超声诊断限制性心肌病1例

<正>患者女,10余天前活动后出现胸痛,休息可缓解。在外院行心脏彩色超声检查,诊断为心力衰竭,扩张性心肌病。入我院后行心脏超声心动图检查,显示:左房前后径48mm,左右径51mm,上下径86mm;右房左右径62mm(图1);左室舒张末期前后径48mm。彩色多普勒:二尖瓣和三尖瓣口均可见蓝色反向血流信号(图2)。频谱多普勒:二尖瓣口血流频谱:E峰:1.11m/s,A峰:0.14m/s,二尖瓣E/A约为8.0,等容舒张时间61ms;三尖     

血浆心钠素与多普勒超声心动图检测左室舒张功能的对比研究

探讨血浆心钠素浓度与多普勒超声心动图检测的左室舒张功能改变的相互关系，用二维，M型和多普勒超声获得心脏各腔室径，容量及二尖瓣，肺静脉血流多普勒参数，根据二尖瓣与肺静脉血流多普勒参数将86例冠心病，高血压病人按左室舒张功能受损程度分类。同时用放免法检测血浆心钠素水平。结果发现，左室舒张功能受损后血浆心钠素水平明显升高，其不家度水平与左室舒张功能受损程度成正比，血浆心钠素水平与反映左室舒张功能的心脏超声指标LAD，E／A，IVRT，DT，AT，S／D及其相关指标LVDd,LVDs,EDV,ESV,LVEF,LVFS明显相关。提示血浆心钠素浓度可作为评价左室舒张功能受损程度的一个有意义的指标。     

超声心动图对不同主动脉瓣病变患者主动脉瓣置换前后左室功能变化评估价值研究

目的 探讨超声心动图对不同主动脉瓣病变患者主动脉瓣置换(AVR)前后左室功能变化的评估价值。方法 选取北部战区总医院2019年1—12月收治的行单独AVR的主动脉瓣疾病患者61例为研究对象,其中,主动脉瓣狭窄(AS)28例(AS组),主动脉瓣关闭不全(AI)33例(AI组)。比较AS组和AI组术前、术后1周、术后1年的超声心动图指标,包括左房前后径、室间隔厚度、左室舒张末期内径、左室后壁厚度、二尖瓣舒张早期峰速(E)/二尖瓣瓣环侧壁舒张早期峰速(e’)、左室射血分数及肺动脉收缩压。结果 (1)AS组：与术前比较,术后1周的室间隔厚度、左室舒张末期内径、左室后壁厚度、肺动脉收缩压降低,术后1年的左房前后径、室间隔厚度、左室舒张末期内径、左室后壁厚度、E/e’、肺动脉收缩压降低且左室射血分数升高,差异有统计学意义(P<0.05);与术后1周比较,术后1年的左房前后径、左室后壁厚度、肺动脉收缩压降低且左室射血分数升高,差异有统计学意义(P<0.05)。(2)AI组：与术前比较,术后1周、术后1年的左房前后径、室间隔厚度、左室舒张末期内径、左室后壁厚度、E/e’、肺动脉收缩压降低且...     

射血分数正常心力衰竭的超声心动图指标与中医辨证分型的相关性研究

目的:探讨射血分数正常心力衰竭(heart failure with normal ejection fraction,HFNEF)患者中医辨证分型与超声心动图指标的相关性。方法:将我院收治的118例HFNEF患者分为心气阴虚证、心肾阳虚证、气虚血瘀证、阳虚水泛证4组,对各证型的超声心动图指标及实验室指标血浆B型钠尿肽(BNP)数据行统计学分析。结果:HFNEF患者各证型的年龄和心功能分级构成比差异有统计学意义,心气阴虚证、心肾阳虚证、气虚血瘀证、阳虚水泛证4组心功能呈逐渐减低趋势;各证型患者均有心脏收缩和舒张功能的异常,其中左房容积指数、二尖瓣环收缩期平均速度(s’mean)、二尖瓣环舒张晚期峰值速度(a’mean)、舒张早期二尖瓣口血流速与二尖瓣环平均速度比(E/e’mean)和血浆B型钠尿肽差异有统计学意义(P0.05)。结论:HFNEF的中医证型与超声心动图指标及血浆BNP具有一定的相关性,超声心动图可作为中医辨证分型的客观量化指标。     

