糖尿病左心房内径容积的超声观测研究

目的用二维超声观测研究糖尿病（DM）左心房内径（LAD）容积,以了解DM左心房（LA）增大的发病率、左心房增大与糖尿病的关系。方法对200例DM患者及200例正常人进行胸骨旁左室长轴观、心尖四腔观,测量左房前后径、左右径、上下径,计算LA容积,测量左室内径、LV壁厚度及主动脉内径等。结果146例（73％）DM患者左房增大（LAH）．99例（49．50％）左室肥厚（LVH）,单纯LAH者年龄为（60．56±11．92）岁．LVH者年龄为（62．17±10．08）岁。结论DM患者LAH比LVH出现早,发生率高。认为LAH既是DM早期心脏并发症,又是DM血流动力学改变指标之一。加强DM患者LAD的超声研究．对尽早防治DM心脏并发症有着积极的临床意义。     

超声心动图评价类风湿性关节炎患者左房功能

目的：应用超声心动图评价类风湿性关节炎患者左房功能改变。方法：选取73例病程〉4年的RA患者及20例正常对照,应用二维超声心动图测量左房最大容积、左房最小容积和左房P容积,用体表面积对各容积值进行变标化后,得到左房最大容积指数,左房最小容积指数,左房P容积指数,计算左房容积指数、左房被动射血容积指数、左房主动射血容积指数、左房射血分数、左房被动射血分数、左房主动射血分数。结果：与对照组相比,RA组左房最大容积指数、左房P容积指数、左房容积指数、左房主动射血容积指数、左房主动射血分数增加;左房被动射血容积指数、左房被动射血分数减低,差异均有显著性意义（P〈0.05）。结论：RA患者左房功能明显降低,超声心动图为早期发现RA患者左房收缩功能改变提供了一种敏感无创的方法。     

运动与心脏左房增大

作者根据４２２例运动员超声心动图检查，讨论影响左房增大的因素、机制和临床意义。结果表明运动员心脏左房内径不超过４０ｍｍ，男大于女，年龄大者大于年轻的，耐力运动员大于其他项目运动员，训练年限长者大于初集训者，强化训练后出现一过性左房增大，二尖瓣病变者更易发生左房增大。左房增大与运动时回心血量增多及左室顺应性下降有关。     

气管隆凸角(TCA)与左心房大小

通过对TCA(经胸片测得)与左房径线(经超声心动测量)的对比研究,首次发现TCA能反映左房扩大与否及其程度。共观察70例病人,男37例女33例,年龄18～87岁,其中35例经超声心动确定左房增大(左房>4.5cm即认为异常),另35例与前者行年龄配对,其左房正常(左房<4.0cm)。TCA为两侧主支气管轴线之交角,由一不知超声心动结果者用量角仪测量此角。受试者的胸片是随机抽取立位或卧位片,90%胸片均清楚到可以测量TCA。将TCA值与超声测得左房径线绘成点图以确定两者间的关系。作者发现,若TCA≥90°即可认为左房扩大、两者相关系数r=0.746(P<0.001)。     

特征追踪心脏MRI定量评估非梗阻性肥厚型心肌病左房功能的应用研究

【摘要】目的：应用特征追踪心脏MRI（FT-cMRI）对非梗阻性肥厚型心肌病（NOHCM）患者进行左房应变分析来评估左心房功能,并探究NOHCM对左心结构和功能的影响。方法：回顾性分析2020年1月-2022年12月本院58例非梗阻性肥厚型心肌病患者（NOHCM组）和30例健康对照者（HC组）的临床和MRI资料。MRI扫描序列主要为单次激发FSE亮血序列,扫描平面包括两腔、四腔和短轴位。应用CVI42软件测量左房容积指数（LAVI）和左房整体功能参数,后者包括心肌储备功能参数［总应变（εs）、峰值正向应变率（SRs）、左房总射血分数（LATEF）］、导管功能参数［主动应变（εe）、峰值早期负向应变率（SRe）、左房被动射血分数（LAPEF）］和升压泵功能参数［被动应变（εa）、峰值晚期负向应变率（SRa）、左房主动射血分数（LAAEF）］,以及左室的功能［左室射血分数（LVEF）、左室心输出量（LVCO）和左室心脏指数（LVCI）］和大小参数［左室最大室壁厚度（LVWTmax）、左室心肌质量（LVM）、左室质量指数（LVMI）、左室舒张末期容积指数（LVEDVi）和左室收缩末期容积指数（LVESVi）］。采用两样本t检验、Mann-Whitney U检验等统计学方法比较两组间各项定量参数值的差异,并采用Pearson或Spearman相关系数分析左房功能参数与左室的结构和功能参数之间的相关性。结果：NOHCM组的LVWTmax、LVM、LVMI和LAVI值均显著高于HC组（P<0.05）,NOHCM组的左房功能参数值（LATEF、LAPEF、LAAEF、εs、εe、εa,SRs、SRe和SRa）均显著低于HC组（P<0.05）。NOHCM组左室心肌不同肥厚部位的LVWTmax的差异有统计学意义（P<0.05）,两组之间其它的左房、左室结构和功能参数值的差异无统计学意义（P>0.05）。左房大小正常的NOHCM患者的LATEF、LAPEF、εs、εe、SRs和SRe值均显著低于HC组（P<0.05）,而LAAEF、εa和SRa值在两组之间的差异无统计学意义（P>0.05）。所有受试者的LATEF与εs、LAPEF与εe、LAAEF与εa之间均具有显著相关性（r>0.70）。结论：与健康对照组相比,NOHCM患者各时相左房功能均下降。在左房增大之前,左房的心肌储备和导管功能下降,而升压泵功能正常。各时相左房功能受损与左室的肥厚部位无显著相关性。各时相左房的LAEF与各项应变参数之间具有较强的相关性。     

