A comparison of video and digital data in the assessment of myocardial perfusion abnormalities by myocardial contrast echocardiography

Objective: The objective of the present study was to compare the digital and video data of myocardial contrast echocardiography (MCE) to assess altered myocardial blood flow produced by graded coronary stenoses. Methods: Three grades of left anterior descending (LAD) coronary artery stenosis and occlusion were created in eight open-chest canine models. MCE was performed with BR1 infusion by harmonic power Doppler with ECG gated intermittent triggered imaging at pulsing intervals ranging from 1:1 to 1:10. For images that were recorded simultaneously on both a videotape (video data) and an optical disk (digital data), myocardial signal intensity in the LAD region was plotted vs. pulsing intervals and was fitted to an exponential function:y=A(1 − e^−bt ), where A is the peak plateau signal intensity, and b is the rate of signal intensity rise for quantification of myocardial blood flow. Results: Both values for A and b progressively decreased with a greater level of stenosis. The correlation of A with myocardial blood flow (determined by use of fluorescent microspheres) was weak with digital data (r= 0.38, p= 0.037), and was insignificant with video data (r= 0.16, p= 0.38). The correlation of b with microsphere-derived myocardial blood flow was better than that of A with both video and digital data, and was similar between the two kinds of data (video:r= 0.69, p < 0.0001; digital:r= 0.68, p < 0.0001). Conclusions: Video and digital MCE data are equivalent in their ability to quantify altered myocardial blood flow produced by graded coronary stenoses.     

Pulsed tissue Doppler imaging for the detection of myocardial ischaemia, a comparison with myocardial perfusion SPECT

In order to compare the diagnostic ability of pulsed tissue Doppler and myocardial perfusion Single Photon Emission Computed Tomography (SPECT) in patients with a history of unstable coronary artery disease, CAD, 26 patients, 22 men and four women, age 47-76 years, were investigated in a prospective study, 5-10 day after an episode of unstable angina. Tissue Doppler and two-dimensional echocardiography were performed during dobutamine stress testing and myocardial scintigraphy after bicycle exercise and at rest. Patients with a normal SPECT had higher peak systolic velocity during dobutamine infusion, 18.9 +/- 4.1 cm s(-1), than patients with ischaemia, 12.2 +/- 3.8 cm s(-1) (P<0.001) or scar, 8.8 +/- 3.0 cm s(-1) (P<0.01). In a territorial analysis the difference in peak systolic velocity between areas with a normal and abnormal SPECT was less apparent. Failure to achieve >/=13 cm s(-1) in mean-peak systolic velocity was the most accurate criterion for detection of significant CAD on SPECT. We conclude that pulsed tissue Doppler can be used for objective quantification of left ventricular wall motion during dobutamine stress testing and for identification of patients with CAD on SPECT but not for identification of regional ischaemia.     

A new device combining laser Doppler perfusion imaging and digital photography

Summary. We describe a new method for acquisition and analysis of skin perfusion images acquired by laser Doppler scanning and digital photographs of the area scanned. Photographs are obtained with a commercial digital still video camera. A commercial software package is used to handle the perfusion image file and the digital photo. We describe software developed to assess blood flow distribution in detail in relation to the visual appearance of the skin, palpatory findings and other clinical signs. Possible clinical applications of the method described by case reports are post-operative evaluation of vascularized grafts and monitoring of treatment of chronic skin ulcers.     

