双源CT与三维超声心动图对左心房容积及功能评估的比较

目的探讨双源CT(DSCT)对心动周期中不同时相左心房容积和功能的评估价值,并与实时三维超声心动图(RT-3DE)的检查结果进行比较。方法选择2008年6-12月在北京安贞医院进行冠状动脉CT血管造影(CTA)检查的患者50例,男26例,女24例,年龄58±16岁,所有患者均为窦性心律,在同一天完成DSCT和RT-3DE检查,获得左心房、左心室的DSCT容积数据和RT-3DE容积数据,然后分别采用Circulation和Q-LAB心功能分析软件进行数据后处理,获得左心房最大容积(LAVmax)、左心房最小容积(LAVmin)、左心房开始收缩时的容积(LAVp)并计算左心房功能指标,包括左心房射血分数(LAEF)、左心房存储功能(LARV)、左心房被动收缩功能(LAPV)、左心房主动收缩功能(LAAV)和左心房管道功能(LACV)。所有的左心房容积和功能指标都经体表面积校正。DSCT和RT-3DE所得的左心房容积和功能指标的一致性分析采用配对t检验。操作者间的变异性采用Bland-Altman分析和相关性分析。结果通过两种方法获得的体表面积校正的左心房容积和功能结果无显著性差异(P0.05)。与采用RT-3DE相比,DSCT得出的左心房容积和功能指标测量值的变异较低。结论 DSCT在评估冠状动脉的同时可以较准确地测定左房容积和功能。     

双源CT与3.0T MRI比较评估不同时相的左心房容积和功能

目的 与3.0 T MRI比较,探讨双源CT(DSCT)评估心动周期中不同时相左心房容积和功能的能力.方法 回顾性分析行冠状动脉CTA检查的49例患者,同一天完成DSCT和MR检查,并获得DSCT容积数据及左心房垂直长轴和左心室短轴快速稳态平衡进动序列(FIESTA)电影图像.分析左心房不同时相容积并计算左心房功能指标,所有的左心房功能指标都经体表面积校正.通过线性相关和Bland-Altman分析评估DSCT和MR电影(CMR)两种检查方法间的相关性和一致性.结果 DSCT与CMR测量的体表面积校正参数分别为:最大左心房容积(LAVmax):(47.4±11.1)和(46.2±9.7)ml/m2;最小左心房容积(LAVmin):(22.2±6.9)和(21.3±5.8) ml/m2;P波对应的左心房容积(LAVp):(34.8±8.8)和(33.6±7.8) ml/m2;左心房存储容积(LARV):(24.0±5.7)和(21.5±5.0) ml/m2;左心房被动收缩容积(LAPV):(11.6±3.9)和(10.9±3.9)ml/m2;左心房主动收缩容积(LAAV):(12.4±3.9)和(10.7±3.6) ml/m2;左心房管道容积(LACV):(22.6±8.4)和(21.0±6.4)ml/m2;左心房射血分数(LAEF):(52.8±7.4)％和(54.5±6.3)％;DSCT与CMR测值之间的相关性分别为:0.89、0.90、0.90、0.80、0.82、0.80、0.76和0.78(P值均＜0.01).但DSCT高估了校正后的LAVmax、LAVmin、LAVp、LARV、LAPV、LAAV和LACV,其高估的偏差分别为1.2、0.9、1.1、0.3、0.1、0.2和0.4 ml/m2.与CMR相比,DSCT稍微低估了LAEF约0.6％.对左心房功能指标的测量,DSCT操作者间的差异低于CMR操作者间的差异(P＜0.05).结论 DSCT对心动周期内不同时相左心房的容积和功能的评估较准确、重复性较强,可为临床提供冠状动脉以外的信息.     

实时三维超声心动图联合二维斑点追踪技术评价左心耳封堵器对左心房结构及功能的影响

目的 探讨采用实时三维超声心动图(real-time three-dimensional echocardiography, RT-3DE)和二维斑点追踪技术(two-dimensional speckle tracking imaging, 2D-STI)评价左心耳封堵器对左心房(LA)结构及功能的影响。方法 选取86例接受左心耳封堵术(left atrial appendage closure, LAAC)治疗的非瓣膜性房颤(NVAF)患者为LAAC组，另选未接受LAAC治疗的31例NVAF患者为对照组。采用RT-3DE获取LAAC患者术前、术后45天(n=86)、术后12个月(n=57)和对照组患者的左心房容积(LAV)、左心房容积指数(LAVI)、左心房射血分数(LAEF),采用2D-STI获取左心房心肌应变值，比较各组间的差异。结果 LAAC组术前与术后45天和12个月比较，LAAC组术前与对照组比较，各组间左心房容积参数和左心房心肌应变值差异无统计学意义(P>0.05)。结论 LAAC术后无论短期还是远期均未发现封堵器对左心房的结构和功能有不良影响，提示左心耳封堵器适...     