不同年龄阶段单纯继发孔型房间隔缺损患者 心脏腔室内径与临床症状变化特征

目的分析不同年龄阶段单纯继发孔型房间隔缺损患者的临床资料,总结伴随年龄增长,房间隔缺损患者心脏腔室内径与其临床症状的变化特征。方法将北部战区总医院自2017年1月至2019年4月收治的213例单纯继发孔型房间隔缺损患者纳入患病组,其中,未成年患者(年龄<18岁)141例,成年患者72例;另将同期141例心脏超声正常的未成年人纳入正常组。再根据人体生长发育阶段,将研究对象分入年龄<1岁婴儿期组、1～3岁幼儿期组、4～6岁学龄前期组、7～12岁学龄期组、13～17岁青春期组、18～40岁青年组、41～65岁中年组、年龄>65岁老年组。比较正常组和患病组不同年龄阶段的心脏腔室内径及其临床症状、心房颤动发生情况。结果 1～3岁幼儿期、4～6岁学龄前期、7～12岁学龄期、13～17岁青春期时,患病组右房舒张期最大横径、右室舒张期最大内径均大于正常组,差异有统计学意义(P<0.05);4～6岁学龄前期、7～12岁学龄期、13～17岁青春期时,患病组左室舒张末期内径均小于正常组,差异有统计学意义(P<0.05)。41～65岁中年患病组、年龄>65岁老年患病组左房舒张期最大内径均高于正常成年人,且年龄>65岁老年患病组高于41～65岁中年患病组,差异有统计学意义(P<0.05)。18～40岁青年患病组、41～65岁中年患病组、年龄>65岁老年患病组左室舒张末期内径与正常成年人比较,差异均无统计学意义(P>0.05)。18～40岁青年患病组、41～65岁中年患病组、年龄>65岁老年患病组右房舒张期最大横径、右室舒张期最大内径均高于正常成年人,差异有统计学意义(P<0.05)。18～40岁青年患病组、41～65岁中年患病组、年龄>65岁老年患病组的临床症状发生率均高于年龄<18岁患病组,且随着年龄增长,临床症状发生率呈上升趋势,组间比较,差异均有统计学意义(P<0.05)。41～65岁中年患病组、年龄>65岁老年患病组的心房颤动发病率均高于年龄<41岁患病组,且随着年龄增长,心房颤动发病率呈上升趋势,组间比较,差异有统计学意义(P<0.05)。结论随着年龄增长,单纯继发孔型房间隔缺损患者逐渐出现心腔内径增大并超过正常人群标准值。病变最初单纯累及右房、右室,之后进展至累及左房,导致左房、右房、右室同时增大,但左室舒张末期内径无明显增大。且随着年龄增长,临床症状和心房颤动的发生率也明显升高。     

3D MIA DICOM数据分析软件对心腔容积定量评估的准确性分析

目的 评价3D MIA DICOM数据分析软件对心腔容积定量评估的准确性.材料与方法对10个新鲜猪心和10例经心脏超声检查后的住院患者行64排螺旋CT心脏扫描,采用3D MIA DICOM数据分析软件分析并测量猪心的右心室容积和患者左室心腔容积,分析3D MIA DICOM数据分析软件测昔值与猪心实际容积和人体心脏超声测量值之间的相关性.结果 3D MIA DICOM软件所测猪心的右室容积和人体心脏舒张末期左室容积与物理测量值及心脏超声测量值之间具有很好的相关性(r1=0.94,r2=0.97),Altman and Bland一致性分析表明二者具有高度的一致性.结论 3D MIA DICOM数据分析软件为定量分析心腔容积提供了一种无创、简单可行且准确町信的新方法.     

