MRI和心导管检查对肺动脉血流动力学的对比性研究

目的　评价磁共振血流分析技术无创性检测肺动脉血流动力学的价值。材料与方法　应用MR相位速度图测量 45例患者的主肺动脉直径、流速及其最大返流速度并与右心导管检查进行比较。通过直线相关分析评判MRI测量结果的敏感性和特异性。结果　 45例患者中 40例存在返流 ,占 88.89%。 2 5例肺动脉高压 (PAH)组主肺动脉的流速及其肺血管的顺应性均低于非PAH组 ,而返流的百分比也显著增高 (P <0 .0 5 ) ,且返流量与肺动脉平均压呈正相关 (r=0 .89,P <0 .0 1) ,与肺动脉峰值流速呈负相关 (r =-0 .82 ,P <0 .0 1)。结论　MR相位速度图是评价肺动脉血流动力学变化一种新的可靠技术     

心血管MRI对肺动脉高压患者肺动脉形态和右心室功能的评估

目的 探讨心血管MRI(CMRI)对肺动脉高压(PAH)的诊断和评估价值.方法 搜集经右心导管检查确诊的PAH患者130例,同期选择年龄匹配的临床及影像学检查无心肺疾患的31名健康志愿者作为对照组,均行CMR检查.测量如下参数:肺动脉干直径(MPAD)、同层升主动脉直径(AOD)、MPAD与AOD之比(MPAD/AOD)、右心室舒张未期容积(RVEDV)、右心室收缩末期容积(RVESV)、右心室心搏出量(RVSV)、有心室射血分数(RVEF)、右心室心肌质量(RVM).2组间差异采用独立样本t检验,另对PAH患者的MPAD、MPAD/AOD、RVEDV、RVESV、RVSV、RVEF、RVM分别与肺动脉压(PAP)进行Pearson相关分析及线性回归分析.结果 PAH组MPAD、MPAD/AOD、RVEDV、RVESV、RVM的测量结果[(3.88±0.57) cm、1.36±0.17、(161.63±56.37) ml、(112.61±41.46) ml、( 82.70±20.73)g]较正常对照组[(2.74±0.31) cm、0.90±0.07、(131.31±15.14) ml、(61.33±9.00)ml、(44.39±5.87)g]升高,PAH组RVSV、RVEF的测量结果[(49.02±19.20)ml、(30.76±5.85)％]较正常对照组[(69.95±9.63) ml、(53.28±4.14)％]下降,组间差异均有统计学意义(tMPAD=10.82,tMPAD/AOD=14.93,tRVEDV=2.96,tRVESV=6.83,tRVSV=-5.89,tRVEF=-20.22,tRVM=10.12,P值均＜0.01).PAH患者的MPAD、RVEDV、RVESV、RVSV与PAP之间无明显相关性(rMPAD=0.299,rRVEDV=0.127,rRVESV=0.278,rRVSV=-0.229).而MPAD/AOD、RVM与PAP呈正相关( rMPAD/AOD=0.702,rRVM=0.683),RVEF与PAP呈负相关(rHVEF=-0.660).结论 CMRI是诊断PAH的可行性方法,MPAD/AOD、RVM、RVEF可以提示PAH的严重程度.     

64层CT在肺动脉高压诊断中的价值

目的探讨64层CT在肺动脉高压(pulmonary arterial hypertension,PAH)诊断中的价值。方法回顾性分析40例经彩色多普勒超声心动图检查确诊为PAH的患者及42例肺动脉压力正常者的临床及CT资料,测量主肺动脉直径、主肺动脉与升主动脉直径比值、主肺动脉与降主动脉直径比值,并进行统计学分析。结果 PAH组和对照组主肺动脉直径分别为(3.39±0.48)cm、(2.55±0.28)cm;主肺动脉/升主动脉直径比分别为(1.13±0.12)、(0.80±0.14);主肺动脉/降主动脉直径比分别为(1.37±0.24)、(0.98±0.11)。两者差异具有显著的统计学意义(P<0.05)。主肺动脉直径≥2.9cm诊断PAH的敏感性、特异性分别为89%、91%。64层CT诊断PAH的准确性为90.3%。结论 64层CT可明确诊断PAH,并为病因诊断提供更多信息。     

多排螺旋CT在肺动脉高压诊断中的价值

目的探讨多排螺旋CT在肺动脉高压(pulmonary arterial hypertension,PAH)诊断中的价值。资料与方法对42例经多普勒超声心动图检查诊断为PAH的患者及48名肺动脉压力正常者进行CT肺动脉造影(CT pul-monary angiography,CTPA),分析其影像学表现,并进行统计学分析。结果 PAH组和对照组CT测量主肺动脉直径分别为(3.37±0.51)cm、(2.58±0.26)cm。主肺动脉直径≥2.9 cm诊断PAH的敏感性、特异性、阳性预测值、阴性预测值分别为85.7%、87.5%、85.7%、87.5%。主肺动脉直径与PAH的程度呈正相关(r=0.68)。PAH组及对照组的主肺动脉/升主动脉直径比分别为1.06±0.16、0.82±0.13,主肺动脉/降主动脉直径分别为1.34±0.22、1.01±0.14。两者差异具有统计学意义(P<0.05)。CTPA诊断PAH的准确性为85.7%。结论 CTPA可准确诊断PAH,并为病因诊断提供有效信息。     