多巴酚丁胺负荷超声下斑点追踪与组织多普勒技术检测存活心肌的临床价值

目的 探讨超声斑点追踪技术(STE)与组织多普勒技术(TDI)分别联合多巴酚丁胺负荷试验检测存活心肌的临床价值.方法 左心室收缩功能下降(左心室射血分数＜50％)冠心病患者37例,在血运重建之前进行联合多巴酚丁胺负荷超声心动图(DSE)的STE与TDI检查,分析计算室壁运动异常节段(RWMA)的静息及DSE后纵向应变率(LSR)和收缩期峰值速度(PSV).血运重建后1、3、6个月分别复查超声心动图,室壁运动改善为判定存活心肌的金标准,分析STE与TDI检测存活心肌的价值.结果 检查RWMA214个,金标准检测119个节段为存活心肌,95个节段为非存活心肌.存活心肌与非存活心肌的LSR和PSV在静息状态下比较差异有统计学意义(P＜0.01),存活心肌组的LSR和PSV在DSE前后比较差异有统计学意义(P＜0.01),而非存活心肌组的LSR和PSV在DSE前后差异无统计学意义(P＞0.05).受试者工作特征(ROC)曲线判定以△LSR(％)≥7.14％为截断点,检测存活心肌的敏感度88.2％,特异度80.0％;以△PSV(％)≥8.04％为截断点,检测存活心肌的敏感度74.8％,特异度83.2％.联合运用LSR和PSV两项指标,检测存活心肌的敏感度和特异度分别提高至89.8％、88.7％.结论 STE与TDI联合DSE检测存活心肌的敏感度和特异度有明显提高,适宜在临床推广使用.     

Real-time myocardial contrast stress echocardiography using bolus application

In myocardial contrast echocardiography (MCE), power modulation technique may quantify myocardial perfusion in real-time. However, constant infusion of the contrast agent (CA) complicates handling. This pilot study sought for the clinical feasibility of quantitative MCE by a CA bolus application during Adenosine stress echocardiography to diagnose coronary artery disease (CAD). Twenty-four consecutive patients (pts) with contemporary coronary angiography underwent rest and maximum Adenosine stress. Signal intensity could be calculated in 316/348 left ventricular (LV) segments (91%) (18-segment model). At rest, gamma-variate (alpha) as well as saturation function (beta) was not significantly different in healthy men (n = 268) as well as CAD pts (n = 48) (alpha: 0.34 s(-1) versus 0.40 s(-1), n.s.; beta: 0.31 s(-1) versus 0.35 s(-1), n.s.). During Adenosine infusion both values increased in healthy men (alpha: 0.34 +/- 0.37 s(-1) versus 0.44 +/- 0.45 s(-1), p < 0.05; beta: 0.31 +/- 0.33 s(-1) versus 0.40 +/- 0.40 s(-1), p < 0.01), but not in CAD (alpha: 0.40 +/- 0.35 s(-1) versus 0.29 +/- 0.29 s(-1), n.s.; beta: 0.35 +/- 0.32 s(-1) versus 0.27 +/- 0.30 s(-1), n.s.). Sensitivity of alpha/beta reserve 相似文献   

多普勒组织成像与二维超声检测梗死心肌运动的比较研究

目的 比较多普勒组织成像（TDI）速度图与常规二维（2D）超声图在检测急性心肌梗死患者节段性室壁运动异常的差异，评估TDI诊断梗死缺血心肌运动的价值。方法对48例健康者和22例急性心肌梗死患者行常规2D超声检查。对心尖四腔切面、二腔切面、左室长轴切面、胸骨旁左室长轴切面和短轴切面的室壁运动，使用TDI技术测量各室壁节段内膜下心肌运动峰值速度。在心尖左室长轴上计算跨壁速度梯度。当测量值低于正常对照值下限（均数～1．96标准差），则判断为室壁运动异常。设置对TDI速度图检测数据的可重复性检验。结果TDI速度图对室壁运动异常总的检出率显著高于2D超声（P〈0.01）。依据6例冠状动脉造影结果发现，TDI速度图检测梗死和缺血心肌的准确性和敏感性高于2D超声（P〈0.05），但其特异性低于后者。TDI速度图检测所得的数据有较好的可重复性。结论在检测梗死和缺血心肌室壁运动异常方面。TDI优于常规2D超声。     

Trends in myocardial contrast echocardiography: parameteric versus volumetric imaging

It is now possible to perform myocardial contrast echocardiography at the bedside with an intravenous injection of commercially available contrast media. Although myocardial contrast echocardiography is a sensitive method for the detection of coronary stenosis and myocardial viability, its diagnosis has relied largely on the subjective interpretation of regional perfusion by experienced clinicians. Thus, quantification of myocardial contrast echocardiography data and displaying comprehensive images have been necessary for its routine application. In this review, new methods for quantifying or displaying myocardial contrast echocardiography parameters will be introduced: firstly, parametric imaging that displays the parameters of myocardial blood volume, blood flow velocity and myocardial blood flow separately; and secondly, color-coded maps of myocardial blood volume established from one myocardial contrast echocardiography image. These quantitative techniques can provide comprehensive and easy-to-understand images, although the quality of the baseline image remains a critical factor.     

