超声心动图诊断原发性心脏肿瘤

目的：探讨原发性心脏肿瘤超声心动图(ECG)特征。方法：利用ECG检查42例心脏肿瘤。其中粘液瘤38例，恶性肉瘤2例，均经手术病理证实。横纹肌瘤2例，经随访证实。结果：ECG对38例粘液瘤，2例横纹肌瘤全部做出正确诊断。2例恶性肿瘤提示相应部位占位病变。粘液瘤多发生在左房，有明确的瘤蒂，肿瘤回声稀疏，活动度大。恶性肿瘤回声较强、无蒂，活动度小。横纹肌瘤多发生在室壁心肌内，呈结节状，与正常心肌间有明确的界限。结论：ECG对原发心脏肿瘤的诊断具有重要意义，可初步区分良、恶性肿瘤。     

心脏原发性肿瘤的超声鉴别诊断

目的：探讨心脏粘液瘤、脂肪瘤和横纹肌瘤的超声鉴别诊断。材料和方法：利用超声心动图检查３６ 例心脏肿瘤,其中粘液瘤３０ 例,脂肪瘤４ 例,横纹肌瘤２ 例。均经手术病理证实。通过左室长轴、短轴、四腔和五腔心等切面观察肿瘤的部位、形态、包膜、活动度、界线和回声特征。结果：粘液溜多发生在左房,有明确的瘤蒂,肿瘤活动度较大,有分叶。脂肪瘤与粘液瘤不同处是多发生在左室,活动度较小,有漂浮感,肿瘤回声较强,没有分叶。横纹肌瘤发生在室壁心肌内,肿瘤与正常心肌间有明确的界线。结论：超声心动图对心脏原发性肿瘤的鉴别诊断具有重要意义。     

超声心动图诊断心脏黏液瘤30例

2004年以来,我们采用超声心动图诊断心脏黏液瘤30例。现分析报告如下。1临床资料1.1一般情况30例中,男11例,女19例;年龄18~59岁,平均44.2岁。表现为活动后心慌、气短等症状28例,突发性脑梗死5例。1.2方法使用Acuson128xp/10彩色多普勒超声诊断仪,探头频率2.5MHz。常规切面扫查心脏,重点观察心腔内瘤体的形态、大小、内部回声强弱、瘤蒂长短、附着部位、活动度及血流动力学变化。1.3结果1.3.1黏液瘤分布情况本组病例均经术后病理学检查证实,其中左心房27例,左心室2例,右心室1例。所有瘤体均通过单个长短不一的蒂连于房间隔或房室壁,其中左心房瘤体附于房间隔中部26个、左房后壁1个;左心室瘤体附于室间隔左室面中段1个、左室侧壁乳头肌下方1个。右心室瘤体附于室间隔右室面下段。1.3.2黏液瘤超声特征(1)在M型超声心动图上,左心房黏液瘤表现为二尖瓣前叶曲线无增粗,舒张期二尖瓣前叶曲线下方及收缩期左心房内均可看到特征性的异常高密度回声。(2)二维超声诊断价值最大,表现为心腔内团块状不均质高回声团,质地较疏松,表面粗糙或呈毛刺状,无包膜,与心内膜面界限清晰,并有长短不一的单蒂与瘤体所在心腔...     

CT在诊断心房肿瘤的价值

CT 检查是非损伤性的,可以清晰地显示左房粘液瘤的大小、位置和形态。约3/4良性心脏肿瘤位于左房,1/4在右房,除少数例外均为粘液瘤。70%的粘液瘤起始于房间隔的卵圆孔区。瘤体有蒂与间隔相连,罕有与间隔牢固附着。作者在2年内借助于超声心动图及CT 证实心房粘液瘤6例,5例作了血管造影、手术及组织学证实。     

心肌淀粉样变性MRI及临床特征分析(附4例报道)

目的综合分析临床和/或病理学确诊的心肌淀粉样变性(cardiac amyloidosis, CA)患者的临床特征、心电图(electrocardiogram, ECG)、心脏超声(echocardiology, UCG)、心脏磁共振(cardiac magnetic resonance, CMR),加强对该疾病综合认识,进一步指导临床治疗及科学研究。方法收集4例经心内膜下活检、肾脏、骨髓穿刺活检及临床随访直接或间接证实的心肌淀粉样变性患者,综合分析其影像学及临床特征。结果 4例患者CMR表现为左心室扩大,左心室壁弥漫性均匀增厚并舒张运动受限,延迟增强呈弥漫性心内膜下粉尘样强化3例;表现为双心室扩大,双心室壁弥漫性均匀性增厚并舒张运动受限,延迟增强呈弥漫性心内膜下强化1例。同时,4例均伴有不同程度的房室瓣返流及心包积液。结论心肌淀粉样变性的MRI表现具有特征性,结合临床表现、ECG、UCG等可做出准确诊断,为临床针对性治疗提供可靠依据。     