超声心动图参数对单纯左室舒张性心衰的疗效观察

目的探讨可靠反映左室舒张功能改善状况的超声心动图指标,以评价临床治疗效果。方法参照2014年中国慢性心力衰竭诊断及治疗指南,选择60例单纯左室舒张性心衰患者,心功能分级为II级和III级,临床治疗4周后,观察二尖瓣口血流频谱、二尖瓣环组织多普勒频谱和左心房容积变化指数的变化,并对比临床B型脑钠肽指标和临床综合心功能改善情况。结果综合临床指标评价心功能,治疗总有效率81.7%,超声指标的变化:E/E’治疗前14.03±2.29,治疗后9.76±1.69,P值=0.000,有显著统计学意义;左房容积指数治疗前(46.36±5.06)ml/m2,治疗后(36.70±3.17)ml/m2,P值=0.000,有显著统计学意义。结论超声心动图检测二尖瓣E/E’比值和左房容积指数的变化可以作为临床评价单纯左室舒张性心衰治疗效果的敏感指标。     

超声心动图检查在评价乳腺癌化疗后左心功能中的价值研究

目的探讨超声心动图检查在评价乳腺癌化疗后左心功能中的价值。方法选取2019年7月至2021年6月在我院接受4个周期(T₁~T₄)以阿霉素为主化疗方案治疗的60例乳腺癌患者为研究对象,每个化疗周期后进行超声心动图检查,对比T₁~T₄后二维超声心动图参数[左心室收缩末期内径(LVDs)、左心室舒张末期内径(LVDd)、左心室射血分数(LVEF)、二尖瓣舒张早期最大血流速度/二尖瓣舒张晚期最大血流速度(E/A)、左心室后壁舒张末期厚度(LVPWT)、室间隔舒张末期厚度(IVST)]及左心房三维参数[左心房收缩末期容积(LAVmin)、左心房舒张末期容积(LAVmax)、左心房主动收缩前容积(LAVprep)]。结果化疗T₁~T₄后的LVDs、LVDd、LVEF、E/A、LVPWT、IVST相比,差异无统计学意义(P>0.05)。化疗T₂~T₄后的LAVmin、LAVmax、LAVprep均高于T₁后,差异有统计学意义(P<0.05)。结论实时三维超声心动图可早期发现乳腺癌化疗药物引发的左心功能变化,有助于为临床及时调整用药方案提供参考。     

负荷条件下二尖瓣环DTI舒张期部分位点波形改变的意义

目的 探讨负荷超声心动图条件下二尖瓣环多普勒组织成像部分位点舒张期波形改变的临床意义.方法 观察对象68人,负荷超声心动图的药物负荷为多巴酚丁胺,取多普勒组织成像条件.入选标准:根据负荷试验后二尖瓣环处4个多普勒组织成像测量位点波形e/a＞或≤1.0改变的点位数在1～3处者.结果 冠状动脉造影证实本组68例患者中39例的冠状动脉有1支以上分支的管腔狭窄≥50%,冠心病的发病率为57.4%.负荷条件下舒张期二尖瓣环处4个取样点多普勒组织成像波形的改变可分为两组:Ⅰ组是试验前部分波形e/a≤1.0的测点,试验后转为＞1.0,即部分位点的波形向正常人转变,称之为波形改善组;本组共19例,冠状动脉造影阳性7例、阴性12例,分别占36.84%、63.16%.Ⅱ组是试验前部分波形e/a＞1.0的测点,试验后转为≤1.0,即部分位点的波形向异常人转变,称之为波形变差组;本组共49例,冠状动脉造影阳性32例、阴性17例,分别占65.31%、34.69%.结论 试验后部分位点转为e/aann≤1.0组的冠状动脉造影阳性率明显高于试验后部分位点转为e/aann＞1.0组(P＜0.05),多巴酚丁胺负荷超声心动图使得安静状态下较潜隐局部左室舒张功能的损害改变得以较明确的显示.因此,多巴酚丁胺负荷超声心动图条件下,二尖瓣环部分位点舒张期e/aann的改变,尤其是出现由e/aann＞1.0转向e/aann≤1.0时,应提示有冠状动脉病变的可能性较大.     