心肌超声造影对大动脉炎冠状动脉受累患者心肌血流灌注的评价价值

目的探讨心肌造影超声技术对评价大动脉炎冠状动脉受累患者局部心肌微循环的价值。 方法选取2017年6月至2019年7月山西省人民医院超声科和太原钢铁（集团）有限公司总医院大动脉炎冠状动脉受累患者15例为大动脉炎冠状动脉受累组,选取同期15名可疑冠状动脉疾病但冠状动脉造影正常的健康人群为对照组。观察大动脉炎冠状动脉受累组冠状动脉狭窄的程度及部位。大动脉炎冠状动脉受累组及对照组均行常规超声心动图检查,采用Simpson法获得左室射血分数。然后,大动脉炎冠状动脉受累组及对照组均行心肌造影超声检查,所测量的心肌血流灌注参数包括灌注开始时间、达峰时间、反映局部心肌血容量的曲线峰值强度A值、反映局部心肌灌注血流速度的曲线斜率β值和局部心肌血流量（A×β值）。使用独立样本t检验比较2组间心肌血流灌注参数的差异。绘制大动脉炎冠状动脉受累心肌灌注参数的受试者工作特征（ROC）曲线,比较各项参数的曲线下面积,确定最佳临界值。 结果15例大动脉炎冠状动脉受累患者共22处冠状动脉受累并发生狭窄,狭窄率50%~69%者占13.6%（3/22）,狭窄率70%~99%者占81.8%（18/22）,完全闭塞者1处占4.5%（1/22）。冠状动脉开口处狭窄受累最多86.4%（19/22）,少数位于冠状动脉中远段9%（2/22）,而且呈节段性改变,仅1处呈单支冠状动脉弥漫性狭窄4.5%（1/22）。15例行冠状动脉造影的患者中单支冠状动脉病变9例（60.0%,9/15）,两支冠状动脉病变5例（33.3%,5/15）,三支冠状动脉病变1例（6.7%,1/15）。大动脉炎冠状动脉受累组Ａ值［（6.55±1.48）dB vs（8.09±1.35）dB］、β值［（0.45±0.13）/s vs（0.64±0.07）/s］、Ａ×β值［（2.75±1.03）dB/s vs（5.23±0.51）dB/s］均比对照组小,差异均具有统计学意义（t=9.978、15.178、25.260,P均<0.001）。大动脉炎冠状动脉受累组灌注开始时间［（2.74±0.78）s vs（2.55±0.63）s］、达峰时间［（12.43±0.79）s vs（7.53±0.93）］均比对照组延长,差异均具有统计学意义（t=2.059、50.068,P=0.013、<0.001）。大动脉炎冠状动脉受累组左心室射血分数比对照组低,差异具有统计学意义（t=19.969,P<0.001）。A×β值的ROC曲线下面积为0.949,当截断值为4.0017 dB/s时的诊断效能最高,此时敏感度为94.2%,特异度为81.5%。 结论大动脉炎冠状动脉受累可引起心肌微循环障碍,导致心脏收缩功能受损。心肌造影可准确定量评价大动脉炎冠状动脉受累的患者的心肌血流灌注情况。     

B-flow imaging of internal carotid artery stenosis: Comparison with power Doppler imaging and digital subtraction angiography