心脏粘液瘤的X线诊断

粘液瘤是心脏最常见的原发肿瘤（1），由于临床表现复杂多样，较易误诊，近年来随着临床经验的积累和检查技术的提高，生前获得正确诊治的病例不断增多（2，3）。我院自1964年以来经手术证实的16例心脏粘液瘤中，1978年以后就有15例，为了提高对本病的认识，进一步提高X线诊断水平，现将本组病例作一临床－X线分析，并着重在X线平片方面进行探讨。     

原发性心脏心包肿瘤的MRI诊断分析

目的：分析原发性心脏心包肿瘤的ＭＲＩ所见，评价ＭＲＩ对本病诊断的意义。材料和方法：１４例原发性心脏心包肿瘤均经ＭＲ检查，男９例，女５例。年龄６个月～６４岁，平均４４岁，其中儿童２例。１４例中８例经手术病理证实６例经ＭＲ和超声诊断。所有病例ＭＲ扫描前均有Ｘ线平片检查。结果：１４例心脏心包肿瘤中心腔内肿瘤５例，证实为粘液瘤，４例位于左房，１例位于左室。肌壁肿瘤６例，１例证实为淋巴管瘤。心包肿瘤３例，２例证实为脂肪瘤和间皮肉瘤。结论：ＭＲ对心脏心包肿瘤具有诊断价值，更适于全面观察肿瘤对心肌的浸润和向腔内外扩散及其与心旁肿瘤的鉴别     

心脏-心包肿块的CT表现

作者报导了CT动态扫描诊断14例心脏充盈缺损的病例。5例心内血栓均附着于左心壁上,与肿瘤蒂位于心腔内不同。大小在1.5～7.0cm,病灶为低密度区,约30HU,无增强,可与正常心肌清楚分界,左心尖附近的血栓CT易发现并且诊断更可靠。3例心内粘液瘤中2例CT值为—80HU,另1例为30～40HU,密度可匀或不均,大小2—4cm。肿块与二尖瓣或三尖瓣及房间隔的密切关系有利于粘液瘤的诊断。3例棘球囊肿,2例单发,1例多发,均较大,直径5～11cm,密度低,     

原发性心脏肿瘤的诊断与外科治疗

目的：探讨心脏原发性肿瘤的诊断和外科治疗经验。方法：1985－01～2001－06手术治疗的49例心脏原发性肿瘤病例进行回顾性分析。结果：手术死亡1例，42例心脏粘液瘤无远期死亡和复发，恶性肿瘤均手术后6个月内死亡。结论：原发性心脏肿瘤的诊断以二维超声检查为佳，治疗均需尽早手术治疗。手术切除时应尽可能全层广泛切除以免术后复发，同时注意心脏功能和结构完整性。     

18F-FDG PET/CT在心脏肿瘤诊断中的临床应用

目的 研究18F-FDG PET/CT在心脏肿瘤诊断中的临床应用价值.方法 自2007年1月至2011年12月行全身18F-FDG PET/CT检查的8649例受检者中,诊断为心脏肿瘤者占0.16％(14/8649).对这14例患者进行回顾性分析,其中男11例,女3例;年龄46.9(35 ～68)岁.患者最终诊断以外科手术病理结果(5例)、肿瘤病史和临床随访结果(9例)为依据,分析18 F-FDG PET/CT诊断情况.结果 14例心脏肿瘤,18F-FDG PET/CT均作出准确定位和定性诊断.其中,转移性肿瘤11例,占78.6％ (11/14);原发恶性肿瘤2例,占14.3％ (2/14);原发良性黏液瘤1例,占7.1％ (1/14).11例转移性肿瘤的原发肿瘤分别为HCC(8例),肺癌(2例)和食管癌(1例).2例原发恶性肿瘤均发生转移.13例恶性肿瘤患者SUVmax为3.2 ～10.7,高于正常心肌.结论 全身18F-FDG PET/CT检查对心脏转移及原发肿瘤诊断有重要价值,可探查心脏恶性肿瘤全身转移情况,从而进行准确分期,指导临床治疗.     

心脏黏液瘤MRI与手术病理对照研究

目的 通过MRI与病理对照研究探讨MRI诊断心脏黏液瘤的价值.方法 22例心脏黏液瘤均经MR检查,分析其MRI表现,并与手术病理对照.结果 22例中21例单发,其中左房12例,右房6例,左室2例,右室1例.1例多发.MRI表现:22例中19例信号欠均匀,3例信号均匀.心脏电影:18例带蒂,4例基底较宽.13例引起瓣膜狭窄或关闭不全.9例出现心功能异常.增强扫描,19例轻至中度不均匀强化,其中4例行首过灌注,时间-信号强度曲线呈锯齿状缓慢上升,延迟扫描瘤蒂及瘤壁明显强化.3例未见强化.手术:21例呈卵圆形略分叶状,1例呈葡萄串状.10例可见新鲜出血,5例见陈旧出血,14例出现坏死,2例出现囊变,4例见钙盐沉积.病理:19例见小血管或炎症细胞分布.结论 MRI在显示心脏黏液瘤大小、位置、形态,特别是评价肿瘤的组织学特征、血供及对心功能的影响,具有一定的价值.     