左室内舒张期血流传播速度评价房颤患者左室舒张功能

目的:探讨彩色多普勒超声心动图诊断房颤患者左室舒张功能障碍的价值.材料和方法:心脏病患者24例(孤立性房颤8例,高血压性心脏病合并房颤7例,扩张性心肌病合并房颤9例),对照组30例.取心尖四腔观,将多普勒取样容积置于二尖瓣口以及距二尖瓣口1、2、3cm处,测量二尖瓣血流E峰流速,计算舒张早期血流播散的速度.结果:对照组左室舒张早期血流速度保持不变.各种心脏病患者左室舒张早期血流速度随传播距离加大而递减.结论:左室舒张早期血流的传播速度,是评价房颤及二尖瓣血流频谱假性正常化者左室舒张功能障碍的方法.     

组织多普勒成像技术评价冠心病心肌梗死后左室整体功能

 目的 应用超声心动图对冠心病心肌梗死患者进行检测,寻找与左室功能相关性良好的指标以利于临床评估.方法 对经临床及冠状动脉造影确诊的心肌梗死(1～6个月)患者68例行多普勒超声心动图检查.根据其二尖瓣口血流频谱形态将患者分为3组:左室松弛性减低组、假性正常化组、限制性充盈组;又根据心脏射血分数(ejection fraction,EF)值将患者分为两组:EF≥50％,EF＜ 50％,将各多普勒超声心动图参数在各组对比分析.结果 随着心脏舒张功能障碍的进展,运用组织多普勒技术(TDI)测得的二尖瓣环舒张早期峰值速度(Ea)及其与舒张晚期峰值速度(Aa)的比值Ea/Aa降低(P＜0.01),其差别尤其表现在对照组与左室松弛性减低组及其与假性正常化组之间(P＜0.01).在正常对照组、冠心病心肌梗死EF正常组及冠心病心肌梗死EF减低组TDI测得的二尖瓣环收缩期峰值速度Sa、Ea及Ea/Aa比值呈逐渐降低趋势(P＜0.01).而且Spearman相关分析表明:Ea值及Ea/Aa比值与左室舒张功能障碍分级相关性良好,Sa与EF值相关性良好.结论 冠心病心肌梗死患者出现左室舒张功能障碍常先于左室收缩功能障碍,TDI测得的Ea及Ea/Aa比值可用于鉴别左室舒张功能的假性正常化;TD1测得的Sa可作为评估冠心病心肌梗死患者左室收缩功能的重要参数.     

组织多普勒超声显像评价左室舒张功能的临床价值

目的:探讨组织多普勒超声显像技术(TDI)评价左室舒张功能的临床价值。方法:对冠状动脉粥样硬化性心脏病30例(冠心病组),及正常人25例(对照组),应用TDI检测二尖瓣环运动频谱,对舒张晚期的峰值(Aa)和舒张早期的峰值速度(Ea)进行检测,最后把两者测量结果进行比较。应用脉冲多普勒技术(PD)检测二尖瓣口血流频谱,测量舒张早期峰值流速(E峰)和舒张晚期峰值流速(A峰),并计算两者比值(E/A),评价左室舒张功能。结果:冠心病组30例均出现二尖瓣环运动频谱异常,其中19例表现为弛张异常型舒张功能减低,8例Ea明显减小,即二尖瓣环运动频谱表现为限制异常型舒张功能减低,与对照组比较,差异有统计学意义(P<0.05);而二尖瓣口血流频谱异常共30例,包括弛张异常型舒张功能减低和18例E峰明显高于A峰,E/A≥2(表现为限制异常型舒张功能减低),与对照组比较差异有统计学意义(P<0.05)。冠心病组有11例二尖瓣口血流频谱与对照组相似,E/A为1～2(表现为假性正常化)。结论:TDI检测二尖瓣环运动频谱比PD检测二尖瓣口血流频谱对左室舒张功能更有效,二者结合应用可明显提高左室舒张功能检测的准确性。     

