼内非磁性异物的有效方法，特别适用于Ｘ线平片和ＣＴ不能显示的少数非金属异物。眼内铁磁性异物不适于ＭＲＩ。     

脊髓纵裂畸形的MRI诊断(附24例报告)

目的：探讨脊髓纵裂畸形的分型和ＭＲＩ诊断价值。材料与方法：男１０例，女１４例。年龄６个月至５２岁，１５岁以下者２０例。２４例脊髓纵裂共累及２５段脊髓。均有病变区脊柱Ｘ线平片、平扫ＣＴ和ＭＲＩ。脊髓纵裂分为有隔刺的Ⅰ型和无隔刺的Ⅱ型。Ⅰ型分为有完整隔刺的Ⅰａ型和不完整隔刺的Ⅰｂ型。Ⅱ型分为完全纵裂的Ⅱａ型和不全纵裂的Ⅱｂ型。结果：（１）２５段脊髓纵裂Ⅰ型和Ⅱ型分别占５６％（１４段）和４４％（１１段）。Ⅰａ型占４８％（１２段），Ⅱａ型占３６％（９段），Ⅰｂ和Ⅱｂ型均占８％（２段）；（２）２５段脊髓纵裂Ｘ线平片、平扫ＣＴ和ＭＲＩ诊断阳性率分别为１２％（３段）、６８％（１７段）和１００％（２５段）。（３）２５段脊髓纵裂ＭＲＩ横轴面全部诊断正确，冠状面和矢状面分别诊断２３段和１６段。结论：ＭＲＩ是诊断脊髓纵裂畸形及其椎管内伴发病变最有效的非创伤性方法；对骨性隔刺的显示以ＣＴ为优；横轴面Ｔ１ＷＩ是诊断脊髓纵裂的最佳断面；Ⅰ型脊髓纵裂的隔刺以Ｔ２ＷＩ显示为优；脊髓纵裂分型有助于反映脊髓纵裂的病理形态和指导手术。     

心内膜心肌纤维化症的MRI诊断

目的评价ＭＲＩ对心内膜心肌纤维化症（ＥＭＦ）的诊断价值和限度。材料与方法对９例经影像学（包括超声心动图、心导管、Ｘ线心血管造影以及放射性核素显像）诊断、或（和）病理证实（５例）的ＥＭＦ患者，行心电图门控心脏自旋回波和梯度回波电影ＭＲＩ扫描。结果ＥＭＦ分为右室型（ＲＶＥＭＦ）、左室型（ＬＶＥＭＦ）和双室型（ＢＶＥＭＦ）三个亚型，ＭＲＩ所见为：（１）右室型（６例）：右室心内膜显著增厚呈较高信号，右室腔缩小变形，流入道短缩，心尖闭塞而流出道扩张，室壁运动减弱，电影ＭＲＩ（３例）显示有中至大量三尖瓣返流。右心房高度扩大，腔静脉亦显著扩张。（２）左室型（１例）：左室心尖圆钝，心内膜凸凹不平、显著增厚，呈“异常肌束”改变，电影ＭＲＩ可见中等量以上的二尖瓣返流，左室壁运动减弱。左心房显著扩大，肺静脉和主肺动脉扩张。（３）双室型（２例）：兼有二心室受累的改变，但以一侧受累为主。其中１例合并右室心尖附壁血栓，表现为Ｔ１ＷＩ球形高信号，Ｔ２ＷＩ为中等度略高信号。结论ＥＭＦ的ＭＲＩ所见具有相当的特征性，ＭＲＩ可以作为确定ＥＭＦ诊断的手段     

MRI诊断先天性右位心并心内复杂畸形(附四例报告)

