320排动态容积CT与超声心动图评价左室射血分数的对比研究

目的：以超声心动图（2DE）为对照，应用320排动态容积CT（320CT）测量左室射血分数（EF），探讨320CT和2DE测定EF值的相关性、320CT评价左心功能的准确性及应用价值。方法：临床疑似冠心病患者68例，全部病例均行心脏320CT和2DE检查。结果：320CT和2DE测量的EF值差异无统计学意义，相关度中等、偏高，r=0.680；320CT系统自动计算的EF值大于2DE测值，320CT人工修正后测得EF稍小于2DE。320CT系统自动计算的EF值大于修正后测值，差异有统计学意义。结论：本研究显示320CT测量左室EF准确。一次320CT扫描即可兼获心脏解剖和功能信息，是一种无创、综合的心脏检查技术，极具临床应用潜力。     

64层螺旋CT与磁共振成像评价左心功能的比较研究

目的以磁共振为对照,应用64层螺旋CT(MSCT)定量评价左心功能,探讨MSCT成像技术和屏气法MRI电影技术心功能评价指标的相关性及MSCT在冠心病左心功能评价中的应用价值。方法临床拟诊冠心病的患者20例,均自愿参加。全部病例均行心脏MSCT和MRI检查。结果MSCT和MRI两种方法的心功能指标无显著性差异,两种方法的心功能指标舒张末期容积(EDV)、收缩末期容积(ESV)、每搏输出量(SV)、左室射血分数(EF)、心肌质量(MM)相关性高,r值=0.72~0.92。MSCT所测EDV、ESV、SV和MM值较MRI偏大,MSCT所测EF值较MRI偏小。结论本研究显示64层螺旋CT在左心功能定量评价方面准确、可靠,与3.0T磁共振两种方法各指标之间相关性高。一次MSCT冠状动脉成像检查,可以同时评估冠状动脉狭窄情况和左心室功能。     

Assessment of ventricular function with cardiovascular magnetic resonance

The high spatial and temporal resolution of cardiovascular magnetic resonance (CMR) images makes it well-suited for use in the assessment of right ventricular and left ventricular function in patients who have cardiovascular disorders. This article reviews CMR methods used to assess regional and global ventricular function.     

An echocardiographic and magnetic resonance imaging comparative study of right ventricular volume determination

Assessment of right ventricular volume and function is important in many clinical settings involving heart or lung disease. However, the complexity of the right ventricular anatomy has prevented accurate volume determination by two-dimensional echocardiography. In the present study, 5 models incorporating standard echocardiographic views, were used to determine right ventricular volume in 10 human subjects. Two models were contingent on the true crescentic appearance of the right ventricle, whereas the remaining 3 calculated the right ventricular volume as a pyramid, an ellipsoid or other tapering geometrical figures, respectively. Subsequently, echocardiographic right ventricular volumes were compared to magnetic resonance imaging derived volumes. Correlation analysis and agreement measurement between the echocardiographic and magnetic resonance end-diastolic volume were performed in 10 out of 10 subjects and in 9 out of 10 subjects for the end-systolic volume. The 2 crescentic models resulted in the most reliable estimation of right ventricular volume. Those findings suggest that models based on right ventricular anatomical landmarks are feasible and should be preferred in echocradiographic studies.     

Value of echocardiography using knowledge-based reconstruction in determining right ventricular volumes in pulmonary sarcoidosis: comparison with cardiac magnetic resonance imaging

The International Journal of Cardiovascular Imaging - Right ventricular (RV) dysfunction in sarcoidosis is associated with adverse outcomes. Assessment of RV function by conventional transthoracic...     

