Fallot四联症的MRI诊断

笔者分析了２１例经心血管造影和手术证实的Ｆａｌｌｏｔ四联症的ＭＲＩ，探讨ＭＲＩ在显示四联症病理解剖中的作用。提出了显示不同解剖结构应采用的扫描方法，认为ＭＲＩ可以较清晰地显示四联症的肺动脉狭窄、室间隔缺损、主动脉骑跨和右心室肥厚。与其他检查方法相比，ＭＲＩ的诊断能力等于或优于超声心动图；在确定室间隔缺损类型、大小，观察右心室肥厚及肺动脉闭锁时观察中央肺动脉方面优于心血管造影检查。     

婴幼儿法乐四联症的MRI诊断(附30例分析)

目的 探讨先正确性一心脏病婴幼儿法乐四联症的ＭＲＩ诊断价值。材料与方法 分析３０例婴幼儿法乐四联症ＭＲＩ所见,并与心血管造影和超声心动图比较。结果 ３０例室间隔及其缺损均在横断面扫描显示最佳,２５例主动脉骑跨在冠状面扫描显示清晰,５例显示不清。３０例肺动脉主干及右肺动脉则在矢状面扫描较清楚,其中４例还显示出第三心室。结论 ＭＲＩ检查安全、无创,优于心血管造影;能对各房室连接及心肌厚度多方位、多手段     

三尖瓣闭锁的MRI诊断(兼与超声心动图和心血管造影对照)

目的：评价ＭＲＩ在三尖瓣闭锁诊断中的作用。材料与方法：回顾分析了１４例三尖瓣闭锁的ＭＲＩ所见并与超声心动图（ＵＣＧ）和心血管造影（ＣＡＧ）比较，１０例经手术证实。结果：１４例三尖瓣闭锁中，１３例为肌型闭锁，１例为隔膜型闭锁；心室动脉异常连接３例；合并肺动脉狭窄１０例；合并房间隔膨出瘤１例。ＭＲＩ正确诊断１３例，清晰地显示三尖瓣闭锁的心内结构及１例房间隔膨出瘤。１例心室动脉异常连接未能确定。结论：比较三种影像方法，在三尖瓣闭锁诊断中，ＭＲＩ优于ＵＣＧ，基本达到ＣＡＧ水平。     

先天性主动脉缩窒的MRI诊断

目的：评价ＭＲＩ在先天性主动脉缩窄中的诊断作用。材料与方法：分析１４例主动脉缩窄的ＭＲＩ，并与超声心动图（ＵＣＧ）和心血管造影（ＣＡＧ）进行比较，其中１２例经手术证实。结果：ＭＲＩ显示了１４例主动脉缩窄及缩窄的程度、形态（细管状狭窄６例，环状狭窄５例，隔膜 狭窄窄３例），并显示了缩窄下与左锁骨下动脉的关系。合并畸形有：１０例室间隔缺损，１３例动脉导管示闭，１例马凡氏综合征，１０例主动脉弓发育不朗     

三尖瓣闭锁的MRI诊断

评价ＭＲＩ在三尖瓣闭锁诊断中的作用。材料与方法：回顾分析了１４例一尖瓣闭锁的ＭＲＩ所见并与超声心动图和心血管造影比较，１０例经手术证实。结果；１４例三尖瓣闭锁中，１３例为肌型闭锁，１例为隔膜型闭锁，心室动脉异常连接３例，合并肺动脉狭窄１０例；合并房间膨出瘤１例。     

15例单心室磁共振诊断

作者报告１５例单心室ＭＲＩ，均经心血管造影（ＣＡＧ）检查证实，５例经手术证实。１１例左室型单心室ＭＲＩ表现为主腔肌小梁纤细，８例有流出小腔，２例为右侧房室瓣部分骑跨流出腔。４例右室型单心室ＭＲＩ表现为主腔肌小梁粗大，半月瓣下有圆锥肌。１５例单心室主要合并畸形有单心房结构５例，肺动脉狭窄８例，房耳并列１例。经与ＣＡＧ和超声心动图（ＵＣＧ）比较，作者认为：对单心室的诊断，ＭＲＩ优于ＵＣＧ，基本达到ＣＡ     

