定量组织速度成像技术对重度妊高征患者左心功能的研究

目的:应用定量组织速度成像技术(quantitative tissue velocity imaging,QTVI)检测重度妊娠高血压综合征患者左心功能。方法:应用QTVI技术测量30例重度妊高征患者和60例正常孕妇二尖瓣环六个部位的收缩期(Vs)、舒张早期(Ve)、舒张晚期(Va)室壁运动峰值速度并分别计算平均值(MVs、MVe、MVa)。结果:①重度妊高征组二尖瓣环前间隔、左室前壁的Sm及除后间隔外各位点的Em值明显高于对照组;②重度妊高征组二尖瓣环各位点组织速度平均值MSm、MEm明显低于对照组。结论:重度妊高征患者因为心肌小动脉的损害,导致左心功能不同程度减低。     

定量组织多普勒Tei指数评价重度妊高征胎儿心功能的研究

目的:应用定量组织速度成像技术(quantitative tissue velocity imaging,QTVI)所测Tei指数评价重度妊高征患者胎儿心功能的临床价值.方法:应用qrvi测量30例重度妊高征患者和60例正常孕妇胎儿右室房室瓣环室壁运动的射血期(ET)、等容收缩期(ICT)和等容舒张期(IRT)的时间问期,计算胎儿Tei指数.结果:重度妊高征组的IRT ICT和Tei指数显著高于与对照组.结论:重度妊高征不仅对母体脏器造成危害,而且累及胎儿心脏功能.     

组织速度成像同步测定右心室三尖瓣环速度和Tei指数评估肺动脉高压右心室功能

目的:探讨应用定量组织速度成像(QTVI)技术同步测定右室游离壁三尖瓣环运动速度和Tei指数评估肺动脉高压(PAH)患者右室功能的联合应用价值。方法:58例PAH患者和47例健康人入选本研究。常规超声心动图测量右室游离壁厚度,右房、右室舒张末期面积和收缩末期面积(RAEDA,RAESA,RVEDA,RVESA)并计算右室面积变化率;获取入选者标准心尖部右室流入道长轴和四腔观TVI图像,离线分析右室4个壁三尖瓣环处组织速度曲线,测量右室游离壁三尖瓣环处收缩期峰值速度(Sa)、舒张早期峰值速度(Ea)、舒张晚期峰值速度(Aa);依据公式计算右室4个壁瓣环处Tei指数,取其平均值作为右室整体心肌做功指数。结果:与正常人相比,PAH患者具有更厚的右室游离壁,更大的RAEDA、RAESA、RVEDA、RVESA、Tei指数,更高的肺动脉收缩压,更低的右室面积变化率、Sa、Ea、Aa、Ea/Aa。PAH患者右室结构参数(右室游离壁厚度,RAEDA、RAESA、RVEDA、RVESA)与功能参数(Tei指数、Sa、Ea、Aa、Ea/Aa、右室面积变化率)间均具有一定的相关性(r=0.34～0.76,P<0.05～0.001)。PAH患者Sa、Ea、Aa、Ea/Aa、右室面积变化率与Tei指数均有一定的相关性(r=0.39～0.68,P<0.05～0.001)。结论:QTVI技术同步测定三尖瓣环运动指标和Tei指数可更好地评估PAH患者右室功能。     

心脏磁共振组织追踪技术定量分析肥厚型心肌病左心室心肌应变

目的 基于心脏磁共振组织追踪技术（CMR-TT）定量分析肥厚型心肌病（HCM）患者左心室心肌应变。方法 对HCM射血分数（EF）正常28例患者（病例组）及14名健康志愿者（对照组）行心脏磁共振电影检查,应用CMR-TT技术定量分析左心室心肌各向应变值、收缩期应变率及峰值位移,就两组左心室整体心肌的各向应变值、收缩期应变率、峰值位移及病例组肥厚节段、非肥厚节段应变参数做统计学分析,构建受试者工作特征（ROC）曲线,计算左心室整体心肌各向应变在鉴别对照组与病例组诊断效能。结果 HCM组左心室整体心肌径向应变、周向应变、纵向应变值及其相应的应变率分别为（23.39±10.11）%和（1.32±0.48）s^-1、（-17.59±5.04）%和（-1.14±0.38）s^-1、（-8.70±2.84）%和（-0.59±0.20）s^-1,均低于对照组。HCM组整体心肌径向、周向及纵向峰值位移分别为（4.32±0.97）mm、（2.63±1.74）deg、（4.43±1.81）mm也较对照组不同程度缩小。病例组肥厚节段径向应变、周向应变...     

