Investigation of human right ventricular cast specimens

Fifty human right ventricular cast specimens were subjected to X-ray cineangiography in biplane right anterior oblique and left anterior oblique (RAO/LAO) projection. From the silhouettes seen in the two projection planes we estimated areas and lengths using a lightpen minicomputer system and calculated the volumes using various methods. The calculated volume values were compared with the true values determined by water displacement. The methods were then arranged is order of decreasing accuracy. Criteria for judging model quality were the mean squared deviations, correlation coefficient, and residual variance. The most accurate calculation of the right ventricular volume was obtained with Ferlinz' method and our own empirical approach.     

Present status of axially angled angiocardiography

Axial angiography visualizes anatomical details of normal and pathological hearts not previously demonstrated by conventional angiography. Progress in the diagnosis of congenital heart malformations using axial projection technique has been reconsidered, emphasizing that the anatomical details of each congenital heart malformation and their associated anomalies that can be revealed by axial angiography. Three angiographic views form the basis of this study: long axial, four chamber, and elongated right anterior oblique. Relevant findings are presented in isolated ventricular septal defect, tetralogy of Fallot, atrioventricular septa defects, common ventricle, and stradding atrioventricular valves. Variability in the position and orientation of the heart requires adjustment of the degree of obliquity and/or angulation of the X-ray beam in individual patients to obtain the appropriate angiographic views.     

Reproducibility of left ventricular volume determinations with use of a semi-automated system

Reliability of a computer-assisted system for determination of left ventricular volumes was judged by multiple measurements of rotation ellipsoids, cadaver hearts, and cineangiograms from patients. The volume measurements in cadaver hearts provided a volume correction factor necessary for reproducible results. Variation coefficient for intraobserver and interobserver variability did not exceed 2.3% when calculated using rotation ellipsoids and was highest at 12.0% for the end-systolic volumes derived from patient films. When appropriate calibration methods are employed, different observers can make reliable left ventricular volume measurements aided by such systems.     

Comparison of left and right ventricular volume measurement using the Simpson's method and the area length method

Purpose

To compare ventricular volume measurement using a volumetric approach in the three standard cardiac planes and ventricular volume estimation by a geometrical model, the Area–Length method (ALM).

Materials and methods

Fifty-six healthy volunteers were examined (27 males, 29 females) on a 1.5 T MR-unit with ECG-triggered steady state free precision (SSFP) Cine-MR sequences and parallel image acquisition. Multiple slices in standardized planes including the short-axis view (sa), 4-chamber view (4ch), left and right 2-chamber views (2ch) were used to cover the whole heart. End-systolic and end-diastolic ventricular volumes (EDV, ESV), stroke volume (SV), and ejection fraction (EF) were calculated with Simpson's rule in all planes and with ALM in the 2ch and 4ch planes. Global function parameters measured in the sa plane were compared with those obtained in the other imaging planes.

Results

A very good correlation is observed when comparing functional parameters calculated with Simpson's rule in all imaging planes: for instance, the mean EDV/ESV of the left and right ventricle of the female population group measured in sa, 4ch, and 2ch: left ventricle EDV/ESV 114.3/44.4, 120.9/46.5, and 117.7/45.3 ml; right ventricle EDV/ESV 106.6/46.0, 101.2/41.1, and 103.5/43.0 ml. Functional parameters of the left ventricle calculated with ALM in 2ch and 4ch correlate to parameters obtained in sa with Simpson's rule in the range of 5–10%: for instance, the EDV/ESV of the left ventricle of the male population group measured in the sa, 4ch, and 2ch: 160.3/63.5, 163.1/59.0, and 167.0/65.7 ml. Functional parameters of the right ventricle measured with ALM in 4ch are 40–50% lower and calculated in 2ch almost double as high as compared with the parameters obtained in sa with Simpson's rule: for instance, male right ventricular EDV/ESV measured in sa, 4ch, and 2ch: 153.4/68.1, 97.5/34.5, and 280.2/123.2 ml. The EF correlates for all imaging planes measured with the Simpson's rule in both ventricles and using ALM in the left ventricle except for males with an overestimation of less than 6%. The EF of the right ventricle is calculated higher using ALM in 4ch and 2ch compared to the EF calculated in sa: female/male EF of the right ventricle measured in the sa, 4ch, and 2ch: 56.8/55.7, 66.0/65.0, and 60.0/57.0%.

Conclusion

In the setting of healthy volunteers the ALM method should not be used in 2ch and 4ch planes of the right ventricle because of lacking correlation of global functional parameters compared to those obtained in the sa plane. Using Simpson's rule functional parameters correlate well to each other in the different imaging planes.     

回顾性心电门控多层螺旋CT对急性肺栓塞右心室功能障碍及溶栓前后右心室功能变化的评价

目的 应用ECG门控MSCT前瞻性对中心型急性肺动脉栓塞(APE)患者右心功能障碍及静脉溶栓前后右心功能变化进行评价.方法 96名可疑APE患者进行了ECG门控MSCT胸痛三联检查,25例确诊为中心型肺栓塞.行胸痛三联检查无心肺疾患且性别、年龄匹配的25例作为对照组.APE患者于静脉溶栓后复查MSCT,评价右心功能恢复情况.测量参数包括横断面舒张期的右心室(RV)及左心室(LV)短轴最大内径,RV及LV舒张末期容积(EDV)、收缩末期容积(ESV)、射血分数(EF)、主肺动脉/主动脉直径比.应用单因素方差分析,如果有统计学意义,则采用两两组间q检验.结果 对照组的右心室EDV、ESV、EF值、收缩末期RV/LV容积比、横断面RV/LV内径比及主肺动脉/主动脉直径比分别为(15O.5±24.1)ml、(71.5±18.5)ml、(53.5±4.2)%、1.08±0.04、1.01±0.04及0.99±0.02,中心型APE患者溶栓前以上各值分别为(190.3±16.2)ml、(128.1±13.2)ml、(32.7±3.6)%、2.00±0.26、1.30±0.09及1.34±0.11,溶栓后分别为(159.2±21.5)ml、(80.7±9.4)ml、(49.2±5.9)%、1.22±0.25、1.02±0.02及1.02±0.11.中心型APE患者与对照组比较,右心室ESV(q=6.28,P<0.01)及EDV均增大(q=7.59,P<0.01),EF减小(q=4.82,P<0.01),收缩末期RV/LV容积比增大(q=6.04,P<0.01),横断面RV/LV内径比(q=4.43,P<0.01)及主肺动脉/主动脉直径比增大(q=4.36,P<0.01),左心室EDV减小.中心型APE患者静脉溶栓后,与溶栓前比较,右心室ESV(q=5.03,P<0.01)及EDV减小(q=6.11,P<0.01),EF增加(q=6.29,P<0.01),收缩末期RV/LV容积比减小(q=4.74,P<0.01),横断面RV/LV内径比(q=3.83,P<0.01)及主肺动脉/主动脉直径比减小(q=3.46,P<0.01),左心室EDV增大(q=4.01,P<0.01).结论 回顾性ECG门控MSCT胸痛三联检查可同时检测APE和测量左右心功能,排除其他胸痛疾病,评价溶栓疗效.