先天性主动脉缩窄的MRI诊断

目的：评价ＭＲＩ在先天性主动脉缩窄中的诊断作用。材料与方法：分析１４例主动脉缩窄的ＭＲＩ，并与超声心动图（ＵＣＧ）和心血管造影（ＣＡＧ）进行比较，其中１２例经手术证实。结果：ＭＲＩ显示了１４例主动脉缩窄及缩窄的程度、形态（细管状狭窄６例，环状狭窄５例，隔膜形狭窄３例），并显示了缩窄处与左锁骨下动脉的关系。合并畸形有：１０例室间隔缺损，１３例动脉导管未闭，１例马凡氏综合征，１０例主动脉弓发育不良。比较三种影像方法：ＭＲＩ诊断能力明显优于ＵＣＧ，基本达到ＣＡＧ水平。结论：在先天性主动脉缩窄的临床诊断中，ＭＲＩ应成为主要或首选检查方法，并有可能部分代替ＣＡＧ成为临床最终诊断方法     

儿童完全性大动脉错位的X线诊断──附心血管造影152例报道

本文报道１５２例经心血管造影证实的完全性大动脉错位，患儿的年龄从３天到１１岁。１５２例中４７例为室间隔完整不伴肺动脉狭窄的单纯型完全性大动脉错位，４４例为室间隔缺损不伴肺动脉狭窄型，６０例为室间隔缺损伴肺动脉狭窄型，１例为室间隔完整伴肺动脉狭窄型。本文详细讨论了完全性大动脉错位的Ｘ线平片诊断、心血管造影技术及造影诊断，作者认为长轴斜位左心室造影是完全性大动脉错位心血管造影的最佳投照体位。     

儿童安全性大动脉错位的X线诊断—附心血管造影152例报道

本文报道１５２例经心血管造影证实的完全性大动脉错位，患儿的年龄从３天到１１岁。１５２例中４７例为室间隔完整不伴肺动脉狭窄的单纯型完全性大动脉错位，４４例为室间隔缺损不伴肺动脉狭窄型，６０例为室间隔缺损伴肺动脉狭窄型，１例为室间隔完整伴肺动脉狭窄型。本文详细讨论了完全性大动脉错位的Ｘ线平片诊断、心血管造影技术及造影诊断，作者认为长轴斜位左心室造影是完全性大动脉错位心血管造影的最佳投照体位。     

MRI诊断先天性右位心并心内复杂畸形(附四例报告)

目的探讨ＭＲＩ诊断先天性右位心并心内复杂畸形的实用价值。方法应用ＭＲＩ心电门控多层自旋回波序列及磁共振电影，对４例先天性心脏病右位心并心内复杂畸形进行多轴位多层面断层扫描，并将检查结果与经手术证实的心脏病理解剖进行对比。同时对心脏ＭＲＩ扫描与超声心动图彩色血流显像的诊断，作进一步比较及评估。结果３例右位心（右旋心）其主要心内结构的改变为：１例Ｆａｌｏｔ四联症（ＴＯＦ）；１例右室双出口（ＤＯＲＶ）、肺动脉骑跨、左上腔静脉残存；１例大动脉左异位（ＬＭＧＡ）、房间隔缺损（ＡＳＤ）、室间隔缺损（ＶＳＤ）、肺动脉狭窄（ＰＳ）、左上腔静脉残存；１例镜面右位心并内脏转位、ＶＳＤ、ＰＳ、双上腔静脉。结论ＭＲＩ对先天性心脏病右位心并心内复杂畸形可以获得准确的病理解剖诊断，借此可说明ＭＲＩ诊断复杂心内畸形有较高的实用价值，它与心血管造影及超声心动图各具独特优势，在诊断应用中可以互补却不能彼此取代     

Ventricular septal defect: visualization of shunt flow and determination of shunt size by cine MR imaging