心脏黏液瘤MRI与手术病理对照研究

目的 通过MRI与病理对照研究探讨MRI诊断心脏黏液瘤的价值.方法 22例心脏黏液瘤均经MR检查,分析其MRI表现,并与手术病理对照.结果 22例中21例单发,其中左房12例,右房6例,左室2例,右室1例.1例多发.MRI表现:22例中19例信号欠均匀,3例信号均匀.心脏电影:18例带蒂,4例基底较宽.13例引起瓣膜狭窄或关闭不全.9例出现心功能异常.增强扫描,19例轻至中度不均匀强化,其中4例行首过灌注,时间-信号强度曲线呈锯齿状缓慢上升,延迟扫描瘤蒂及瘤壁明显强化.3例未见强化.手术:21例呈卵圆形略分叶状,1例呈葡萄串状.10例可见新鲜出血,5例见陈旧出血,14例出现坏死,2例出现囊变,4例见钙盐沉积.病理:19例见小血管或炎症细胞分布.结论 MRI在显示心脏黏液瘤大小、位置、形态,特别是评价肿瘤的组织学特征、血供及对心功能的影响,具有一定的价值.     

Cardiac tumors: assessment with Gd-DTPA enhanced MR imaging

Previous studies have shown the value of MR imaging for the identification of cardiac masses. The distinction of intramural tumors from normal myocardium may be equivocal because of the similarity of signal intensity between tumor and normal myocardium on ECG-gated SE images. The purpose of this study was to assess the role of Gd-DTPA for improving the contrast between cardiac tumors and myocardium. Four patients with established or suspected cardiac tumors were imaged with a 1.5 T imager. The T1-weighted images (TR = RR interval, TE = 20-30 ms) were obtained before and immediately after the intravenous injection of Gd-DTPA, at a dosage of 0.1 mmol/kg. Tumors were identified in three patients. All tumors were isointense to the myocardium in precontrast images but demonstrated differential enhancement relative to myocardium after the administration of Gd-DTPA. Two tumors were hyperintense relative to myocardium, and the third was mostly hypointense, surrounded by a hyperintense rim. In the remaining case, no tumor was found and the myocardium was homogeneously enhanced on postgadolinium images. Gadolinium DTPA can produce differential enhancement of tumor from normal myocardium and therefore demonstrate intramural masses.     

磁共振成像诊断陈旧性心肌梗塞的初步评价

目的：探讨ＭＲＩ在评价陈旧性心肌梗塞的形态和功能中的应用价值。材料和方法：对７例陈旧性心肌梗塞进行ＭＲＩ检查，观察心脏形态学变化、心室壁运动、二尖瓣和主动脉瓣开闭功能，测量左室功能。结果：左室壁限局性变薄６例，其中３例在变薄的左室壁邻近部位见血流信号异常增高，左室壁节段性运动减弱，１例室壁瘤形成。左室射血分数降低。１例见二尖瓣有轻度返流。增强扫描（２例）显示梗塞心肌与正常心肌的增强有明显差异。结论：ＭＲＩ能为临床提供心肌的局部和整体功能、梗塞心肌的信号改变、心脏的瓣膜功能及心肌灌注等信息     

MR imaging of the posterior hypophysis in children

The posterior lobe of the pituitary gland was studied by MR imaging in 30 children without pituitary gland disease and compared with studies from a group of 13 children with central diabetes insipidus, including eight cases of primary diabetes insipidus and five cases of diabetes insipidus secondary to suprasellar tumors (four proved germinomas, one still unknown tumor). Two components in the sella turcica were identified in all 30 children without pituitary gland disease, and the posterior lobe was identified as a high-intensity structure on T1-weighted images. In all 13 patients with diabetes insipidus, the normal hyperintense signal of the posterior hypophysis was absent on T1-weighted images. Three patients with suprasellar tumors presented with a progressively enlarging pituitary stalk on follow-up. Our findings show that absence of the normal hyperintense signal of the posterior lobe is closely related to a loss of function of the neurohypophysis. Size or signal modification of the pituitary stalk should suggest the development of a suprasellar tumor.     