屏气快速稳态进动序列心脏磁共振成像评价右心室功能的初步研究

目的用屏气快速稳态进动（FIESTA）序列心脏磁共振（MRI）电影成像方法测量右心室容积及功能,评价其重复性及左右心室功能的相关性.方法 16例心脏病患者及10例健康志愿者共26例实验者入组,用多次屏气节段采集FIESTA心脏MRI电影获得覆盖心室的短轴像;两名观察者分别独立地测定2次所有入选者的心室容积及功能,包括射血分数（EF）、舒张末期容积（EDV）、收缩末期容积（ESV）、每搏输出量（SV）;评价①右心室功能在观察者内部及观察者间的重复性;②左右心室SV的相关性.结果①观察者内部的右心室参数具有较高可重复性：ESV（r=0.995）,EDV（r=0.998）,EF（r=0.982）,SV（r=0.995）（均P＜0.001）;②观察者间的右心室参数亦具有较高可重复性：ESV（r=0.893）,EDV（r=0.941）,EF（r=0.711）,SV（r=0.867）（均P＜0.001）;③左右心室SV显著相关（r=0.983,P＜0.001）;④右心室SV与身高相关（r=0.471,P＜0.05）.结论屏气FIESTA心脏MRI成像方法检测右心室功能参数具有较好的可重复性,该方法得出的左右心室功能有较高的一致性.     

64排螺旋CT评价右心功能的方法研究

目的 应用64排螺旋CT定量评价右心室功能,分别采用短轴图像的多平面重建法(MPR)和3D容积重建法 (VR)进行处理,并以磁共振为对照,探讨两种方法 右心功能评价指标与MR的相关性及64排螺旋CT在右心功能评价中的应用价值. 方法 30名健康成年志愿者均于24 h内接受心脏MSCT和MR检查.采用MPR、VR对CT原始数据分析后获得舒张末期容积(EDV)、收缩末期容积(ESV)、每搏输出量(SV)及射血分数(EF)等心功能指标,并与MR测得的相应指标进行相关性分析. 结果 MPR法MSCT与MRI右心功能指标差异无统计学意义(r=0.612～0.959);VR法MSCT与MRI右心功能指标相关性低(r=0.312～0.780). 结论 MPR法64排螺旋CT在右心功能定量评价方面较准确、可靠,与1.5T磁共振评价右心功能各指标之间相关性高.VR法64排螺旋CT由于右心室对比剂充盈不均准确性欠佳.     

Assessment of left and right ventricular parameters in healthy Korean volunteers using cardiac magnetic resonance imaging: change in ventricular volume and function based on age,gender and body surface area

The clinical utility of cardiac magnetic resonance imaging (CMR) is growing and is being used predominantly as a means of measuring ventricular function. The normal reference range of ventricular function may vary based on age, sex and ethnicity. At present, most CMR reference values for healthy individuals have been reported from Western countries. The intent of this study was to investigate the normal CMR reference range for left ventricular (LV) and right ventricular (RV) parameters in healthy Koreans. Healthy volunteers between the ages of 20–70 years without any history of cardiovascular disease or associated risk factors were prospectively recruited to be a part of this study. A total of 124 patients were recruited for this study. Steady-state free precession pulse sequences were used to obtain the cine images for LV and RV volume analysis. All parameters were analyzed based on age and gender, and normalized to body surface area (BSA). LV volume, mass and cardiac output were significantly greater in males than in females. However, all of these parameters which are associated with BSA and gender differences disappeared when corrected for BSA. RV volume was less in females even after the data was normalized for BSA. LV and RV volumes normalized for BSA gradually decreased with greater age, whereas the ejection fraction increased with age, thus maintaining the stroke volume index and cardiac index. LV and RV volumes, mass and function values for a healthy population largely depend on BSA and should be evaluated after normalization by BSA. LV parameters show no difference based on gender, but RV volume is less in the female. Greater age is associated with less ventricular volume, suggesting the possibility of volume sensitivity in the elderly.     

Quantification of global and regional ventricular function in cardiac magnetic resonance imaging

One of the strong assets of cardiac magnetic resonance (CMR) is its ability to assess myocardial anatomy, structure, function, flow, and perfusion within a single examination. Quantification of global and regional function from magnetic resonance imaging (MRI) studies was shown to be accurate and reproducible in experimental and clinical research studies. With the advent of high-performance MRI scanners and newly developed pulse sequences, image acquisition times have been reduced considerably in recent years. However, the clinical use of CMR remains limited for various reasons. Among these limitations is that the amount of images obtained in a typical cardiac examination is so large that visual and especially quantitative image analysis is tedious and time consuming. There is an urgent need for optimized dedicated software tools featuring highly automated contour detection and optimized display capabilities to present the quantitative results to the physician in an orderly fashion, thus facilitating clinical decision making. This article focuses on the state of the art in CMR postprocessing techniques for quantitative assessment of global and regional function.     