Cine MR imaging is a new, fast technique that employs low flip angles, short repetition and echo times, and gradient-refocused echoes. This technique was used in three patients with documented ventricular septal defects (VSDs) to obtain transverse and oblique sections of the heart spanning the cardiac cycle. In all patients, cine MR imaging showed high-velocity turbulent blood flow across the defect as areas of low signal intensity extending from the left ventricle to the right ventricle. In the oblique sections oriented parallel to the interventricular septum it was possible to identify the cross-sectional area of the VSD. Quantification of the left-to-right shunt was performed by comparing left and right ventricular stroke volumes determined from end-diastolic and end-systolic volumes of both ventricles. Cine MR imaging provides important functional information and anatomic detail in patients with VSD and may be useful for diagnosis, determination of severity, and noninvasive monitoring of the disease.     

Flattening of the interventricular septum (D-shaped left ventricle) in addition to high right ventricular tracer uptake and increased right ventricular volume found on gated SPECT studies strongly correlates with right ventricular overload

BACKGROUND: Flattening of the interventricular septum (D-shaped left ventricle) detected during echocardiographic examination is correlated with significant right ventricular (RV) overload. There are no reports of this finding with cardiac gated single photon emission computed tomography (SPECT) imaging. We report an observational study correlating this finding with the presence of RV overload. METHODS AND RESULTS: Retrospectively, we compared 8 cases with flattening of the interventricular septum on cardiac gated SPECT imaging for which echocardiographic correlations and clinical data were available regarding the presence of RV overload. All patients but 1 had pulmonary hypertension ranging from 42 to 52 mm Hg measured by echocardiographic Doppler studies. All patients but 1 had reasons for RV overload (chronic obstructive pulmonary disease in 3, history of atrial septal defect in 3, pulmonary embolism in 1, and obstructive sleep apnea in 1). Septal flattening present on gated SPECT images was seen in 50% of the cases by echocardiography. Other signs of RV overload (RV enlargement, RV hypertrophy) were observed by echocardiography in 5 patients and by the gated SPECT in 7 patients. CONCLUSION: The presence of interventricular septal flattening on gated SPECT studies correlates with RV overload and should be routinely assessed during interpretation of gated SPECT studies.     

MR demonstration of septal involvement in arrhythmogenic right ventricular dysplasia

Arrhythmogenic right ventricular dysplasia (ARVD) is a heart muscle disease of unknown origin. Although MR imaging is regarded as the best technique for the demonstration of functional and structural abnormalities in ARVD, fat deposits in the interventricular septum have never been documented on MR imaging. We report the case of interventricular septal fatty deposition demonstrated by fat-suppressed MR imaging in a 48-year-old man.     

Cardiac magnetic resonance imaging of congenital heart defects in adults

The study of congenital cardiopathies (CC) is one of the most clearly established indications of cardiac magnetic resonance imaging (CMRI). Different sequences, including anatomic, functional, flow (phase contrast), and 3D angiographic sequences, enable the diagnosis, treatment planning, and follow-up of these conditions. CMRI allows the anatomy, function, and alterations of flow in these cardiopathies to be evaluated in a single examination. Three-dimensional MR angiography enables the study of the great vessels and the anomalies associated to congenital heart defects in adults. This article describes an examination protocol and provides examples of MR images of the most common CC in adults: atrial septal defect, interventricular communication, atrioventricular canal, tetralogy of Fallot, transposition of the great arteries, congenitally corrected transposition of the great arteries, bicuspid aortic valve, subaortic stenosis, aortic coarctation, and Ebstein's anomaly.     

