新生儿及婴儿复杂先天性心脏病的双源CT诊断

目的:探讨双源CT(DSCT)对新生儿及婴儿复杂先天性心脏病的诊断价值.材料和方法:18例新生儿及婴儿复杂先天性心脏病,年龄7d～20个月,采用DSCT心电门控下对比增强完成心脏检查,舒张末期重建原始图像,并在图形图像工作站完成多平面、最大密度投影和三维容积漫游处理.同期所有病例均完成超声心动图检查,1例进行心导管检查,8例进行手术治疗.结果:18例复杂先天性心脏病中DSCT共检出90处心内外结构异常,超声心动图检出65处.9例经手术、血管造影证实的心内外结构异常共50处,DSCT检出其中的心内畸形14/16处、心室大血管连接异常3/3处、心外血管异常30/31处,超声心动图分别检出16/16处,3/3处和17/31处,DSCT与超声心动图联合应用的诊断准确率为98%.结论:DSCT是新生儿及婴儿复杂先天性心脏病检查的一种良好无创影像技术,对血管病变诊断优于超声心动图,对心脏本身以及心脏大血管连接的诊断与超声心动图相当,两者联合应用可在绝大多数病例中避免创伤性的心血管造影.     

先天性复杂型心脏病磁共振成像的临床应用

目的探讨先天性复杂型心脏病（CCHD）MRI的临床应用。资料与方法对38例CCHD进行双翻转恢复快速自旋回波（DIR—FSE）、快速电影（Fast—Cine）及SE T1WI序列MRI及心脏B超检查,其中8例行X线心血管造影。分析MR成像质量及显示病变情况,并与B超及X线造影对比。23例经手术者对照手术所见。结果DIR．FSE的图像质量较SET,WI的高,检出病变更确切。DIR-FSE结合Fast-eine共检出主要畸形106个及合并畸形75个,与8例X线造影有较高检出符合率（97．62％）,与23例手术所见101个畸形完全一致,检出率及诊断准确率均较B超高。结论黑血技术D—IR—FSE结合白血技术Fast—eine成像可准确有效地诊断CCHD。     

电子束CT对复杂先天性心脏病心外血管畸形的诊断优势

目的 :探讨电子束CT(EBCT)在复杂先天性心脏病 (先心病 )心外血管畸形诊断中的优势。方法 :搜集 3 0例经超声心动图和EBCT检查的复杂先心病 ,其中 11例经心血管成像检查、19例经手术证实。以手术、造影结果为标准 ,对比超声心动图分析EBCT对心外畸形的诊断优势。结果 :3 0例复杂先心病共 119个畸形 ,其中心外血管畸形 5 8个。EBCT对心外血管畸形的诊断符合率为 94.8% ,超声心动图仅为 60 .3 % ,二者差异有显著性意义 ( χ2 =19.82 9,P <0 .0 0 1)。结论 :EBCT对复杂先心病心外血管畸形的诊断较超声心动图具有明显优势 ,部分优于心血管成像检查     

不同MR序列在胎儿脊柱成像中的对比研究

目的：探讨半傅里叶采集单次激发快速自旋回波（HASTE）序列、真实稳态进动快速成像（TrueFISP）序列和磁敏感加权成像（SWI）序列在1.5T MR成像系统中对胎儿脊柱成像的优劣。方法：收集21例中晚期孕妇胎儿脊柱MR影像资料。每例成像序列均包括HASTE、TrueFISP和SWI。用“四分法”对3个序列图像分别进行评分。采用Friedman检验及Mann-Whitney U检验比较差异性。结果：HASTE、TrueFISP两序列图像质量稳定,无明显伪影。5例SWI序列图像出现运动伪影,发生率为31.25%。HASTE序列图像质量的评分显著低于TrueFISP及SWI序列,TrueFISP序列与SWI序列间图像质量无明显差异。结论：在1.5T MR成像系统中,与HASTE、SWI相比,TrueFISP序列对胎儿脊柱的显示具有图像质量稳定、良好的优势。     