Value of repeated cardiac magnetic resonance imaging in patients with suspected arrhythmogenic right ventricular cardiomyopathy.

AIM: Diagnosis of early stages of arrhythmogenic right ventricular cardiomyopathy (ARVC) with minimal structural abnormalities is challenging. The purpose of this study was to assess the value of repeated cardiac magnetic resonance imaging (CMR) in patients referred for right ventricular arrhythmias and clinical suspicion of ARVC. METHODS AND RESULTS: Prospective follow-up study of 18 patients (8 females) studied with CMR for suspected ARVC. Patients with implanted defibrillators (ICD) were excluded. Mean follow-up was 37 +/- 16 (12-59) months. Patients were assigned to 2 categories (ARVC likely or ARVC unlikely) according to a CMR-score based on right ventricular abnormalities. Clinical follow-up revealed no disease progression in 17 patients (94%). In 1 patient, an ICD was implanted because of disease progression. Of 9 patients with initial findings suggestive of ARVC, follow-up CMR remained positive in 3 and was diagnosed as normal in 6, mainly due to the inability to confirm the presence of fatty infiltrates at follow-up (5 of 6 patients). Initially, 9 patients had a normal CMR and 8 of those remained normal during follow-up. CONCLUSION: Repeated CMR after an average follow-up of 3 years was normal in 6 of 9 patients with clinical findings consistent with early stages of ARVC at the time of baseline CMR. Thus, CMR diagnosis of early stage ARVC is difficult and should be made with caution.     

320排螺旋CT观察正常心脏二尖瓣

目的 探讨320排螺旋CT评价正常人心脏二尖瓣形态与功能的价值。方法 50名心脏瓣膜正常成年人接受320排螺旋CT冠状动脉检查,重建心动周期10个时相,采用各时相多平面重组(MPR)、最大密度投影(MIP)、色彩点亮技术(Colored Lit)、容积再现技术(VRT)并结合容积电影成像观察和分析二尖瓣的形态,在垂直或平行室间隔左心室长轴、双口位和左心室短轴位上测量二尖瓣长度、厚度、二尖瓣附着缘宽度、二尖瓣开口直径和面积、二尖瓣环直径和面积、二尖瓣口环直径比、面积比以及二尖瓣前后瓣开放角度。结果 二尖瓣前瓣长(25.91±4.70)mm,厚(1.97±0.05)mm和后瓣长(13.19±2.52)mm,厚(1.13±0.03)mm,二尖瓣附着缘宽度前瓣(39.14±6.84)mm、后瓣(81.50±9.90)mm,二尖瓣口直径(18.90±3.12)mm、面积(413.44±69.92)mm²,二尖瓣环直径(31.89±5.78)mm、面积(823.94±114.17)mm²,二尖瓣口环直径比为约1 ∶ 1.68,面积比约1 ∶ 1.98,二尖瓣前后瓣开放角度分别为(63.26±12.03)°和(53.54±10.35)°。结论 320排螺旋CT可定量分析二尖瓣形态特征及其运动功能。     

320排全脑动态容积CT血管造影及灌注成像在烟雾病中的应用

目的：探讨320排全脑动态容积CT血管造影及灌注成像在烟雾病中的应用价值。方法：18例烟雾病患者均行320排全脑动态容积CT扫描,并利用容积再现（VR）技术进行图像重组且采用电影模式观看,同时完成全脑灌注成像检查。结果：所有病例均获得良好的平扫容积图像、动态DSA图像及全脑灌注图像,均清晰显示发生狭窄、闭塞的颈内动脉及颅底异常血管网,其中双侧颈内动脉闭塞9例,单侧颈内动脉闭塞2例,单侧大脑中动脉闭塞7例,侧支血管表现为相应血管及其分支的粗大、增多及迂曲延长。全脑灌注图像中,显示平均通过时间（MTT）延长,为0.5~13.0s;局部脑血流量（rCBF）下降10例,降低幅度为26.0%~54.5%;局部脑血容量（rCBV）显示有8例在正常范围内,4例出现不同程度的降低（30.0%~68.5%）。结论：320排全脑动态容积CT成像可以动态观察颅内血管的形态及动态血流信息,全脑灌注图像可以量化评价烟雾病患者全脑灌注情况,真正实现了全脑一站式容积扫描,对于烟雾病的诊断和评价脑组织血供具有极高的临床应用价值。     