超声心动图评估阵发性心房颤动患者左心房功能早期改变

目的探讨二维和三维超声心动图(2DE和3DE)指标在评估阵发性心房颤动(PAF)患者左心房早期重构中的价值。方法选取PAF患者48例,正常者40例。采集常规超声心动图参数及三维图像,应用2DE、3DE和三维斑点追踪成像技术(3D-STI)测定左心房相关容积和应变指标,比较两组间的差异。结果2DE和3DE提示PAF患者左心房各期容积均增大(P<0.05)。2DE测定的容积相关指标提示左心房三相功能均受损(P<0.05);3DE测定的应变指标提示左心房应变受损(P<0.05)。结论2DE和3DE指标评估左心房结构与功能改变可帮助发现PAF患者左心房功能的早期改变。     

脑钠肽前体对于糖尿病透析患者心功能评价的临床意义

目的评价脑钠肽前体(N-terminal-pro-B-type-natriuretic-peptide,NT-proBNP)对于糖尿病血液透析患者心功能不全的临床诊断意义。方法检测46例血液透析患者血浆NT-proBNP水平,其中糖尿病19例。采用心脏超声测定46例左室舒张末内径(LVDd)及左室射血分数(LVEF),分析糖尿病透析患者血浆NT-proBNP水平与其心脏功能的关系。结果 (1)糖尿病组透析间期血浆NT-proBNP浓度[(8627.2±5958.1)pg/ml]明显高于非糖尿病组[(3585.5±1455.1)pg/ml],差异有统计学意义(P<0.05);(2)糖尿病组左心室扩大比例高于非糖尿病组。糖尿病组中,合并左室扩大的患者血浆NT-proBNP[(11 756.2±6928.7)pg/ml]浓度明显高于不合并左室扩大的患者[(4910.4±2480.2)pg/ml],差异有统计学意义(P<0.05)。结论血浆NT-proBNP浓度升高在一定程度上可反映糖尿病血液透析患者存在左心功能障碍。     

三维斑点追踪技术测定左心房容积与功能在评价糖尿病患者左心室舒张功能障碍中的应用

目的 ：通过三维斑点追踪技术（3D-STI）测定左心房容积与功能,评价其诊断糖尿病患者左心室舒张功能障碍的价值。方法：对78例左心室射血分数正常的糖尿病患者行超声心动图检查,依据超声心动图评定的左心室舒张功能简化流程,分为舒张功能正常组和舒张功能障碍组各39例;另纳入健康志愿者40例作为对照组。应用GE Vivid E95的3D-STI左心房容积及心肌应变自动定量软件获得左心房容积及功能参数,包括左心房最大容积（LAVmax）、左心房最小容积（LAVmin）、左心房收缩前容积（LAVpreA）、左心房最大容积指数（LAVImax）、左心房排空分数（LAEF）、左心房存储期应变（LASr）、左心房管道期应变（LAScd）及左心房收缩期应变（LASct）。比较3组间的左心房参数差异。结果：LAVmin、LAVmax及LAVpreA在舒张功能障碍组中较舒张功能正常组显著增大（均P<0.001）。LAVmax经体表面积校正后,舒张功能障碍组仍较舒张功能正常组增大（P<0.001）。LASr及LAScd在对照组、舒张功能正常组、舒张功能障碍组依次递减,舒张功能正常组及舒张功能障碍组均...     

超声心动图评价非瓣膜性心房颤动患者心耳血栓形成危险因素

目的应用超声心动图评价非瓣膜性心房颤动患者心耳血栓形成的危险因素。方法回顾性分析2022年1—6月于北部战区总医院就诊的102例非瓣膜性心房颤动患者的临床资料。根据是否检测出心耳血栓将患者分为血栓组(n=20)与非血栓组(n=82)。经胸超声心动图检查两组患者收缩末期左房前后径(LAD)、左室射血分数(LVEF)、左房舒张末期容积(LAEDV)、左房收缩末期容积(LAESV),计算左房射血分数(LAEF),定量估测三尖瓣反流面积及三尖瓣跨瓣压差。行经食道超声心动图测量两组患者左心耳口径及左心耳排空速度,观察心耳内有无自发显影。采用二元Logistic回归分析探讨心耳血栓形成的相关因素。结果血栓组LAEDV、LAESV、左心耳口径、自发显影比例高于非血栓组,左心耳排空速度、LAEF、LVEF低于非血栓组,两组比较,差异均有统计学意义(P<0.05)。两组患者三尖瓣反流面积、LAD、三尖瓣跨瓣压差比较,差异无统计学意义(P>0.05)。LAESV、LAEF是心耳血栓形成的独立危险因素(95%可信区间分别为1.012~1.158、0.000~0.001,P均<0.05)。结论心房颤动患者心耳血栓形成与心房结构及功能改变有关。     