PURPOSE: Digital subtraction angiography (DSA) is the gold standard in the diagnosis of carotid artery stenosis, but it has a relatively high complication rate. We evaluated the efficacy of B-flow imaging (BFI) in examining internal carotid artery stenosis (ICAS) compared with power Doppler imaging (PDI) and DSA. METHODS: We performed BFI, PDI, and DSA on 56 consecutive patients with suspected ICAS. The degree of stenosis was calculated for each technique, and results of BFI and PDI were then correlated with those of DSA. RESULTS: Measurements of the percentage of stenosis made using both sonographic techniques were significantly correlated with those of DSA (p < 0.0001). However, the coefficient of correlation between DSA and BFI (r = 0.94) was higher than that between DSA and PDI (r = 0.87). The mean difference between ICAS measurements with BFI and DSA was -1.3% (95% confidence interval [CI], -2.5 to 0). The mean difference between ICAS measurements with PDI and DSA was -6.5% (95% CI, -8.2 to -4.7). ICAS was graded significantly lower on PDI than on DSA, whereas BFI findings were similar to those of DSA. CONCLUSION: BFI shows high correlation with DSA and provides a more accurate planimetric evaluation of ICAS than PDI does.     

Real-time myocardial contrast echocardiography for assessing perfusion and function in healthy and infarcted wistar rats

Real-time myocardial contrast echocardiography (MCE) is a noninvasive perfusion imaging method, whereas technical and resolution problems impair its application in small animals. Hence, we investigated the feasibility of MCE in experimental cardiovascular set-ups involving healthy and infarcted myocardium in rats. Twenty-five male Wistar rats were examined under volatile anesthesia (2.5% isoflurane) with high-resolution conventional 2-D echocardiography (2DE) and real-time MCE (Sonos 7,500 with 15MHz-transducer, Philips Medical Systems, Andover, MA, USA) in short-axis view. Contrast agent (SonoVue, Bracco, Milan, Italy) was infused as a bolus into a sublingual vein. Background-subtracted contrast signal intensity (SI) was measured off-line in six end-systolic segments and fitted to an exponential curve (gamma variate). Derived peak SI was subsequently calculated and compared with wall motion and common functional measured quantities (left ventricular end-diastolic diameter [LVEDD], area shortening [AS]). Recordings were performed before and 14 days after left anterior descending (LAD) ligature. Infarction induced anterior wall motion abnormalities (WMA) in all animals (16 akinetic, 9 hypokinetic), increased LVEDD (9.1 +/- 0.6 vs. 7.9 +/- 0.6 mm, p < 0.001), reduced AS (36.1 +/- 10.0 vs. 59.5 +/- 4.1%, p < 0.001) and reduced anterior segmental SI (0.4 +/- 0.4 dB akinetic / 1.7 +/- 1.7 dB hypokinetic vs. 15.8 +/- 10.9 dB preinfarct, p < 0.001 / p < 0.001). Segmental SI in normokinetic segments remained unchanged. Area at risk (perfusion defect) correlated well with WMA (r = 0.838). These data confirmed high-resolution real-time MCE as a rational tool for assessing myocardial perfusion of Wistar rats. It may therefore be a useful diagnostic tool for in-vivo cardiovascular research in small animals.     

谐波能量显像评价正常犬肝脏声学造影的实验研究

目的 评价谐波能量显像（ＨＰＩ）在正常肝脏声学造影中的造影增强效果,并与彩色多普勒血流显像（ＣＤＦＩ）进行对比。方法 ４只健康杂种犬经外周静脉注射氟碳声学造影剂,分别用ＨＰＩ和ＣＤＦＩ观察肝脏。视觉判断彩色增强效果和伪像分级。结果 造影后,肝脏ＨＰＩ与ＣＤＦＩ均有３级强烈彩色信号增强,但ＣＤＦＩ有严重的３级“彩色怒放”伪像,而ＨＰＩ的彩色伪像均为１级。结论 ＨＰＩ在声学造影嗵较起初地反映肝脏血流灌     

Stress radionuclide myocardial perfusion imaging detects more residual ischemia than stress echocardiography following acute myocardial infarction