法洛四联症肺动脉发育指数及血流动力学改变的MRI研究

目的 研究MRI在评价法洛四联症肺动脉发育不良及评估法洛四联症根治术疗效中的应用价值.资料与方法 应用MRI测量30例法洛四联症患者的McGoon比和肺动脉指数(PAI),对其肺动脉血流动力学指标包括平均流速(Vm)、峰值流速(Vp)、流量(FV)等手术前后的改变进行分析,并与正常对照组进行比较.结果 TOF组的McGoon比和PAI均小于正常对照组(P＜0.05).TOF组的Vmmpa、FVmpa低于正常对照组(P＜0.05),而Vmlpa、Vp/Vm高于正常对照组(P＜0.05).术后Vpmpa、Vp/Vm较术前降低(P＜0.05),FVmpa增加(P＜0.05).结论 MRI测量的McGoon比、PAI、Vpmpa、Vp/Vm和FVmpa可作为评估肺动脉发育和手术疗效的可靠参考指标.     

肺动脉流速的MRI测量与多普勒超声比较研究

目的探讨相位对比法MR I(PC-MR I)测量肺动脉血流的准确性以及临床应用价值。方法①选取正常健康志愿者42例,随机分为2组,采用PC-MR I和多普勒超声测量了主肺动脉的内径、最大流速和平均流速。②采用公式分别计算出主肺动脉1个心动周期的血流量。结果①PC-MR I和多普勒超声测量主肺动脉的内径分别为(24.4±3.41)mm和(21.5±2.55)mm。②PC-MR I测量主肺动脉的最大流速和平均流速分别为(79.9±24.0)cm/s和(50.3±7.71)cm/s。③多普勒超声测量主肺动脉的最大流速和平均流速分别为(88.8±8.33)cm/s和(53.7±5.04)cm/s。④PC-MR I测量主肺动脉的血流量为(73.5±6.60)m l,多普勒超声测量主肺动脉的血流量为(69.0±10.6)m l。应用统计学方法成组样本均数t-检验分析2种测量结果,选择检验水平为α为0.05。结论PC-MR I可以准确测量肺动脉的血流速度和血流量,对评价肺动脉血流动力学的改变具有一定价值。     

MRI和心导管检查同步测定肺动脉舒张压的相关性研究

目的　探索MRI无创性测量肺动脉舒张压 (PADP)的新途径。材料与方法　应用MR相位速度图测量 40例具有肺动脉瓣返流 (PR)患者的最大返流速度并计算出舒张末期肺动脉与右心室间的压差 (PVDG) ,同时 ,与右心导管检查结果进行比较 ,通过直线相关与回归分析MRI测量PADP的敏感性和特异性。结果　MRI测定的PADP为 4.82± 1.2 4mmHg(1mmHg =0 .133kPa) ,右心导管的测值为 4.5 2± 2 .0 0mmHg ,二者之间无明显差异 (t=1.45 ,P >0 .0 5 ) ,但具有高度相关性 (r =0 .94,P <0 .0 1)。回归方程y =0 .82x + 4.5 8,其敏感性和特异性高达 90 %。结论　MRI是评价PR患者PADP的较可靠的新技术。     

MRI对慢性阻塞性肺疾病患者肺动脉血流和右心功能评估的应用价值

目的 探讨MRI在检测慢性阻塞性肺疾病(COPD)患者肺动脉血流与右心功能评估中的应用价值。方法选取我院COPD患者52例,依据患者有无肺动脉高压划分成观察组(存在肺动脉高压) 22例和对照组(无肺动脉高压) 30例,对比两组左右心室功能、肺动脉血流有关指标水平。结果 观察组右心室ESV、EDV、EF、SV、MM及左心室EF、SV和对照组相比差异有统计学意义(P <0.05),观察组右心室ESV、EDV、MM均高于对照组(P <0.05),右心室EF、SV和左心室EF、SV均低于对照组(P <0.05);两组左心室ESV、EDV和MM相比差异无统计学意义(P> 0.05)。观察组主肺动脉的血流量平均值、血流峰值及顺应性和对照组相比差异有统计学意义(P <0.05),观察组主肺动脉的血流量平均值、血流峰值及顺应性均低于对照组(P>0.05)。结论 MRI作为COPD患者右心功能与肺动脉血流检测中的一项无创影像学技术,能为临床提供参考依据。     