表阿霉素和紫杉醇单用或联合使用对乳腺肿瘤细胞ZR75-1的体外细胞毒性

目的观察表阿霉素联合紫杉醇方案对乳腺肿瘤细胞的增殖抑制作用。方法采用结晶紫染色法,比较表阿霉素及紫杉醇单用及联合应用对乳腺癌细胞ZR75-1的增殖抑制率。结果 1 mg·ml-1表阿霉素和3 mg·ml-1紫杉醇联合作用40 h,其联合效应Q值为0.935。结论 1 mg·ml-1表阿霉素和3 mg·ml-1紫杉醇联合应用40 h对ZR75-1细胞的增殖抑制具有相加作用。     

Evaluation of 1H-magnetic resonance spectroscopy of breast cancer pre- and postgadolinium administration

OBJECTIVES: We sought to evaluate spectroscopic measurements in breast cancer and compare variability in choline peak parameters related to contrast administration versus that inherent to repeated measurements. MATERIALS AND METHODS: Single-voxel, proton spectroscopy measurements were obtained before and after the administration of gadolinium on 15 patients with > or = 1-cm breast cancers. The protocol was repeated on a separate day in 7 patients. RESULTS: Postcontrast spectra demonstrated a significant increase in choline peak linewidth (day 1: 15% +/- 21%, P = 0.03; day 2: 19% +/- 12%, P = 0.001) and decrease in choline peak area (day 1: 11% +/- 9% (P < 0.001); day 2: 18% +/- 21% (P = 0.03). A variance-components analysis indicated that day-to-day variation in linewidth accounted for 0.0% of the total variation in width measurements and was not significant (P = 0.85). Day-to-day variation in area was also not significant (0.0%, P = 0.95). CONCLUSIONS: Contrast administration caused significant increases in choline peak linewidth and decreases in choline peak area in spectroscopic measurements of breast cancer.     

多西他赛与表柔比星联合或序贯化疗治疗局部晚期乳腺癌临床观察

目的：评估多西他赛与表柔比星的化学药物治疗（化疗）组合对局部晚期乳腺癌（ locally advanced breast cancer , LABC）的预后影响。方法回顾分析沈阳军区总医院2009-01至2012-12接受新辅助化疗（ neoadjuvant chemotherapy ,NACT）的120例LABC患者,收集入选患者的基本信息、临床分期、雌激素和孕激素受体状态等指标。联合用药方案（联合组）为6个DEC周期（每周第1、3天联合使用多西他赛75 mg/m2,表柔比星75 mg/m2,环磷酰胺500 mg/m2）;序贯用药方案（序贯组）为4个FEC周期（5-氟尿嘧啶600 mg/m2,表柔比星75 mg/m2,环磷酰胺600 mg/m2）,以及4个多西他赛（85 mg/m2）周期。统计两组患者的临床和病理缓解情况、复发时间及3年生存率。结果患者平均年龄46岁。 T4期肿瘤患者96例（80％）,其中90％可触及淋巴结。原发肿瘤平均大小为5．9 cm。激素受体阳性患者占55％,HER2阳性患者占25％,三阴乳腺癌患者占25％。两组中临床完全或部分缓解的有100例,占83％,疾病稳定15例,疾病进展5例;病理缓解18例,占15％。两种给药方式所获得的临床及病理缓解率无统计学差异。随访期平均为22个月,平均复发时间20个月,3年无复发病例占50％,3年生存率70％,两组间无明显差异。联合组有5例患者死于毒性反应,15％患者有伴发热的中性粒细胞减少症。结论 NACT可以改善LABC患者预后,序贯化疗方案患者耐受性较好。     