冠心病左房增大的临床意义

随着超声心动图的广泛应用,冠心病左房增大的检出率明显增高。作者通过超声心动图测定冠心病111例左房的大小,探讨左房增大对冠心病诊断及病情估计的临床意义。1　对象和方法1.1　对象　111例均为住院病人,诊断符合1979年冠心病诊断参考标准。男103例,女8例;年龄31～78岁,平均60.3±9岁,≥60岁者65例,占58.6%,<60岁46例,占41.4%。伴陈旧性心肌梗死60例,占54.5%;心力衰竭35例,占31.5%,心房纤颤20例,占18.02%。除外伴高血压病及其他心脏病的患者。本组依病情轻重分为3级:1级:不伴心肌梗死、心衰、房颤3项中的任何一项;2级:伴有上述3项中的1～2…     

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...     

彩色多普勒超声诊断右房巨大粘液瘤1例

粘液瘤常发生在左房,我们近期用彩色多普勒超声诊断了1例右房巨大粘液瘤。经手术证实,报告如下: 病例:男,20岁.胸闷、运动后气促2个月就诊。体征:胸骨左缘3～4肋间闻及Ⅱ～Ⅲ级双期杂音,临床考虑为风心病。心脏彩色多普勒超声检查:右室右房增大,心尖四腔及右     

Quantification of coronary low-attenuation plaque volume for long-term prediction of cardiac events and reclassification of patients

BackgroundTo investigate the incremental prognostic value of low-attenuation plaque volume (LAPV) from coronary CT angiography datasets.MethodsQuantification of LAPV was performed using dedicated software equipped with an adaptive plaque tissue algorithm in 1577 patients with suspected CAD. A combination of death and acute coronary syndrome was defined as primary endpoint. To assess the incremental prognostic value of LAPV, parameters were added to a baseline model including clinical risk and obstructive coronary artery disease (CAD), a baseline model including clinical risk and calcium scoring (CACS) and a baseline model including clinical risk and segment involvement score (SIS).ResultsPatients were followed for 5.5 years either by telephone contact, mail or clinical visits. The primary endpoint occurred in 30 patients. Quantified LAPV provided incremental prognostic information beyond clinical risk and obstructive CAD (c-index 0.701 vs. 0.767, p < .001), clinical risk and CACS (c-index 0.722 vs. 0.771, p < .01) and clinical risk and SIS (c-index 0.735 vs. 0.771, p < .01. A combined approach using quantified LAPV and clinical risk significantly improved the stratification of patients into different risk categories compared to clinical risk alone (categorical net reclassification index 0.69 with 95% CI 0.27 and 0.96, p < .001). The combined approach classified 846 (53.6%) patients as low risk (annual event rate 0.04%), 439 (27.8%) patients as intermediate risk (annual event rate 0.5%) and 292 (18.5%) patients as high risk (annual event rate 0.99%).ConclusionQuantification of LAPV provides incremental prognostic information beyond established CT risk patterns and permits improved stratification of patients into different risk categories.     

MR image segmentation using vector decomposition and probability techniques: A general model and its application to dual-echo images

A general model is developed for segmenting magnetic resonance images using vector decomposition and probabilfty techniques. Each voxel is assigned fractional volumes of q tissues from p differently weighted images (q ≤ p + 1) in the presence of partial-volume mixing, random noise, and other tissues. Compared wtth the eigenimage method, fewer differently weighted images are needed for segmenting the q tissues, and the contrast-to-noise ratio in the calculated fractional volumes is improved. The model can produce com-posrte tissue-type images similar to that of the probability methods, by comparing the fractional volumes assigned to different tissues on each voxel. A three-tissue (p = 2, q = 3) model is illustrated for segmenting three tissues from dual-echo images. M provides statistical analysis to the algebraic method. A three-compartment phantom is segmented for validation. Two clinical examples are presented.     

A simple technique for producing cast specimens of the cardiac ventricles

In a convenient method, a methacrylate dental plastic, Kallocryl C, was used to make cast specimens of both ventricles of man. The casts are suitable for use in comparative measurements and highly accurate determinations of ventricular volumes.     

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.     

Extradural hematomas: Measurement of size by volume summation on CT scanning

Summary The method of volume summation (V = T(A₁ + A₂...A_n ) was used to measure the size of extradural hematomas. The accuracy was tested on six different artificial silicone hematomas and the mean difference was-2.7 ml, SD 3.7 ml. The reproducibility was tested on CT scans of clinical hematomas, SD was 2.1 ml. An empirical formula for volume estimation then found: 0.5xheightxlengthxdepth was moderately reliable, while midline shift and vesselfree space were poor indicators of size. In conclusion, the volume summation with manual outlining was found to be highly accurate, but the problems of CT smoothing, spectral shift artifact, partial volume effect and separation of the hematoma from other structures must be considered.     