目的探讨ＭＲＩ诊断先天性右位心并心内复杂畸形的实用价值。方法应用ＭＲＩ心电门控多层自旋回波序列及磁共振电影，对４例先天性心脏病右位心并心内复杂畸形进行多轴位多层面断层扫描，并将检查结果与经手术证实的心脏病理解剖进行对比。同时对心脏ＭＲＩ扫描与超声心动图彩色血流显像的诊断，作进一步比较及评估。结果３例右位心（右旋心）其主要心内结构的改变为：１例Ｆａｌｏｔ四联症（ＴＯＦ）；１例右室双出口（ＤＯＲＶ）、肺动脉骑跨、左上腔静脉残存；１例大动脉左异位（ＬＭＧＡ）、房间隔缺损（ＡＳＤ）、室间隔缺损（ＶＳＤ）、肺动脉狭窄（ＰＳ）、左上腔静脉残存；１例镜面右位心并内脏转位、ＶＳＤ、ＰＳ、双上腔静脉。结论ＭＲＩ对先天性心脏病右位心并心内复杂畸形可以获得准确的病理解剖诊断，借此可说明ＭＲＩ诊断复杂心内畸形有较高的实用价值，它与心血管造影及超声心动图各具独特优势，在诊断应用中可以互补却不能彼此取代     

缩窄性心包炎磁共振成像的诊断研究

目的评价ＭＲＩ对缩窄性心包炎的诊断和鉴别诊断价值及其限度。材料与方法２６例经临床资料、心电图、Ｘ线和（或）手术证实的缩窄性心包炎患者，行心电图门控ＳＥ和ＧＥ电影ＭＲＩ扫描，ＭＲＩ所见与３０例正常成人志愿者行对比分析。结果缩窄性心包炎的主要ＭＲＩ征象有：心包脏壁层界限不清，呈不规则增厚（厚度＞４ｍｍ），以右心房室侧多见；增厚的心包呈中等信号或中等度低信号，内部信号不均，其中可有斑状极低信号或高信号；室间隔僵直，心室内径缩小，室壁运动减弱；右心房扩大，上下腔静脉扩张，少数病例左心房扩大，肺静脉扩张；可合并房室瓣少至中等量返流。结论ＭＲＩ很容易确定缩窄性心包炎的心包增厚，具有诊断和鉴别诊断的价值，但其价格昂贵、对钙化不敏感为其主要限度。     

二尖瓣及附件病变的造影诊断

68 cases with 76 left ventriculographies, including rheumatic mitral valvular disease, congestive and hypertrophic types of cardiomyopathy, endocardial cushion defect, atrial and ventricular septal defects, coronary heart disease and mitral valve prolapse were analyzed with respect to the morphological and functional changes of the mitral valve and its appendages. Dynamic study with cineradiographic technic was the chief method used in this investigation. Except for ventricular septal defect, all the above-mentioned disease entities showed one or several of the changes of the mitral valvular apparatus including stenosis, insufficiency, displacement, cleft, deformity, prolapse and functional disorder. Regurgitation associated with mitral insufficiency exhibiting specific manifestations in different conditions was analyzed and its method of grading discussed. Mitral valve prolapse with its suggested method grading and functional disorder of the mitral valve were also discussed in detail.     

产前超声对胎儿先天性心脏病的诊断价值

目的:探讨胎儿先天性心脏病(简称先心病)的超声诊断价值。方法:采用彩色多普勒超声对41875例孕20周以上的胎儿常规进行心脏普查,并与尸解及生后心脏手术结果及随访结果对照。结果:发现20例胎儿有先天性心脏缺陷,其中完全性心内膜垫缺损2例,原发孔性房间隔缺损3例,单心房、单心室、右室双出口、三尖瓣下移畸形各2例,室间隔缺损5例,法乐四联症2例。产前超声确诊16例,漏诊4例。结论:21孕周以上常规采用顺序显示法(四腔切面-五腔切面-左室长轴切面-大动脉短轴切面)进行胎儿心脏超声检测对先心病的诊断具有重要价值。     

肺动脉吊带的彩色多普勒超声心动图诊断

目的:探讨彩色多普勒超声心动图对肺动脉吊带的诊断价值。方法:经心导管及手术证实为肺动脉吊带的6例患者为研究对象,回顾性分析其超声心动图表现。结果:6例肺动脉吊带患者中,超声诊断3例,诊断正确率50%;漏诊3例,漏诊率50%。6例肺动脉吊带患者中,2例合并四联症,2例合并房间隔缺损,1例合并室间隔缺损,1例合并左心发育不育综合症。结论:肺动脉吊带是极为少见的先天性心脏病,常规超声心动图检查时,在正常左肺动脉起源处若未发现左肺动脉,提示可能存在肺动脉吊带。     