胎儿超声心动图在胎儿先天性心血管异常中的诊断价值

目的:探讨超声心动图诊断胎儿先天性心血管畸形的临床价值,分析其漏诊及误诊原因,提高诊断的准确率.方法:12165例行产前胎儿超声心动图检查的孕妇为研究对象,将产前超声诊断结果与引产后尸体解剖结果、产后超声心动图诊断结果进行对比分析.结果:12165例胎儿超声心动图检出452例胎儿心血管异常,其中单纯性三尖瓣反流341例,左室假腱索30例,心腔内强回声光团17例,单纯性肺动脉瓣反流10例,结构性心血管异常54例.54例患者中超声诊断正确49例,占90.3%;误诊5例,占9.7%.结论:胎儿超声心动图是胎儿先天性心脏病产前检查的有效方法.     

超声心动图在诊断胎儿先心病中的价值

目的探讨超声心动图筛查胎儿先天性心脏病的可行性及临床价值、意义。方法对5 851例孕妇进行超声心动图检查,筛查严重的胎儿先天性心脏病。结果经5 851例胎儿超声心动图探查,共检出88例胎儿心血管畸形。5 851例胎儿中漏诊肌部室间隔缺损3例。部分孕妇到上级医院进一步检查得到证实,部分生后超声心动图随访结果与产前诊断相符。结论胎儿超声心动图是检查胎儿心脏畸形的有价值的无创性检测技术,可以早期发现严重先心病胎儿,应用超声心动图筛查胎儿先天性心脏病是可行的。     

MRI在稳定性晚期妊娠出血的临床应用方面优于超声

目的比较MRI与彩色多普勒超声诊断妊娠晚期出血的准确性,评价不同的MR成像序列诊断出血原因的准确性。方法运用MRI及超声检查对42例妊娠末3个月病人无痛性阴道流血的原因进行评价。采用的MRI序列有:半傅里叶采集单次激发快速自旋回波(HASTE)技术、磁共振稳态     

紫绀型先天性心脏病肺血管成像方法的对比研究

目的 评价超声心动图、64排螺旋CT(MSCT)及电影心血管成像(CAG)对于紫绀型先天性心脏病肺血管成像的临床应用价值.方法 回顾42例紫绀型先天性心脏病患者的超声心动图、MSCT、CAG影像学资料,并和手术结果对比,进行统计学分析.其中男29例,女13例,年龄11 d～28岁,平均7.26岁.结果 本组42例患者经手术证实肺血管共有109处畸形.超声心动图正确诊断93处畸形,符合率85.3%;漏诊误诊16处; MSCT确诊102处畸形,符合率93.6%;漏诊误诊7处畸形;CAG确诊106处畸形,符合率97.2%;漏诊误诊3处畸形.超声心动图和MSCT、CAG对比诊断符合率均有显著性差异. MSCT和CAG对比诊断符合率无显著性差异.结论 MSCT对紫绀型先天性心脏病肺血管成像具有较高的临床应用价值.     

高场MRI在超声疑诊胼胝体发育不全胎儿中的应用价值

目的 探讨MRI对超声疑诊胎儿胼胝体发育不全的诊断价值.方法 产前例行超声检查后疑诊有胎儿胼胝体发育不全的19例孕妇,年龄20～37岁(平均28岁),孕龄22～38周(平均29周),24 h内行MR检查, T2WI采用半傅立叶单激励快速自旋回波(HASTE) 快速扫描序列, T1WI采用二维快速小角度激励( FLASH)序列.将超声、MRI结果与尸体解剖或随访结果对照.结果 19例孕妇共检出胎儿19个,MRI证实超声疑诊的胎儿胼胝体发育不全14例,3例为单纯侧脑室轻度扩张,2例考虑脑白质发育不良,合并Dandy-Walker综合征1例,胼胝体脂肪瘤1例,检出超声漏诊合并Dandy-Walker综合征1例及脑小畸形1例.结论 MRI对胎儿胼胝体发育不全的显示明显优于超声,有助于明确胎儿胼胝体发育不全、分型及合并畸形的诊断.     