OBJECTIVES: This investigation sought to compare the abilities of stress radionuclide myocardial perfusion imaging and stress echocardiography to detect residual ischemia in patients following acute myocardial infarction (MI). BACKGROUND: Stress radionuclide myocardial perfusion imaging and stress echocardiography are both commonly used to assess patients (patients.) in the immediate post MI period. However, the relative value of these techniques in identifying post MI ischemia remains unclear. METHODS: Eighteen patients. underwent both dipyridamole radionuclide perfusion imaging and dobutamine stress echocardiography on the same day or on consecutive days, 3-7 days following uncomplicated acute MI. Pts. who had an acute percutaneous intervention were excluded. Images were reviewed with clinical information available, but blinded to the opposing modality, for perfusion defects, wall motion abnormalities (WMA), and evidence of ischemia (reversible defect(s) on perfusion imaging, worsening WMA on stress echocardiography). Of the 18 patients, 11 subsequently underwent cardiac catheterization. RESULTS: Perfusion imaging identified defects in 16 (89%) patients, of whom 15 (83% of total) were found to be ischemic. Stress echocardiography identified a fixed wall motion abnormality in 17 (94%) and ischemia in 8 (44%, p < 0.05 compared with perfusion imaging ischemia). Among 11 patients who underwent catheterization, there was a trend towards perfusion imaging identifying more ischemia in the territory of an obstructed (> or = 70%) vessel--100% (11/11) vs. 64% (7/11) for stress echocardiography (p = 0.09). CONCLUSION: In the immediate post-infarction period, dipyridamole stress radionuclide myocardial perfusion imaging more often shows evidence of residual ischemia than dobutamine stress echocardiography.     

心肌超声造影结合计算机灰阶分析技术对兔心肌灌注的研究

目的探讨心肌超声造影（MCE）联合计算机灰阶分析技术定量评价心肌灌注的应用价值。方法30只兔根据阻断和再灌注冠状动脉左室支时间不同分为两组：阻断30 min再灌注60 min（Ⅰ组）和阻断120 min再灌注60 min（Ⅱ组）。于阻断时和再灌注后行MCE,造影图像经自制计算机辅助灰阶分析软件处理后,自动得出每个节段心肌的标化灰阶造影剂密度（CI）,并对心肌灌注进行彩色编码。根据心肌灌注缺损（MPD）和异常的彩色编码区分别计算出危险心肌和梗死心肌面积,分别与荧光微球染色和氯化三苯基四氮唑染色（TTC）结果对照分析。结果再灌注后,Ⅱ组危险节段的标化CI值比非危险节段明显减低（P〈0.01）,而Ⅰ组危险节段的标化CI值与非危险节段间无明显差异。以标化灰阶CI为-70 pix为截断值,识别梗死节段的敏感性为95%,特异性87%。阻断时,MPD和异常彩色编码测量的危险心肌面积与荧光染色呈正相关（r=0.84,P=0.003和r=0.91,P〈0.001）;再灌注时,MPD和异常彩色编码测量的梗死心肌面积与TTC结果呈正相关（r=0.75,P〈0.001和r=0.89,P〈0.001）。结论心肌超声造影联合计算机灰阶分析技术可以定量评估心肌灌注,识别危险和梗死心肌区域。     

左心声学造影对STEMI病人PCI术后心肌灌注及预后的评估价值

目的 探讨心肌声学造影(MCE)对急性STEMI病人PCI术后评估心肌灌注及预后的价值。方法 纳入本院78例急性STEMI且行PCI手术患者的病例资料,且术后48h均行MCE,根据MCE结果分为A组(灌注充盈正常：心肌节段造影剂充盈均匀,完全显影)43例,B组(灌注充盈稀疏：心肌节段造影剂充盈不均匀或部分显影)20例,C组(灌注充盈缺损：心肌节段造影剂充盈缺损,完全不显影)15例。应用常规超声与MCE技术获取各组患者术后48h、1个月、3个月左心功能指标[左室射血分数(LVEF)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)]。记录三组患者术后6个月、12个月、24个月的主要不良心血管事件(MACE)发生率,并应用Logistic向后逐步回归分析急性STEMI患者PCI术后发生MACE的独立危险因素。结果 与A组比较,B、C组LVEDV、LVESV均较高,Am、E、LVEF较低,差异均有统计学意义(均P＜0.05)。与B组比较,C组LVEDV、LVESV均较高,Am、E、LVEF较低,差异均有统计学意义(均P＜0.05)。与A组比较,B、C组PCI术后MACE发生率较高,差异均有统计学意义(均P＜0.05)。多因素Logistic回归分析结果显示,LVEDV、LVESV、LVEF、MCE结果均为影响急性STEMI患者PCI术后发生MACE的独立危险因素(P＜0.05)。结论 MCE可有效评估急性STEMI患者PCI术后心肌灌注情况,可独立预测术后MACE事件的发生,利于患者预后。     

Twinkling artifact in color Doppler imaging of the orbit.