心内膜垫缺损的MRI诊断及其与超声心动图对比研究

目的:评价MRI诊断心内膜垫缺损(ECD)的价值和限度.方法:11例ECD患者,术前均行超声心动图和MRI检查,将诊断结果与手术病理对照.结果:MRI诊断ECD有11例,其中部分型心内膜垫缺损(PECD)6例,完全型心内膜垫缺损(CECD)5例;超声心动图诊断ECD有9例,1例CECD误诊为法乐四联症,1例CECD误诊为右室双出口.结论:MRI能较好的显示ECD的解剖畸形和复杂的血流动力学改变,在判断心脏血管畸形方面优于超声心动图,两种方法在诊断ECD中应互为补充.     

Time‐resolved spin‐labeled balanced steady‐state free precession cineangiography for visualizing intracardiac shunt: technical considerations and clinical feasibility

A time‐resolved spin‐labeled cineangiographic MRI technique for visualizing blood flow in the heart and defects of the atrial septum is described. The method utilizes a spin labeling preparation and a time‐resolved balanced steady‐state free precession imaging readout that enhances blood in the left atrium or right atrium and suppresses background signal through inversion recovery. Four volunteer studies and 10 patient studies were performed at 1.5 T to characterize the signal properties and to test the clinical feasibility of depicting atrial septal defects. In volunteers, the spin‐labeled cineangiographic method depicted intracardiac blood flow patterns and demarcated the intact atrial septum. Peak target to adjacent atrial chamber contrast‐to‐noise ratios of 84 and 94 were obtained 758 and 689 ms postlabeling; 50% of peak contrast‐to‐noise ratio was maintained for 803 and 599 ms in the left atrium and right atrium, respectively. In all patients with an atrial septal defect, the spin‐labeled cineangiographic method demonstrated left‐to‐right flow and maintained good morphological assessment of surrounding cardiac structures. Right‐to‐left flow was seen in three patients. In conclusion, the spin‐labeled cineangiographic method displayed favorable signal properties in volunteers and demonstrated shunting in patients with atrial septal defects. The technique is expected to be a viable alternative to the few techniques available for visualizing blood flow in the heart. Magn Reson Med, 2012. © 2012 Wiley Periodicals, Inc.     

Ventricular septal defect: visualization of shunt flow and determination of shunt size by cine MR imaging

Cine MR imaging is a new, fast technique that employs low flip angles, short repetition and echo times, and gradient-refocused echoes. This technique was used in three patients with documented ventricular septal defects (VSDs) to obtain transverse and oblique sections of the heart spanning the cardiac cycle. In all patients, cine MR imaging showed high-velocity turbulent blood flow across the defect as areas of low signal intensity extending from the left ventricle to the right ventricle. In the oblique sections oriented parallel to the interventricular septum it was possible to identify the cross-sectional area of the VSD. Quantification of the left-to-right shunt was performed by comparing left and right ventricular stroke volumes determined from end-diastolic and end-systolic volumes of both ventricles. Cine MR imaging provides important functional information and anatomic detail in patients with VSD and may be useful for diagnosis, determination of severity, and noninvasive monitoring of the disease.     

MRI of supracristal ventricular septal defects

The MR features of two cases of supracristal ventricular septal defect are described. In both patients, axial SE T1-weighted images demonstrated a defect between the base of the aorta and the upper posterior aspect of the right ventricular infundibulum. Cine MRI in the two cases showed left-to-right shunting with a flow jet in the distal right ventricular outflow tract that propagated into the main pulmonary artery. Both patients had prolapse of the right sinus of Valsalva, and one had aortic insufficiency.     

Fallot四联症的MRI诊断

笔者分析了２１例经心血管造影和手术证实的Ｆａｌｌｏｔ四联症的ＭＲＩ，探讨ＭＲＩ在显示四联症病理解剖中的作用。提出了显示不同解剖结构应采用的扫描方法，认为ＭＲＩ可以较清晰地显示四联症的肺动脉狭窄、室间隔缺损、主动脉骑跨和右心室肥厚。与其他检查方法相比，ＭＲＩ的诊断能力等于或优于超声心动图；在确定室间隔缺损类型、大小，观察右心室肥厚及肺动脉闭锁时观察中央肺动脉方面优于心血管造影检查。