孕晚期健康胎儿及新生儿主肺动脉血流量正常范围及其变化机制

 目的 观察健康孕晚期胎儿产前和产后主肺动脉血流量正常范围,探讨其可能的变化机制。方法 按不同孕产阶段,将315例受检者分为三组,孕晚期(32～40周)为A组,产后1 d为B组,产后28 d为C组,分别测量主肺动脉的管径(the main pulmonary artery peak,DMPA)、速度时间积分(the velocity time integral,VTI)、流量(the main pulmonary artery flow,QMPA),将三组对比并进行统计学分析。结果 健康孕晚期胎儿、产后1 d及产后28 d新生儿两两比较:主肺动脉的管径[孕晚期(0.694±0.087) cm,产后1 d为(0.805±0.050) cm,产后28 d为(0.910±0.050) cm]、速度时间积分、流量差异均有统计学意义(P＜0.05)。结论 管径不随年龄增加需警惕主肺动脉发育不良等情况;流量增加显著,需警惕继发性肺动脉高压;流量增加不显著,需警惕引起肺血流量减少的原发性及继发性疾病。     

The Clinical Value of Combined MRI and Diffusion Weighted Imaging in Ankylosing Spondylitis

目的 探讨MRI联合DWI对强直性脊柱炎(AS)的诊断价值.资料与方法 搜集经修订纽约标准确诊的31例AS病例和25例正常对照组,两组均行两侧骶髂关节常规MRI横断位和冠状位抑脂T2WI、T1WI联合SE/EPI扩散加权成像(DWI)横断位扫描(b值0,600 s/mm2),观察两组骶髂关节的信号改变,测量表观扩散系数(ADC)值并作统计学检验.结果 31例病例组中的24例双侧或单侧骶髂关节面下骨质抑脂T2WI呈高信号,29例DWI呈高信号,25例对照组骶髂关节面下骨质T2WI、DWI均呈等信号,测量ADC值,病变组为(0.993±0.169)×10 -3mm2/s,对照组为(0.649±0 395)×10 -3 mm2/s,病变组ADC值明显高于对照组(t=4.14,P＜0.001),两者间差异有统计学意义.结论 MRI联合DWI对AS早期诊断有重要的临床价值.     

低剂量屏气三维对比增强磁共振肺动脉造影

目的:探讨低剂量屏气三维对比增强磁共振肺动脉造影(3DCEMRPA)的方法及初步应用。方法:18例病人接受3DCEMRPA检查,造影剂用量为每公斤体重0.1～0.15mmol,分别进行增强前、增强后第期、增强后第期三维快速稳态进动(3DFISP)成像,所有图像分别经最大信号强度投影法(MIP)重建。比较增强前后各级肺动脉的信号噪声比(SNR)和对比噪声比(CNR)。结果:所有病例增强后的图像均优于增强前图像。增强后第期图像各级肺动脉的SNR和CNR均较增强前图像有显著升高(P<0.05)。结论:3DCEMRPA作为一种安全直观地评价肺动脉的方法,有着广阔的临床应用价值。     

Transcatheter Embolization of Pulmonary Artery False Aneurysm Associated with Primary Pulmonary Hypertension

A 29-year-old woman with primary pulmonary hypertension presented with recurrent hemoptysis. Contrast-enhanced CT of the chest demonstrated the enhanced mass surrounded by consolidation related to parenchymal hemorrhage. Pulmonary angiography suggested that the mass was a pulmonary artery false aneurysm. After a microcatheter was superselectively inserted into the parent artery of the false aneurysm, the false aneurysm was successfully treated by transcatheter embolization with coils. Her hemoptysis has never recurred.     

先天性心脏病重度肺动脉高压肺动脉灌注的临床探讨

目的 探讨肺动脉灌注对治疗重度肺动脉高压的作用。方法 对11例重度肺动脉高压患者（肺动脉压为110－133／60－78mgHg，平均82－100mmHg），术中用含抑肽酶等药物的肺保护液，进行肺动脉灌注。结果 11例病人中死亡1例，余术后恢复良好，顺利出院。结论 肺动脉灌注进行肺保护为临床治疗重度肺动脉高压开辟了一种新途径。     

Endovascular Treatment of a Coronary Artery Bypass Graft to Pulmonary Artery Fistula with Coil Embolization

Fistula formation between a coronary artery bypass graft (CABG)and the pulmonary arterial circulation represents a rare cause of recurrent angina in patients following bypass grafting. Therapy has traditionally involved surgical ligation by open thoracotomy. We describe a case of left internal mammary artery–left upper lobe pulmonary artery fistula presenting as early recurrent angina following CABG. The fistula was embolized using platinum coils, resulting in symptomatic relief and improvement in myocardial perfusion on cardiac perfusion scintigraphy. Coil embolization should be considered a therapeutic option in patients with coronary–pulmonary steal syndrome.     