MRI在显示胎儿中枢神经系统发育畸形中优势的初步探讨

目的:探讨MRI在检出胎儿中枢神经系统发育异常中的优势。方法:对42例超声检查发现胎儿异常的孕妇进行胎儿MRI检查(超声检查48h内完成),孕妇年龄22~35岁,胎龄16~35周。MRI检查采用半傅立叶单激励快速自旋回波(HASTE)序列获得T2WI,其中8例还行快速小角度激励(fastlowangleshot,FLASH)T1WI成像,4例行扩散加权成像。将超声结果、MRI与尸体解剖、手术或/和出生后随访MRI比较。结果:产前超声漏诊的病例共20例,MRI的T2WI仅漏诊1例。超声漏诊病例多数为脑实质及脊髓病变,且多种中枢神经系统发育畸形的声像图可表现相同,缺乏特异性。结论:MRI可直接显示脑实质、脊髓以及病变与脑脊髓的关系,在超声检查基础上进行胎儿磁共振成像,有助于弥补超声之不足,进一步完善、验证、甚至更正超声诊断。     

MRI在心脏瓣膜病中的诊断价值

目的 探讨多序列MR扫描在心脏瓣膜病中的诊断价值。方法 回顾性分析56例心脏瓣膜病患者的影像学资料，患者分别采用超声心动图（UCG）、二维（2D）黑血及亮血序列、K-空间节段真实稳态进动快速扫描序列（True FISP）对瓣膜病进行定性评价，15例患者还进行小角度快速激发（FLASH）电影序列和流速编码电影（VEC）定量分析，并将MR结果与UCG进行对比。结果 UCG和MRI诊断二尖瓣狭窄（MS）2例，二尖瓣关闭不全（MI）23例；主动脉瓣狭窄（AS）7例，其中二瓣畸形5例；主动脉瓣关闭不全（AI）13例；三尖瓣关闭不全（TI）2例；复合或联合瓣膜病9例。受累心腔的增大和升主动脉的扩张是其主要形态学改变，异常的血液湍流信号是受累瓣膜的直接征象。VEC-MR定量分析与多普勒超声一致性好：6例AS，MR和UCG检查结果相关性分析，相关系数和校正相关系数分别为：R=0，975、Rsq=0．951（P〈0．01），AI9例，分别为R=0．965、Rsq=0．932（P〈0．01）。结论 MR多序列综合扫描可对心脏瓣膜病特别是主动脉瓣疾病进行准确的定性及定量评价。     

MR Imaging of Congenital Heart Diseases in Adolescents and Adults

Echocardiography and catheterization angiography suffer certain limitations in the evaluation of congenital heart diseases in adults, though these are overcome by MRI, in which a wide field-of view, unlimited multiplanar imaging capability and three-dimensional contrast-enhanced MR angiography techniques are used. In adults, recently introduced fast imaging techniques provide cardiac MR images of sufficient quality and with less artifacts. Ventricular volume, ejection fraction, and vascular flow measurements, including pressure gradients and pulmonary-to-systemic flow ratio, can be calculated or obtained using fast cine MRI, phase-contrast MR flow-velocity mapping, and semiautomatic analysis software. MRI is superior to echocardiography in diagnosing partial anomalous pulmonary venous connection, unroofed coronary sinus, anomalies of the pulmonary arteries, aorta and systemic veins, complex heart diseases, and postsurgical sequelae. Biventricular function is reliably evaluated with cine MRI after repair of te ralogy of Fallot, and Senning''s and Mustard''s operations. MRI has an important and growing role in the morphologic and functional assessment of congenital heart diseases in adolescents and adults.     

HASTE sequence and cine-MRI evaluation of the cervical spinal canal: evaluation in 11 healthy subjects

PURPOSE: We studied 11 healthy subjects were evaluated using cine MR imaging comparing HASTE and gradient echo sequences. Materials and methods :HASTE is a high-speed turbo-spin echo T2-weighted sequence. All examinations were performed using dynamic MRI using a simple process allowing acquisition of images at different stages during flexion and extension. The cine MR evaluation was obtained by rebuilding a cine-loop sequence. RESULTS: HASTE sequence provides a myelographic effect of the cervical spine. The size, the pattern and the movements of the cervical spine, the spinal cord, as well as the functional reserve of cerebro-spinal fluid are analysable. CONCLUSION: Because of its very high speed, HASTE sequence is particularly useful for cine MR imaging.     