原发性纵隔肿瘤的CT诊断(附4O例报告)

目的：评价CT对原发性纵隔肿瘤的诊断价值。材料与方法：回顾性分析40例经手术与活俭病理证实的原发性纵隔肿瘤的CT表现，其中胸内甲状腺肿13例，恶性淋巴瘤10例，神经源肿瘤8例，胸腺瘤6例，生殖细胞瘤2例，心包囊肿1例。结果：40例纵隔肿瘤CT定位正确39例，定性正确34例，CT检查对纵隔肿瘤的显示明显优于常规X线检查。结论：CT检查对纵隔肿瘤具有较高的诊断价值，多数肿瘤结合临床和CT扫描可作出明确诊断。     

原发性心脏肿瘤（非粘液瘤）的影像学诊断

目的：研究与比较原发性心脏肿瘤的各种影像学特征性表现及其诊断价值。材料和方法：1957年至1994年间经手术病理证实原发性心脏肿瘤17例。良性11例(海绵状血管瘤2例、错构瘤2例、纤维瘤4例、纤维间皮瘤2例、脂肪组织浸润1例)．恶性6例(平滑肌肉瘤2例、血管肉瘤4例)。影像学检查有：胸片(正侧位）及UCG各17例：CT2例；MRI4例；ACG(电影或DSA)9例；冠状动脉造影3例。结果：X线平片检查无特征性表现，UCG征象为云絮状或团块状回声(敏感性100%)。MRI图像能显示肿块轮廓．大小、与心腔壁的关系及有无心包积液等．优于一般CT，ACG（DSA或Cine)能在动态下观察肿瘤对血液动力学的影响及与周围组织(如瓣膜、大血管等）的关系．结论：UCG及MRI对心脏肿瘤诊断敏感性高，且能同时显示心包及心肌的改变，能确诊．应作为首选和必需的检查方法。ACG在准备手术的病例中应用。不同性质肿瘤之间鉴别困难。     

小儿原发性心脏肿瘤的超声心动图诊断及心功能评估

目的 探讨超声心动图诊断小儿原发性心脏肿瘤的临床价值,评价多普勒超声心肌活动指数(myocardial performance index,MPI)估测心脏肿瘤患儿心功能的准确性.方法 58例心脏肿瘤患儿及58例正常儿童为研究对象,分析肿瘤患儿的超声心动图资料,并计算MPI.结果 16例手术者超声漏诊率为6％.58例肿瘤患者的左、右心室MPI与对照组无显著差异(P ＞0.05).其中16例患儿行手术治疗,肿瘤手术组MPI较对照组明显升高(P＜0.05),手术后多普勒超声MPI明显下降(P＜0.05).结论 超声心动图可以准确的诊断心脏肿瘤的部位、大小、数目,但是不能确定肿瘤的性质;MPI可以准确反映肿瘤患者的心功能变化.     

Dynamic cine mode imaging of the normal aortic valve using 16-channel multidetector row computed tomography

BACKGROUND: We investigated the feasibility and image quality of dynamic cine-mode imaging of the normal aortic valve using multidetector row computed tomography (MDCT). MATERIALS AND METHODS: We acquired contrast-enhanced retrospectively echocardiography (ECG)-gated cardiac MDCT datasets of 35 patients (mean age, 62 years; range, 53-77) who received a transoesophageal echocardiography (TOE) precedent to cardiac bypass graft surgery. Twenty data sets in 5% steps of the R-R interval were reconstructed, and data analysis was performed using a 4D software. Read-out of the MDCT data was performed in parallel and perpendicular planes, similar to TOE standard planes, by 2 independent, blinded readers using a 4-point Likert scale (best score: 4) for the following parameters: image quality of the aortic valve components, contrast media enhancement, contrast media inflow related artifacts, and ECG gating-related artifacts. The aortic valve area (AVA) was measured planimetrically and was compared between TOE and MDCT. RESULTS: The best phase for assessing the open valve using MDCT was at 5% and the closed valve at 65% of the cardiac cycle. The mean image quality scores for cine-mode MDCT ranged between 3.26 and 3.75, with inter-reader agreements ranging between good (kappa = 0.723) and excellent (kappa = 1.00). They did not differ significantly from TOE scores for assessment of the closed and open valve. In transitional phases (close-to-open and open-to-close) TOE performed significantly better when compared with static MDCT images, whereas no significant difference was present between cine-mode presentation of MDCT and TOE. Planimetric AVA measurements correlated significantly between TOE and MDCT (Pearson correlation coefficient, r = 0.96; P < 0.0001). Contrast media inflow-related and ECG gating related artifacts were rated as slightly compromising (scores 3.24 and 3.21). CONCLUSION: Retrospectively ECG-gated MDCT offers a noninvasive, accurate, and dynamic imaging method for quantitative and qualitative evaluation of the normal aortic valve allowing determination of morphology and function throughout the cardiac cycle. Further studies regarding assessment of diseased valves are necessary.