Percutaneous Stent-Graft Repair of a Mycotic Pulmonary Artery Pseudoaneurysm

Ruptured mycotic pulmonary pseudoaneurysm is a lethal complication. Emergent surgical repair is usually recommended, but still associated with a high mortality rate. We present a patient in whom mycotic pulmonary pseudoaneurysm was a complication after surgical lobectomy 2 weeks earlier. This patient had suffered from repeated massive hemoptysis. After emergent surgical repair of the ruptured pulmonary artery stump, another episode of massive hemorrhage occurred. The pulmonary arteriogram revealed a segmental stenosis and a large, wide-necked, lobulated pseudoaneurysm at the left proximal pulmonary artery. We deployed a balloon-expandable stent-graft (48 mm in length mounted on a 12 mm × 40 mm angioplasty balloon) across the stenotic segment and the neck of the pulmonary pseudoaneurysm. Hemostasis was achieved immediately and, under a 4-week antibiotic treatment, patient was transferred to a local hospital for medical care. This case report demonstrates the benefit of minimally invasive endovascular therapy in a critically ill patient. A literature review of the etiology and management of mycotic pulmonary pseudoaneurysm is included.     

An Unusual Aneurysm of the Main Pulmonary Artery Presenting as Acute Coronary Syndrome

A 70-year old man presented with retrosternal chest pain. His electrocardiogram showed nonspecific T wave changes. Cardiac-specific troponin I (cTnI) was elevated. His condition was managed as acute coronary syndrome, following which he had two minor episodes of hemoptysis. A CT pulmonary angiogram showed no evidence of pulmonary embolism, but a large mass lesion was seen in the mediastinum. Echocardiography and cardiac MRI demonstrated a large solid mass, arising from the right ventricular outflow tract and causing compression of the main pulmonary artery (MPA). The differential diagnosis included pericardial and myocardial tumors and clotted aneurysm of the MPA. At surgery, a clotted aneurysmal sac was identified originating from the MPA and the defect was healed. Aneurysms of the MPA are rare. They most commonly present with dyspnea and chest pain. Compression of surrounding structures produces protean manifestations. A high index of suspicion coupled with imaging modalities establishes the diagnosis. Blunt trauma to the chest, at the time of an accident 4 years previously, may explain this aneurysm. The patient’s presentation with chest pain was probably due to compression and/or stretching of surrounding structures. Coronary artery compression simulating acute coronary syndrome has been documented in the literature. The rise in cTnI may have been due to right ventricular strain, as a result of right ventricular outflow obstruction by the aneurysm. This has not been reported previously in the literature. The saccular morphology and narrow neck of the aneurysm predisposed to stagnation leading to clotting of the lumen and healing of the tear, which caused the diagnostic difficulty.     

正常肺动脉分支直径CT测量

目的：在 Ｃ Ｔ 像上测量正常肺动脉分支直径并探讨其准确测量的可能性。方法：选１ ０１ 例正常成人, 在常规静脉注射碘造影剂后１０ ｓ 立即自隆突层面开始以５ ｍ ｍ 层厚连续动态扫描至下肺静脉水平; 分别在各持有特定参考标志的 Ｃ Ｔ 层面测量肺动脉大分支直径。结果：左、右肺动脉及左、右叶间动脉直径依次为１７ ．７ ±１ ．９ ｍ ｍ ,１６ ．７ ±２ ．０ ｍ ｍ ,１３ ．５ ±１ ．６ ｍ ｍ ,１１ ．９ ±１ ．５ ｍ ｍ ,左、右肺动脉直径与年龄呈非常显著正相关（ Ｐ ＜ ０ ．０１） 。结论： Ｃ Ｔ 是测量肺动脉分支直径的可靠方法。     

CT肺动脉造影在诊断原发性肺动脉肿瘤中的应用

目的分析原发性肺动脉肿瘤的CT肺动脉造影(CTPA)表现并复习文献,以期提高肺动脉肿瘤的诊断正确率。资料与方法对4例经手术、病理证实的原发性肺动脉肿瘤(纤维肉瘤、低度恶性肌纤维母细胞肉瘤、平滑肌肉瘤、恶性间叶细胞瘤各1例)进行回顾性分析。4例均于术前行CTPA检查,其中1例术前CTPA检查2次。结果3例首次CTPA检查作出正确诊断;另1例首次CTPA诊断为肺动脉栓塞,经溶栓治疗后复查CTPA显示病变进展而诊断为原发性肺动脉肿瘤。结论原发性肺动脉肿瘤属于少见疾病,术前诊断困难,准确认识其CTPA征象并结合临床资料对提高诊断正确率非常重要。