超声五切面在筛查胎儿先天性心脏病中的临床价值

目的探讨超声五切面(UAT、4C、LVOT、RVOT和3VT)在产前筛查胎儿先天性心脏病中的临床价值。方法采用超声五切面对9237例孕16～41周胎儿进行心脏超声筛查,发现心血管异常或可疑异常,即进行详细的胎儿超声心动图检查。将产前超声检查结果与引产后尸解结果和产后超声心动图检查结果进行对照分析。结果 9237例胎儿产前超声诊断胎儿先天性心脏病38例,其中4例(10.53%,4/38)合并其它心内畸形,11例(28.95%,11/38)合并心外畸形。胎儿心脏畸形在五切面上的产前超声图像特征包括腹部大血管位置异常、心尖指向异常、非四腔心结构、四腔心不对称、室间隔缺损、冠状静脉窦扩张、室壁增厚、心腔占位、胸部大血管连接、数目、位置、瓣膜和内径比例异常、房室瓣反流、穿隔血流、主、肺动脉弓血流反向。38例胎儿心脏畸形均经病理解剖或产后随访验证,其中36例与产前诊断结果符合,1例法洛四联症误诊为永存动脉干,1例主动脉弓缩窄胎儿经产后超声心动图复查正常。漏诊3例,包括2例室间隔缺损和1例房间隔缺损。超声五切面筛查胎儿先心病的敏感度为90.24%,特异度为100%。结论超声五切面在产前筛查胎儿先天性心脏病中具有重要的临床价值,能够筛查出大多数的先心病,但对部分室间隔缺损和房间隔缺损易漏诊。     

Abnormal septal motion after aortic valve replacement for chronic aortic regurgitation: no evidence for myocardial ischaemia by exercise radionuclide angiography

To evaluate interventricular septal motion and left ventricular function after aortic valve replacement for chronic aortic regurgitation, we studied 12 patients at rest and during exercise by radionuclide angiography after a mean of 19 (range 12–36) months after operation (group I). Twenty patients with chronic aortic regurgitation without aortic valve replacement served as controls (group II). None of the patients had coronary artery disease as documented by arteriography. Abnormal interventricular septal motion at rest was seen in 11 patients of group I, of whom 8 showed hypokinesis and 3 akinesis. During exercise, the interventricular septal wall motion improved in 4 patients, worsened in 3 patients and did not change in 5 patients. All patients of group II had normal interventricular septal motion at rest. During exercise, 5 patients showed septal wall hypokinesia together with apical and posterolateral wall motion abnormalities. The left ventricular ejection fraction at rest was 62% ± 20% in group I and 66% ± 8% in group II (not significant). During exercise, the left ventricular ejection fraction was 59% ± 24% in group I and 68% ±13% in group II (not significant). We conclude that abnormal interventricular septal motion at rest is commonly found in patients with aortic valve replacement for chronic aortic regurgitation. During exercise, septal wall motion in the patients with aortic valve replacement shows a variable response from complete normalization to akinesia. These findings are mostly associated with a normal global left ventricular function both at rest and during exercise, which precludes myocardial ischaemia as a primary cause for abnormal septal wall motion after aortic valve replacement.     

Abnormal septal motion after aortic valve replacement for chronic aortic regurgitation: no evidence for myocardial ischaemia by exercise radionuclide angiography

To evaluate interventricular septal motion and left ventricular function after aortic valve replacement for chronic aortic regurgitation, we studied 12 patients at rest and during exercise by radionuclide angiography after a mean of 19 (range 12-36) months after operation (group I). Twenty patients with chronic aortic regurgitation without aortic valve replacement served as controls (group II). None of the patients had coronary artery disease as documented by arteriography. Abnormal interventricular septal motion at rest was seen in 11 patients of group I, of whom 8 showed hypokinesis and 3 akinesis. During exercise, the interventricular septal wall motion improved in 4 patients, worsened in 3 patients and did not change in 5 patients. All patients of group II had normal interventricular septal motion at rest. During exercise, 5 patients showed septal wall hypokinesia together with apical and posterolateral wall motion abnormalities. The left ventricular ejection fraction at rest was 62% +/- 20% in group I and 66% +/- 8% in group II (not significant). During exercise, the left ventricular ejection fraction was 59% +/- 24% in group I and 68% +/- 13% in group II (not significant). We conclude that abnormal interventricular septal motion at rest is commonly found in patients with aortic valve replacement for chronic aortic regurgitation. During exercise, septal wall motion in the patients with aortic valve replacement shows a variable response from complete normalization to akinesia. These findings are mostly associated with a normal global left ventricular function both at rest and during exercise, which precludes myocardial ischaemia as a primary cause for abnormal septal wall motion after aortic valve replacement.     