应用心血管磁共振成像评估中国男子篮球运动员左心房容积和功能

目的：应用心血管磁共振成像（CMR）评估中国男子篮球运动员左心房的容积和功能,为科学训练和医学监督提供参考依据。方法：纳入20名中国男子篮球运动员（年龄20.5±1.5岁,技术等级为国家二级运动员）为研究组,选取15名无运动习惯者为对照组（年龄21.6±2.8岁）。所有被检者行CMR扫描获得电影序列,由2名医师独立应用心血管分析软件测量心脏容积和功能,应用CMR特征追踪（CMR feature tracking,CMR-FT）技术测量左心房应变和应变率等参数,两组间对比采用独立样本t检验。结果：与对照组相比,篮球运动员的左、右心室舒张末期容积指数（LVEDVI、RVEDVI）和左心室质量指数（LVMI）明显增大（P<0.05）,左、右心室射血分数（LVEF、RVEF）减低（P<0.05）,左心房的最大容积指数（LAVImax）、最小容积指数（LAVImin）增大（P<0.05）。在左心房功能方面,左心房的总射血分数（LATEF）、被动射血分数（LAPEF）和主动射血分数（LAAEF）在两组间的差异无统计学意义（P>0.05）。篮球运动员的左心房总应变（εs）、被...     

实时三维超声心动图应用于房颤患者左心耳功能评价的价值

目的探讨实时三维超声心动图应用于房颤患者左心耳(left atrial appendage,LAA)功能的评价功能。方法选择2015年9月~2019年2月在本院住院患者188例,根据心律情况分为观察组(房颤)100例与对照组(窦性心律)88例,采用常规超声检查记录左心房(left atrium,LA)指标,采用实时三维超声心动图评定LAA功能并进行相关性分析。结果观察组的LAD值显著高于对照组(P<0.05),而LAEF与LAFI值显著低于对照组(P<0.05)。LAA含有丰富的梳状肌、肌小梁,形态各异,凹凸不平,分叶数目不等,两组左心耳分叶数目对比差异无统计学意义(P>0.05)。观察组的LAA-OL、LAA-OS、LAA-H、LAA-V值显著高于对照组(P<0.05)。在观察组中,直线相关分析显示LAA-OL、LAA-OS、LAA-H、LAA-V与LAD呈现正相关性,与LAEF与LAFI呈现负相关性(P<0.05)。结论实时三维超声心动图可准确评估房颤患者的LA容积与LAA功能,对判定患者病情与预测预后都具有重要价值。     

基于心脏磁共振组织追踪初步探究左心房功能预测缺血性心脏病患者预后的价值

目的:初步探究左心房功能预测缺血性心脏病患者出现主要不良心血管事件(MACEs)的价值。方法:回顾性搜集2018年10月-2020年7月共30名确诊缺血性心脏病患者,在二腔心、四腔心层面分别勾画左心房储存期、导管期以及泵血期的心内膜、心外膜轮廓,得到各期左心房容积,采用心脏磁共振组织追踪技术自动生成左心房应变-时间曲线以及应变率-时间曲线并得到左心房三期射血分数、应变以及应变率。采用受试者操作特征(ROC)曲线计算左心房功能参数对于缺血性心脏病患者出现MACEs的预测价值。采用Bland-Altman图评价两位有心脏磁共振诊断经验的医生测量左心房功能参数的一致性。结果:MACEs组左心房储存期射血分数[(37.85±13.86)%vs.(48.40±10.95)%,P=0.028]、应变[13.40(7.25,15.80)%vs.19.20(13.38,24.68)%,P=0.011],导管期应变[4.6(2.65,7.38)%vs.9.2(6.5,11.20)%,P=0.003]以及泵血期应变率[-0.65(-1.3,-0.5)/s vs.-1.55(-1.83,-1.00)/s,P=0.003]均小于无MACEs组,差异均有统计学意义。MACEs组左心房三期容积标化值[(68.54±19.84)mL/m2 vs.(39.22±11.68)mL/m2,(42.93±14.84)mL/m2 vs.(20.69±7.75)mL/m2,(54.21±21.44)mL/m2 vs.(29.57±10.94)mL/m2]均显著大于无MACEs组(P<0.001)。ROC曲线提示左心房三期容积标化值、导管期应变、储存期应变以及泵血期应变率曲线下面积较大(AUC>0.75,P<0.05),对预测预后有一定价值。两位医生测量左心房功能参数的组内和组间一致性良好。结论:左心房三期容积指数增大、应变降低对预测缺血性心脏患者出现MACEs具有一定的预测价值。     