OBJECTIVE: To show an artifact related to color Doppler flow imaging of the orbit. METHODS: Three patients with strongly reflective structures in the orbit were selected from those routinely referred by clinicians for color Doppler ultrasonography of the orbit. Gray scale and color flow images were obtained with a 7.5-MHz linear array probe for a region with strongly reflective structures. A spectral display was acquired to confirm the presence of blood flow. RESULTS: One patient had a metallic foreign body just behind the bulb; another had calcification within the irregular mass of phthisis bulbi; and the third had hyperechoic drusen in the periphery of the intraocular melanoma. The color mosaic, suggesting the presence of blood flow, was detected beyond all hyperechoic structures. Close vertical bands with no outer wrapping were detected in the spectrum display, obtained by placing the sample volume on the region of color flow. The artificial color flow was recognized as a color Doppler twinkling artifact. CONCLUSIONS: The color flow beyond the strongly reflecting structures in the orbit might be mistakenly interpreted as real blood flow if an examiner is not familiar with the artifact. It should prompt further imaging with spectral Doppler ultrasonography.     

三维超声心动图结合心肌超声造影评价2型糖尿病患者心肌功能障碍

目的 探讨实时三维超声心动图结合心肌超声造影对评价2型糖尿病（T2DM）患者心肌功能障碍的价值。方法 选取单纯糖尿病组（Ⅰ组）和糖尿病合并微血管并发症组（Ⅱ组）各29例,对照组（C组）32名,运用实时三维超声心动图获取左心室16节段、12节段及6节段达最小收缩容积时间的标准差（Tmsv16-SD、Tmsv12-SD、Tmsv6-SD）和最大时间差值（Tmsv16-Dif、Tmsv12-Dif和Tmsv6-Dif）及其心率校正值。通过心肌超声造影获得各室壁各节段的峰值强度A、充盈速度β并计算A·β,进行组间数据分析。结果 ①同步性运动评估：Ⅱ组除Tmsv6-Dif以外,其余左心室同步化指标均较C组延长（P均<0.05）;Ⅰ组Tmsv12-Dif、Tmsv12-SD、Tmsv12-Dif%和Tmsv12-SD%较C组延长（P均<0.05）。②心肌血流灌注整体评估：C组、Ⅰ组、Ⅱ组A、β、A·β均呈逐渐下降趋势,Ⅱ组A、β及A·β均低于C组（P均<0.05）;Ⅱ组β及A·β均低于Ⅰ组（P均<0.05）;Ⅰ组β及A·β均低于C组（P均<0.05）;3组内同一指标3个节段差异均无统计学意义（P均>0.05）。结论 单纯T2DM及合并血管并发症患者左心室运动均存在不同步现象;T2DM患者心肌灌注减低,呈弥漫性损害,随其他脏器微循环病变出现而加重。     

间歇式谐波显像声学造影评价肾实质血流灌注

目的：评价间歇式谐波显像观察肾实质血流灌注声学造影的优越性。方法：自制的白蛋白包裹氟碳气体的造影剂对８只兔外周静脉造影。分别用基波显像、基波间歇显像、二次谐波显像、间歇式谐波显像四种成像方式观察造影效果。结果：间歇式谐波显像的视觉效果分级最高,视频密度值高达１６０．７４±３．７２,与其它组差异显著（Ｐ＜０．０１）,较基波显像延长造影峰值半降时间（１６．７±３．６ｓ,８．４±１．８ｓ）,差异显著（Ｐ＜０．０１）。结论：间歇式谐波显像能增强肾实质造影信号强度,延长造影时间,是一种较好的造影显像方法。