磁共振波谱技术在乳腺癌诊断中的应用

目的:利用氢质子磁共振波谱(1H MRS)技术检测活体乳腺癌病灶与对侧正常乳腺组织内的物质代谢和物质生化含量的差异及其反映在分子水平上的病理改变。方法:对30例经乳腺钼靶摄影疑为一侧乳腺癌的患者行1H MRS检查,比较其病侧与对侧相应部位正常腺体组织的胆碱(Choline,Cho)、乳酸(Lactine,Lac)含量有无显著性差异。结果:正常乳腺组织1H MRS在1.32ppm处显示一独立清晰的乳酸峰,胆碱峰显示低平,Cho峰顶与Lac峰顶的连线呈上升趋势。30例病侧组在3.2ppm处Cho峰显著增高,Lac峰明显降低,Cho峰顶与Lac峰顶的连线呈下降趋势;两组间行秩和检验,差异有显著性(P<0.05)。结论:氢质子磁共振波谱(1H MRS)对于乳腺癌的定性诊断可提供有价值的辅助信息。     

MRI三维动态增强减影技术鉴别乳腺良恶性病变的研究

目的探讨磁共振三维动态增强减影技术在乳腺癌诊断中的应用价值。方法52例乳腺病变磁共振检查分别进行反转恢复法加权成像、动态增强扫描、减影成像。评价乳腺良恶性病变的MRI征象(包括形态学、内部信号及其动态增强特征等)、早期增强率、峰值增强率、峰值时间、时间-信号强度(T-SI)曲线等指标的诊断价值。结果乳腺癌的形态学特征性表现有形态不规则、环形强化和毛刺征。乳腺良性病变特征性表现有类圆形或分叶状,边缘光整,强化均匀及强化后可见低信号间隔。良恶性病变的早期增强率、达到峰值强化的时间以及曲线类型分布之间的差异有显著性意义(P<0.05),峰值增强率无显著性意义。结论MRI三维动态增强减影技术能满意显示乳腺良恶性病变的形态学特征和增强的血液动力学特点,是诊断乳腺癌十分有用的检查方法。     

Hepatic parenchymal enhancement during triple-phase helical CT: can it be used to predict which patients with breast cancer will develop hepatic metastases?

PURPOSE: To evaluate the efficacy of hepatic enhancement characteristics for identification of patients with breast cancer who are at risk for future hepatic metastases. MATERIALS AND METHODS: Triple-phase helical computed tomography (CT) was performed in 60 patients with known breast cancer without visible hepatic metastases. Peak hepatic attenuation and enhancement, and attenuation and enhancement at 25 and 30 seconds were obtained. Ratios of hepatic attenuation or enhancement at 25 and 30 seconds to peak hepatic attenuation or enhancement were calculated. A Wilcoxon rank sum test was used to compare patients with and those without subsequent hepatic metastases. RESULTS: During a mean 18-month follow-up, 18 patients (30%) developed hepatic metastases. Decreases in peak hepatic attenuation and enhancement and increases in hepatic attenuation and enhancement ratios at 25 and 30 seconds were seen in patients who developed metastases compared with those who did not (P < .05). When corrected for chemotherapy interval, these differences were not statistically significant. Using a threshold value of 0.40 or more for the enhancement ratio at 30 seconds resulted in sensitivity of 28%, specificity of 92%, and accuracy of 55%. CONCLUSION: Patients with breast cancer who develop subsequent hepatic metastases have higher relative hepatic arterial perfusion during triple-phase CT; however, after correction for chemotherapy interval, this difference was not statistically significant. Threshold values cannot be used reliably to identify patients who will develop metastases.     

MR氢质子波谱成像在乳腺癌中的应用

目的:探讨乳腺癌磁共振~1H波谱成像特点及其与病理分子生物学之间的相关性.方法:对36例原发性乳腺癌患者术前行乳腺波谱成像(MRS),分析乳腺癌磁共振功能成像特点,术后标本行免疫组织化学染色测定癌细胞CerbB-2、PCNA、P53的表达情况并分析与磁共振波谱成像之间的关系.结果:36例乳腺癌中10例病例完成MRS成像,可见明显升高的Cho峰,Cho平均值为1156±116单位,Cho峰与PCNA表达呈轻度正相关(r=0.761,P<0.05).结论:乳腺癌磁共振波谱成像表现与其病理、分子生物学之间存在一定相关性.     