Stress MR imaging for evaluation of popliteal artery entrapment

The popliteal artery entrapment (PAE) syndrome has been recognized as a cause of arterial occlusion in young people. It is the result of an anomaly of the relationship between the popliteal artery and the gastrocnemius muscle. Eight young healthy volunteers (16 legs) and six patients (10 legs) with suspected PAE underwent magnetic resonance (MR) imaging. Gradient-echo images were obtained in axial planes with the leg at rest and during active plantar flexion against resistance. Imaging at rest allowed identification of PAE signs in only one leg, which had an anomalous medial course of the popliteal artery. In the other cases, only the stress technique was able to show signal loss in the popliteal artery due to muscular compression (two legs) or the presence of accessory muscle slip around the vessel (two legs), as confirmed at surgery. MR imaging is therefore a useful technique for the diagnosis of PAE because of its capability of combining information obtainable with other modalities.     

MR imaging of muscle and tender points in fibromyalgia

Fibromyalgia is a syndrome manifested by chronic, diffuse muscu-loskeletal aching and soreness, palpable muscle tender points, and other symptoms. Standardized clinical diagnostic criteria have recently been developed. Skeletal muscle has been postulated as the end organ in this disease. Biochemical, histologic, electromyographic, and conventional radiographic studies have demonstrated no definitive abnormality. This study sought to establish whether magnetic resonance (MR) imaging could demonstrate any abnormality in these patients. Eighteen patients were entered in the study, 14 of whom were able to complete their examinations. T1 -weighted, T2-weighted, gradient-echo, and STIR (short-tau inversion-recovery) sequences were performed in all patients, with selected patients examined with T1weighted, gadopentetate dimeglu-mine-enhanced sequences. The trapezius and suboccipital regions were imaged in patients who, clinically, had active fibro-myalgia. No abnormalities could be detected. The authors conclude that the conventional MR imaging used in this study was unable to depict any primary skeletal muscle abnormality in fibromyalgia.     

Uterine contractions: Possible diagnostic pitfall at MR imaging

A total of 206 nongravid patients with various gynecologic problems underwent pelvic magnetic resonance (MR) examinations that included both sagittal T2-weighted and contrast agent–enhanced T1-weighted images. MR images were retrospectively reviewed to identify changes in endometrial configuration on serial images obtained during the same MR examination. In 20 MR examinations (all in women of reproductive age), endometrial distortion due to myometrial bulging was noted on T2-weighted or contrast-enhanced T1-weighted images. It was absent on other MR images obtained at different times. Myometrial bulging exhibited low signal intensity in 18 examinations. The finding resembled adenomyosis or leiomyoma on T2-weighted or contrast-enhanced T1-weighted images. These results evidence the presence of transient myometrial bulging and transient low-intensity myometrium in the nongravid uterus. This phenomenon is thought to represent uterine contraction. Clinicians should be aware of the potential presence of transient low-signal-intensity myometrial bulging that could present diagnostic problems in the normal uterus.     

Controversies in cervical spine imaging in trauma patients

No area of emergency radiology has generated as much discussion in recent years as the subject of cervical spine imaging for trauma patients. This review will be in three parts. The first will examine the indications for cervical imaging and will focus on those factors that make patients at high risk or low risk for cervical injury. The second part will discuss the merits of radiography and computed tomography as the main screening diagnostic examination. In addition to the roles of each modality in the evaluation process, such factors as efficacy of diagnosis, time (duration) of study, and cost will be discussed. Finally, the third part will explore the methods currently employed to clear the cervical spine in comatose patients.Presented at the Annual Meeting of the American Society of Emergency Radiology, Las Vegas, Nevada, 22–25 October, 2003     

Brodie Abscess: MR imaging appearance in 10 patients

The magnetic resonance (MR) imaging features of Brodie abscess have not yet been fully evaluated. Ten patients with Brodie abscess, eight of long bone and two of vertebra, were studied with MR imaging. Long bone abscess had a characteristic “target” appearance with four layers: (a) a center with low signal intensity on T1-weighted images and high signal intensity on T2-weighted and STIR (short-inversion-time inversion recovery) images, (b) an inner ring isointense to muscle on T1-weighted images and with high signal intensity on T2-weighted and STIR images, (c) an outer ring hypoin-tense on all images, and (d) a peripheral halo hypointense on T1-weighted images. In six of eight cases, a soft-tissue mass was found. The two vertebral abscesses had a less specific appearance, with low signal intensity on T1-weighted images and high signal intensity on T2-weighted and STIR images. Only the peripheral halo was clearly identified in both cases.     