Detection and characterization of intracardiac thrombi on MR imaging

OBJECTIVE: The aim of our study was to compare the diagnostic accuracy achieved using different MR techniques with the diagnostic accuracy achieved using transthoracic and transesophageal echocardiography to detect intracardiac thrombi. MATERIALS AND METHODS: Twenty-four patients with known or suspected intracardiac thrombi were examined using MR imaging and echocardiography. All MR examinations were performed on a 1.5-T MR scanner using dark-blood-prepared half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences, fast imaging steady-state free precession (trueFISP) cine sequences, and inversion recovery gradient-echo fast low-angle-shot (inversion recovery turbo FLASH) sequences after injection of 0.2 mmol/kg of gadolinium diethylene triamine pentaacetic acid. RESULTS: MR imaging and echocardiography revealed 12 thrombi-two in the right atrium, one in the right ventricle, three in the left atrium, and six in the left ventricle. Compared with echocardiography, MR imaging revealed three additional thrombi in the left ventricle; these thrombi were confirmed at surgery. All 15 thrombi appeared as filling defects on early contrast-enhanced inversion recovery turbo FLASH MR images. Only seven thrombi were detected on HASTE images, and 10 thrombi were seen on trueFISP images. Four thrombi showed enhancement 10-20 min after contrast material injection and were characterized as organized clots. CONCLUSION: Contrast-enhanced inversion recovery turbo FLASH sequences were superior to dark-blood-prepared HASTE and trueFISP cine MR images in revealing intracardiac thrombi. Compared with transthoracic echocardiography, MR imaging was more sensitive for the detection of left ventricular thrombi. The characterization of thrombi may be used to predict the risk of embolism, which is higher for subacute clots than for organized thrombi.     

MR imaging of aortic coarctation

Aortic coarctation accounts for 5%–10% of all congenital heart diseases and represents 7% of critically ill infants with heart disease. Magnetic resonance (MR) imaging allows the study of this disease with several advantages in comparison with conventional angiography, transesophageal echocardiography, and computed tomography. The MR protocol applied at our institution for both diagnosis and follow-up after surgical or endovascular treatment consists of four steps: morphologic study, cine MR study, flow analysis, and MR angiography (MRA). The first three sequences are acquired during breath-hold and with electrocardiographic gating. Anatomy is well depicted with dark-blood half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences. Cine true-fast imaging with steady-state precession (true-FISP) sequences show not only morphologic features but also blood-flow changes inside the aorta. Gradient-echo sequences for phase-velocity mapping allow flow analysis. Application of Bernoulli’s equation — here briefly presented and discussed — allows for calculation of the pressure gradient caused by the coarctation. MRA, acquired with a breath-hold three-dimensional T1-weighted gradient-echo sequence and intravenous administration of paramagnetic contrast material, allows for optimal depiction of the aortic lumen, with a panoramic view of the whole aorta, its main branches and possible collateral circulation.     

Kardiovaskuläre Ganzkörper-MRT mit paralleler Bildgebung

PURPOSE: To create a whole-body cardiovascular MRI protocol with parallel imaging (iPAT). MATERIAL AND METHODS: Twenty two persons participated in the whole body scan. Due to iPAT high resolution imaging of the heart could be performed. 3D contrast enhanced MR angiography (3D-CE-MRA) took only 62 s to cover the whole body at a spatial resolution of less than 1.4x1.0x1.5mm(3). Scan time for HASTE lung imaging could be reduced by the factor of 2 while maintaining the signal to noise ratio (SNR). Image quality was rated by 2 radiologists blinded to each other. RESULTS: Mean scan time was 104 min on the standard system and less than 80 min on the new system. 75% of all MRA segments were rated good in terms of vessel conspicuity, more than 80% had no venous overlay. One case of distal occlusion of the anterior tibial artery and two cases of myocardial infarction were detected. CONCLUSION: Parallel imaging offers the possibility of fast whole body imaging. A combination of morphologic and functional imaging can be performed within less than 80 min.     