Coronary, ventricular, and pulmonary abnormalities associated with rupture of the interventricular septum complicating myocardial infarction.

Left ventricular wall motion abnormalities, the extent and location of coronary artery stenoses, and the radiographic evidence of pulmonary venous hypertension were analyzed in a retrospective study of 40 patients who had surgically proven rupture of the interventricular septum after myocardial infarction. In 33 patients in whom chest films were available, interstitial or alveolar pulmonary edema was present in 78%, while left ventricular enlargement was present in 82%. Of 26 patients who had coronary angiography, complete occlusion of the right coronary artery, left anterior descending artery, or left circumflex artery was present in 92%, with few, if any, collateral vessels around the occlusion. The location of the rupture in the muscular septum was always in the region of akinesis or dyskinesis. Posterior defects were associated with posterobasal and diaphragmatic akinesis, and anterior defects with apical akinesis. Left ventricular aneurysms were adjacent to the septal rupture in 68%, and 74% had mitral regurgitation. The right ventricular diaphragmatic wall in posterior rupture was always akinetic, indicating right ventricular infarction. Thus ventricular septal defect after myocardial infarction (1) tends to occur with multiple coronary occlusions about which little collateral flow develops; (2) can accurately be localized anteriorly or posteriorly in the muscular septum by the location of the akinetic left ventricular wall segment; and (3) has an associated right ventricular infarct when rupture is posterior.     

复杂先天性心脏病双向Glenn分流术后:3.0T MRI评价心脏结构和功能

目的探讨3.0 T MRI SE序列结合电影成像诊断复杂先天性心脏病(CCHD)双向Glenn分流术(BGS)后心脏畸形、主心室和房室瓣功能的价值。资料与方法采用Triple-IR和快速稳态平衡进动序列(FIESTA)对22例BGS术后患者进行心脏检查,用Report Card软件分析心脏畸形、主心室和房室瓣功能,应用配对样本t检验分析MRI测量主心室舒张末期容积(EDV)、收缩末期容积(ESV)、射血分数(EF)及轴缩短率(FS)与超声心动图(UCG)测量相应指标的差异性和相关性;应用Spearman等级相关对电影MRI测量的房室瓣返流程度与UCG进行检验分析。结果 Triple-IR结合FIESTA能清楚显示心内畸形和心脏大血管连接部畸形;3.0 T MRI测量EDV、ESV、EF及FS与UCG测量值之间差异无统计学意义,两者相关性良好(r=0.727～0.990);电影MRI测量房室瓣返流程度与UCG呈显著正相关(rs=0.712),两者吻合度较好(Kappa=0.453,P=0.01)。结论 3.0 T MRI SE序列结合电影成像能全面显示BGS术后患者复杂心内畸形和心脏大血管连接关系,评价主心室和...     

Mitral stenosis: evaluation with MR imaging after percutaneous balloon valvuloplasty

To evaluate the pathoanatomic findings of mitral valve stenosis and changes after percutaneous balloon valvuloplasty (PBV), magnetic resonance (MR) imaging was performed in 23 patients. The patients were imaged with a 2.0-T system within 1 week before and 3-10 days after PBV. The angle of the interatrial septum was measured on the transverse image to facilitate a successful transseptal puncture. On MR images, the mean transverse and anteroposterior diameters of the left atrium at the level of the aortic root in the ventricular diastolic phase decreased significantly after PBV. Areas of flow-related intraluminal signal intensity detected in the left atrial cavity of 17 patients (74%) before the procedure disappeared in 15 patients after the procedure. Other MR imaging findings after PBV were the disappearance of intraluminal signal intensity in the pulmonary artery, normal curvature of the interatrial and interventricular septa, and pericardial effusion as a complication. MR imaging was thought to provide useful information before and after PBV in patients with mitral stenosis.