Dynamic contrast-enhanced MR imaging assessment of vascularized free fibular grafts

Magnetic resonance (MR) imaging may be a noninvasive method for assessing perfusion of vascularized bone grafts placed for treatment of avascular necrosis. One proximal femur of seven beagles was devascularized, with insertion of a vascularized fibular graft. MR imaging at 1 week (seven dogs) and 6 weeks (five dogs) after surgery included pre- and postcontrast spin-echo sequences, unenhanced twodimensional time-of-flight (TOF) vascular imaging, and dynamic gradient-echo imaging during infusion of gadolinium. Relative signal intensity values of selected regions obtained from the dynamic gradientecho images were plotted as percent enhancement versus time. In the operated hip, MR imaging did not show enhancement in six of seven femoral heads and greater trochanters at 1 week after surgery, with similar results after 6 weeks. MR imaging of fibular grafts 6 weeks after surgery showed an initial rapid increase in enhancement and a subsequent slower increase in five of five dogs, although no enhancement was seen in six of seven dogs at 1 week. These findings contrasted with a rapid initial increase in enhancement followed by slow decline in non-operated hips. Two-dimensional TOP imaging did not show the vascular pedicle of the graft in any dog. Findings of radionuclide bone scanning performed 1 week after surgery were consistent with devascularization of the operated femur and fibular graft. However, tetracycline distribution and histologic findings confirmed the viability of five of five grafts within the devascularized femurs 6 weeks after surgery. Thus, dynamic contrast-enhanced MR imaging at 6 weeks after surgery is valuable for assessing vascular bone graft perfusion, while similar imaging at 1 week may suggest otherwise.     

Right-side aortic arch with aneurysm of aberrant left subclavian artery: MR imaging appearance.

Reports of aneurysms of the subclavian artery in both normal and anomalous aortic arches have been rare. The authors describe a patient with a right-side aortic arch and an aneurysm of the aberrant left subclavian artery, which, to the authors' knowledge, is a previously unreported association. At presentation, the aneurysm appeared as a calcified left superior mediastinal mass. Magnetic resonance imaging enabled preoperative diagnosis and guided surgical planning.     

Adrenal tissue characterization with 0.5-T MR imaging: Value of T2*-weighted images

The authors investigated the value of magnetic resonance (MR) imaging at 0.5 T for distinguishing adrenal adenomas from adrenal metastases. The series included 23 adrenal adenomas (18 nonhyperfunctioning, five hyperfunctioning) and 23 adrenal metastases from various organs. Adrenal tumor–liver signal intensity ratios on T1-, T2-, and T2*-weighted images were calculated for adrenal tissue characterization. Adrenal adenomas were more precisely distinguished from adrenal metastases on T2*-weighted images (21 of 23, 91%) than on T2-weighted images (15 of 23, 65%). T1-weighted images were not useful for this distinction. In conclusion, T2*-weighted images were better than routine T2-weighted images for distinguishing adrenal adenomas from adrenal metastases. It can be postulated that the total signal intensity of adrenal adenomas, which contain some fat components, decreased on T2*-weighted images because of an out-of-phase effect.     

MR angiography of congenital heart disease: Value of segmented two-dimensional inflow technique and maximum-intensity-projection display

Magnetic resonance (MR) angiography of the cardiovascular system was evaluated in 41 patients with congenital heart disease by using a two-dimensional (2D) inflow technique based on a magnetization-prepared gradient-echo pulse sequence with segmented k-space data acquisition and electrocardiographic gating at 0.5 T. Inversion and saturation prepulses were used to suppress stationary tissue and enhance intravascular signal. Presaturation slabs were applied where certain vascular structures had to be suppressed. Sequence parameters were optimized by evaluating signal intensity and contrast characteristics for various flip angles and inversion and saturation delay times. The heart and intrathoracic vasculature were encompassed with 40–50 overlapping sections. Both 2D angiograms and maximum-intensity-projection images were evaluated. Combining data sets acquired in the sagittal and transverse orientations provided the most satisfactory information about the pulmonary arteries. The highest signal-to-noise ratios were obtained with a flip angle of 65° and short prepulse delay times. Two-dimensional MR angiography can provide useful diagnostic information but requires a thorough understanding of in-plane and hemodynamically induced signal intensity changes.