MR imaging in congenital heart disease: where is the leading edge?

MRI has proved to be a useful tool in the evaluation of congenital heart disease. Two types of information can be gleaned from this new imaging modality. The first has to do with the acquisition of anatomical details which are best retrieved from "static" scanning using a low field strength. We have found magnetic resonance to be superior to angiocardiography and/or echocardiography in gathering anatomical information in the following situations: congenital heart defects having giant compartments; conotruncal malformations; and assessment of surgical results. Secondly, physiological information can be obtained using "dynamic" or cine magnetic resonance imaging, utilizing a high field strength.     

Role and effectiveness of cardiovascular magnetic resonance in the diagnosis, preoperative evaluation and follow-up of patients with congenital heart diseases

The substantial advances in the medical and surgical treatment of congenital heart diseases have dramatically improved patients' life expectancy, as well as increased the number of those needing lifelong monitoring to identify complications and residual defects. Magnetic resonance imaging (MRI) is an ideal imaging modality for the follow-up of these young patients owing to its noninvasiveness, high reproducibility and morphological and functional accuracy. This paper describes the most appropriate MRI techniques and sequences for the study of cardiovascular heart diseases on the basis of an analysis of MRI studies carried out between January 2003 and June 2006 on 274 patients affected by all of the main congenital cardiovascular malformations, as well as a review of the literature. The advantages of MRI with respect to other imaging techniques, the problems encountered and the main clinical applications and indications of MRI, with special reference to the most common disease entities, are then discussed to define the role, the utility and the future perspectives of this imaging technique in the study of congenital heart diseases.     

磁共振快速成像技术在肺癌分期中的应用

目的:探讨MRI快速成像序列在肺癌分期中的成像质量及其临床应用价值。方法:36例肺癌患者,分别行MRI快速序列成像及CT增强扫描。分析快速序列的伪影,与CT对比分析肿瘤与胸部邻近结构的关系、淋巴结肿大情况。结果:HASTE各项伪影评分均为0,FLASH伪影也低于常规序列。FLASH和true FISP无呼吸伪影,但搏动伪影高于常规序列。与CT对比,在显示胸部邻近结构侵犯方面,HASTE效果可靠,FLASHt、rueFISP因不同程度受伪影影响而效果次之。HASTE和FLASH均可显示纵隔肿大淋巴结。结论:HASTE无伪影,可作为肺癌MRI分期的首选快速成像序列,FLASH则主要用于冠状位成像,trueFISP可以选择应用。     

MRI of the liver: Can true FISP replace HASTE?

PURPOSE: To determine the diagnostic accuracy of two fast breath-hold magnetic resonance (MR) imaging sequences, half-Fourier acquired single turbo spin-echo (HASTE) and true fast imaging with steady state precession (TrueFISP), for the detection and characterization of focal liver lesions MATERIALS AND METHODS: A total of 186 patients with suspected focal liver lesions were enrolled in this study. All patients underwent the same standardized study protocol including HASTE and TrueFISP. A consensus reading based on all available image data served as a standard of reference for classifying lesions into cysts, hemangiomas, focal nodular hyperplasia, or malignant/other lesions. All malignant lesions, as well as hepatic adenomas and abscesses, were histologically verified. Each separated by an eight-week interval, HASTE and TrueFISP images were retrospectively reviewed in random order for the detection and characterization of focal hepatic lesions. Finally, a receiver operating characteristic (ROC) analysis was calculated. RESULTS: HASTE images had an overall sensitivity of 0.86 and a specificity of 0.91, whereas TrueFISP showed an overall sensitivity and specificity of 0.79 and 0.83, respectively (p>0.1). CONCLUSION: Neither HASTE nor TrueFISP alone are sufficient for the detection and characterization of hepatic lesions.