彩色多普勒超声及超声造影在乳腺癌新辅助化疗疗效评估中的价值

目的探讨彩色多普勒超声及超声造影对乳腺癌新辅助化疗(neoadjuvant chemotherapy,NAC)疗效评估中的应用价值。方法选取2014年1月—2015年6月收治的行NAC乳腺癌患者60例,分别于NAC前和NAC后应用彩色多普勒超声记录病灶大小、血流分级、血流阻力指数等指标;对其中26例行超声造影检查患者记录造影相关参数,包括造影剂到达肿瘤的时间、达峰时间及峰值强度。根据NAC前、后各项指标变化情况评估NAC疗效。结果NAC后病灶最大径、形态、边界、周边晕带、内部回声变化、血流分级及血流阻力指数均较NAC前差异有统计学意义（P<0.05）。NAC后造影相关参数到达肿瘤的时间、达峰时间及峰值强度均较NAC前有明显变化,差异有统计学意义（P<0.05）。结论超声造影可以通过检测乳腺癌NAC前、后各项指标变化情况,准确评估NAC疗效。     

Visualization of the female breast in bone scintigraphy]

Breast cancer incidence rates in Japan have more than doubled in the decade between 1975 and 1985 due to a well-established and affluent Western life-style. One hundred patients having breast cancer, 107 patients having mastectomies, and 243 patients having no breast cancer were reviewed for whole body and spot views of bone scintigraphy with 99mTc-MDP. The frequency of positive breast uptake in patients with no breast cancer showed a maximum in those patients between the ages of 30 and 40, with a progressive rise and fall before and after the peak, respectively. Patients between the ages of 50 and 60 with breast cancer showed a maximum uptake of 83%, while those patients between the ages of 70 and 80 with breast cancer showed an uptake higher than 50%. There was a markedly higher breast uptake ratio in the breast cancer group compared to the breast cancer free group. Although this scanning agent was of no value in recognition of tumor localization from breast uptake, we have to suspect a high incidence of cancer existence whenever there was unilateral increased breast activity. Even though the mechanism of 99mTc-MDP uptake by breast tissue is unknown, breast concentration of 99mTc-MDP appears to be influenced by hormones, especially estrogen.     

Association between survival in patients with primary invasive breast cancer and computer aided MRI

Purpose:

To identify the potential of semi‐quantitative enhancement‐analysis in breast MRI to predict disease‐related death in primary breast cancer patients.

Materials and Methods:

The present study was planned and conducted according to international recommendations. All patients referred for pretherapeutic staging of primary breast cancer during 24 consecutive months were included into the study collective. They were followed‐up by our multidisciplinary breast center. For semi‐quantitative MRI‐analysis dedicated CAD‐software (computer assisted diagnosis) was used. Association between enhancement parameters and disease‐related survival was investigated using Cox proportional‐hazards ‐regression (CR).

Results:

A total of 115 patients were eligible for CR analysis. Median follow‐up time was 52 months. In 15 patients, disease‐related death occurred. CR analysis identified four enhancement parameters as independent and significant (P < 0.001) predictors of the endpoint. Coefficients were “Initial enhancement” (B = 0.0166), “Time to peak‐enhancement” (B = 1.0573), “Tumor volume” (B = 0.0175), and proportion of “tumor volume” showing “slow initial enhancement” followed by a “persistent” curve‐type (B = ?0.0586).

Conclusion:

This study demonstrates the significant relationship between semi‐quantitative enhancement analysis in breast MRI and disease‐related death of breast cancer patients. As results were extracted from a routine staging examination, MRI noninvasively provides not only diagnostic information but also outcome data at one step. Future studies should address the impact of these findings on patient management and therapeutic approach. J. Magn. Reson. Imaging 2013;37:146–155. © 2012 Wiley Periodicals, Inc.