Assessment of myocardial delayed enhancement with cardiac computed tomography in cardiomyopathies: a prospective comparison with delayed enhancement cardiac magnetic resonance imaging

To evaluate the feasibility of cardiac CT for the evaluation of myocardial delayed enhancement (MDE) in the assessment of patients with cardiomyopathy, compared to cardiac MRI. A total of 37 patients (mean age 54.9?±?15.7 years, 24 men) who underwent cardiac MRI to evaluate cardiomyopathy were enrolled. Dual-energy ECG-gated cardiac CT was acquired 12 min after contrast injection. Two observers evaluated cardiac MRI and cardiac CT at different kV settings (100, 120 and 140 kV) independently for MDE pattern-classification (patchy, transmural, subendocardial, epicardial and mesocardial), differentiation between ischemic and non-ischemic cardiomyopathy and MDE quantification (percentage MDE). Kappa statics and the intraclass correlation coefficient were used for statistical analysis. Among different kV settings, 100-kV CT showed excellent agreements compared to cardiac MRI for MDE detection (κ?=?0.886 and 0.873, respectively), MDE pattern-classification (κ?=?0.888 and 0.881, respectively) and differentiation between ischemic and non-ischemic cardiomyopathy (κ?=?1.000 and 0.893, respectively) for both Observer 1 and Observer 2. The Bland–Altman plot between MRI and 100-kV CT for the percentage MDE showed a very small bias (?0.15%) with 95% limits of agreement of ?7.02 and 6.72. Cardiac CT using 100 kV might be an alternative method to cardiac MRI in the assessment of cardiomyopathy, particularly in patients with contraindications to cardiac MRI.     

心脏磁共振特征追踪技术评估右室心肌应变的研究进展

右室功能准确评价在多种心肺疾病的诊断分级和预后评估中的价值不断被发现.心肌应变技术逐渐发展为一项优于射血分数,且能定量分析心脏整体及局部心肌运动功能改变的方法 .本文就心脏磁共振特征追踪技术在右室心肌应变评估及预后方面的应用进行全面的总结与分析.     

心肌磁共振显像、核素心肌灌注显像和超声心动图测定左心功能的对比研究

目的评价心肌磁共振显像(MRI)、门控核素心肌灌注显像(SPECT)和超声心动图(Echo)检测急性心肌梗死(AMI)患者左心室功能的应用价值。方法AMI患者23例,分别于一周内行MRI、SPECT及Echo三项检查,测定左室舒张末期容积(EDV)、收缩末期容积(ESV)和射血分数(EF),将MRI检测结果作为标准,并与SPECT及Echo结果比较,行相关分析及一致性检验。结果MRI采用多层Simpson法,图像空间分辨率高,可以准确划分血池和心肌的界限。SPECT较MRI低估左室容积EDV15.9ml,ESV8.3ml,EF值两者大致相等。Echo较MRI低估左室容积EDV53.2ml,ESV33.0ml,高估EF5.3%。经相关分析,SPECT与MRI所测EDV、ESV、EF相关系数分别为0.79、0.84、0.84(P均<0.001),Echo与MRI所测EDV、ESV、EF相关系数分别为0.54(P<0.01)、0.43(P<0.05)、0.63(P<0.01)。经Bland-Altman一致性检验,SPECT与MRI所测左室容积及射血分数有等价性。结论MRI检测心功能准确、可靠。SPECT与MRI具有等价性。Echo左心功能测值较MRI有明显偏倚,需进一步改进检测方法以提高准确性。     

Role of cardiovascular magnetic resonance imaging in arrhythmogenic right ventricular dysplasia