Quantification of mitral regurgitation with MR phase-velocity mapping using a control volume method

Reliable diagnosis and quantification of mitral regurgitation are important for patient management and for optimizing the time for surgery. Previous methods have often provided suboptimal results. The aim of this in vitro study was to evaluate MR phase-velocity mapping in quantifying the mitral regurgitant volume (MRV) using a control volume (CV) method. A number of contiguous slices were acquired with all three velocity components measured. A CV was then selected, encompassing the regurgitant orifice. Mass conservation dictates that the net inflow into the CV should be equal to the regurgitant flow. Results showed that a CV, the boundary voxels of which excluded the region of flow acceleration and aliasing at the orifice, provided accurate measurements of the regurgitant flow. A smaller CV provided erroneous results because of flow acceleration and velocity aliasing close to the orifice. A large CV generally provided inaccurate results because of reduced velocity sensitivity far from the orifice. Aortic outflow, orifice shape, and valve geometry did not affect the accuracy of the CV measurements. The CV method is a promising approach to the problem of quantification of the MRV.     

Can left ventricular end-diastolic volumes be estimated with prospective ECG-gated CT coronary angiography?

Background

With the goal of minimizing patient radiation exposure, many centres have adopted prospective ECG-gated computed tomographic coronary angiography. Since image acquisition occurs only during ventricular diastasis, the ability to measure left ventricular (LV) ejection fraction (EF) and LV volumes has been lost. Given that LV volumes have prognostic value, the ability to estimate LV end diastolic volume (EDV) may be clinically desirable.

Objective

We sought to predict LV EDV using CT coronary angiography (CTA) images obtained during ventricular diastasis.

Methods

Consecutive patients who underwent retrospective ECG-gated CTA were enrolled. Images were reconstructed at the 75% phase and at end-diastole. LV and left atrial (LA) volumes were measured.

Results

A total of 153 consecutive patients were analyzed (mean age = 56.7 ± 11.2 years; men = 56.2%). The mean LV EDV and EF were 144.4 ± 40.2 mL and 63.4 ± 9.9%, respectively. There appeared to be a very strong linear relationship between the 75% phase LV volume and LV EDV with an R² of 0.993. Using LV and LA volumes at the 75% phase, a prediction model of LV EDV was developed (LV EDV = (1.021 × 75% phase LV volume) + (0.259 × 75% phase LA volume), adjusted R² = 0.995).

Conclusion

LV EDV can be estimated using CTA data obtained during ventricular diastasis. Further studies are needed to demonstrate that such estimates of LV EDV have incremental prognostic value over coronary artery disease severity assessment with prospective ECG-gated CTA.     

基于四分位距值的调强放疗计划剂量体积直方图分析

目的 提出一种基于四分位距值的调强放射治疗（IMRT）计划靶区及危及器官剂量体积直方图（DVH）差异分析方法。方法 回顾分析22例宫颈癌IMRT计划,将靶区和危及器官（膀胱、直肠和左右股骨头）5组DVH曲线从Pinnacle³计划系统中导出,对每组DVH曲线求出平均DVH曲线和四分位距值曲线。结果 计划靶区DVH在54.03 Gy处差异最大,四分位距值为6.95%,处方剂量包绕的靶区体积为（96.43±1.63）%。膀胱DVH在17.24 Gy处差异最大,四分位距值为14.62%,V₄₀和V₃₀分别为（32.79±7.06）% 和（56.47±9.94）%。直肠DVH在35.92 Gy处差异最大,四分位距值为19.94%,V₄₀和V₃₀分别为（30.17±10.80）%和（58.16±11.99）%。膀胱与直肠的四分位距值差异有统计学意义（z=-6.59, P<0.05）。左侧股骨头DVH在16.06 Gy处差异最大,四分位距值为31.47%。右侧股骨头DVH在17.47 Gy处差异最大,四分位距值为32.82%,左右股骨头间的四分位距值间差异无统计学意义（P>0.05）。结论 四分位距值曲线可以分析靶区和危及器官DVH曲线的变化趋势,为自动计划优化参数设置提供指导。     

The Voxel Sensitivity Function in Fourier Transform Imaging: Applications to Magnetic Resonance Angiography

In this paper the problem of small structure visualization in magnetic resonance imaging (MRI) is considered. The relationship between the structure and the image intensities is defined in terms of the voxel sensitivity function (VSF). Using the VSF, the spatial dependence of the voxel signal for small spheres and cylinders is computed. Although the spatial fluctuation is smaller in the MRI VSF than that which would be obtained from a uniformly sensitive cubical voxel, the deviation still results in significant signal loss near the edges and corners of the voxels. Finally, the VSF formalism is used to demonstrate the improvement in signal uniformity that can be obtained by using zero-filled (band-limited or sinc) interpolation.