Arrhythmogenic right ventricular dysplasia (ARVD) is a genetic cardiomyopathy characterized clinically by ventricular arrhythmias and progressive right ventricular (RV) dysfunction. The histopathologic hallmark is fibro-fatty replacement of RV myocardium. It is inherited in an autosomal pattern with variable penetrance. ARVD is unique in that it most commonly presents in young, otherwise healthy and highly athletic individuals. The cause of ARVD is not well-known but recent evidence suggests strongly that it is a disease of desmosomal dysfunction. The disease involvement is not limited only to the RV as left ventricle (LV) has also been reportedly affected. Diagnosis of ARVD is challenging and is currently based upon a multi-disciplinary work-up of the patient as defined by the Task Force. Currently, implanted cardioverter defibrillators (ICD) are routinely used to prevent sudden death in patients with ARVD. Cardiovascular MR is an important non-invasive diagnostic modality that allows both qualitative and quantitative evaluation of RV. This article reviews the genetics of ARVD, current status and role of CMR in the diagnosis of ARVD and LV involvement in ARVD.     

Left ventricular wall thickness in patients with hypertrophic cardiomyopathy: a comparison between cardiac magnetic resonance imaging and echocardiography

We assessed whether cardiac MRI (CMR) and echocardiography (echo) have significant differences measuring left ventricular (LV) wall thickness (WT) in hypertrophic cardiomyopathy (HCM) as performed in the clinical routine. Retrospectively identified, clinically diagnosed HCM patients with interventricular-septal (IVS) pattern hypertrophy who underwent CMR and echo within the same day were included. Left Ventricular WT was measured by CMR in two planes and compared to both echo and contrast echo (cecho). 72 subjects, mean age 50.7 ± 16.2 years, 68 % males. Interventricular septal WT by echo and CMR planes showed good to excellent correlation. However, measurements of the postero-lateral wall showed poor correlation. Bland–Altman plots showed greater maximal IVS WT by echo compared to CMR measurement [SAX = 1.7 mm (?5.8, 9.3); LVOT = 1.1 mm (?5.6, 7.8)]. Differences were smaller between cecho and CMR [SAX = 0.8 mm (?9.2, 10.8); LVOT = ?0.2 mm (?10.0, 9.6)]. Severity of WT by quartiles showed greater differences between echo and SAX CMR WT compared to cecho. Echocardiography typically measures greater WT than CMR, with the largest differences in moderate to severe hypertrophy. Contrast echocardiography more closely approximates CMR measurements of WT. These findings have potential clinical implications for risk stratification of subjects with HCM.     

Advances in cardiac CT imaging: 64-slice scanner

Background: Clinical progress by the development of multi-slice CT (MSCT) technology beyond 16 slices can more likely be expected from further improved spatial and temporal resolution rather than from a mere increase in the volume coverage speed. We present an evaluation of a recently introduced 64-slice CT (64SCT) system, which makes use of a periodic motion of the focal spot in the longitudinal direction (z-flying focal spot) to double the number of simultaneously acquired slices. Materials and Methods: A recently introduced 64SCT system (SOMATOM Sensation 64, Siemens Medical Solutions, Forchheim, Germany) is being described and tested in first clinical practice, applying the following parameters: z-flying focal spot technology, 64×0.6 mm slices; spatial resolution, 0.4 × 0.4 × 0.4 mm; gantry rotation time, 330 ms; temporal resolution, 83–165 ms. Various phantom studies and first clinically implemented protocols are being described, to evaluate the full spectrum of possible applications for this scanner type, with a focus on cardiac imaging. Results:ECG-gated cardiac scanning with this 64-slice CT system benefits clearly from both the improved temporal resolution and improved spatial resolution. These benefits enable a more reliable assessment of mixed plaques, due to reduced partial-voluming and beam-hardening artefacts caused by calcifications, and holds great promise for the reliable assessment of in-stent stenoses, as stent lumen visibility is clearly improved as compared to earlier MSCT systems. With the increased volume coverage and acquisition speed of the 64SCT system, a comprehensive emergency protocol of the thorax becomes feasible within an acceptable breath-hold time, performing an ECG-gated CT angiography of the complete thoracic vasculature. This protocol enables a detailed assessment of the thoracic aorta, the pulmonary arteries and the coronary arteries in one single examination. Conclusion:64SCT Cardiac imaging provides an increased spatial resolution with an isotropic voxel size of 0.4 mm and an improved temporal resolution of 83–165 ms. These benefits hold great promise especially for fast-moving organs requiring detailed imaging, such as the heart and coronary arteries.