双多普勒成像技术测量Tei指数评价原发性高血压患者右心室功能

目的探讨实时双多普勒成像技术测量Tei指数评价原发性高血压患者右心室功能的价值。资料与方法原发性高血压患者按Ganau分类法分为4型:正常左心室构型(Ⅰ组,16例)、向心性重构(Ⅱ组,17例)、向心性肥厚(Ⅲ组,15例)、离心性肥厚(Ⅳ组,15例);对照组22例。采用实时双多普勒成像技术在同一心动周期内测量出a[等容收缩时间(ICT)+射血时间(ET)+等容舒张时间(IRT)]、b射血时间(ET),计算出同步Tei指数。结果Ⅱ、Ⅲ、Ⅳ组右心室Tei指数均较对照组增加(0.38±0.06,0.49±0.07,0.67±0.12与0.28±0.02,P<0.01);Ⅲ组与Ⅰ组比较,差异有统计学意义(P<0.05);Ⅳ组与Ⅰ、Ⅱ组比较,差异均有统计学意义(P<0.01);右心室Tei指数与左心室Tei指数呈正相关(r=0.879,P<0.01),与IRT+ICT(a-b)呈正相关(r=0.629,P<0.01),与ET(b)呈负相关(r=-0.282,P<0.01)。结论高血压患者不同左心室构型其右心室功能减低的程度不同。实时双多普勒成像技术测量右室Tei指数能简便、有效、综合评价原发性高血压患者右心室的整体功能,并能测量心律失常患者的Tei指数。     

组织多普勒成像在肥厚型心肌病的应用

多普勒组织成像(doppler tissue imaging，DTI)又称多普勒心肌成像(doppler myocardial imaging，DMI)，是近十年来开发的一项超声心动图新技术，1992年由McDicken等提出，随后被应用于临床分析心肌的活动与功能。DTI可选择性地实时显示心肌运动的方向与速度，为定量分析心肌运动及功能提供了新的方法，弥补了传统二维及M型超声心动图的一些局限。     

Tei指数评价儿童三尖瓣下移畸形手术前后心功能的变化

目的:评价Tei指数估测儿童三尖瓣下移畸形手术前后心功能变化的价值。方法:38例接受三尖瓣下移畸形手术治疗的患儿,分别于手术前后应用超声心动图测量左、右心室Tei指数。另选取80名正常儿童作为对照组。结果:正常组左、右心室Tei指数分别为0.30±0.08、0.26±0.08,三尖瓣下移畸形患儿术前左、右心室Tei指数分别为0.46±0.09、0.50±0.11,均高于正常组(P<0.05),术后患者左、右心室Tei指数分别为0.36±0.06、0.33±0.06,明显降低,但尚未恢复至正常组水平(P<0.05)。结论:三尖瓣下移畸形患者术前存在心功能不全,手术可以得到改善;Tei指数可以较准确评价三尖瓣下移畸形患者的心功能变化。     

组织多普勒技术定量评价陈旧性室间隔心肌梗死的右室功能

目的:采用不同组织多普勒技术定量研究陈旧性室间隔心肌梗死患者的右室局部和整体功能。方法:20例陈旧性室间隔心肌梗死患者,30例健康成人。采用应变率及组织速度成像获取右室侧壁各节段的组织速度、位移、应变及应变率曲线。测量收缩功能参数:收缩期峰值速度(Vs)、最大位移(D)、收缩期峰值应变(S)及应变率(SR);测量舒张功能参数:舒张早期充盈速度(Ve)、心房收缩期充盈速度(Va)、舒张早期充盈应变率(Esr)、心房收缩期充盈应变率(Asr)。脉冲组织多普勒获取三尖瓣环运动频谱曲线,计算右室Tei指数。结果:陈旧性室间隔心肌梗死组右室侧壁基底段的S和D以及心尖段的SR和D均较正常组明显减低;基底段及中间段的Ve和Esr均较正常组明显减低;右室Tei指数明显高于正常组。结论:陈旧性室间隔心肌梗死患者右室侧壁多个节段的局部收缩和舒张功能明显受损,此外右室整体功能也明显受损。     

实时三维超声心动图结合二维斑点追踪技术评价运动负荷前后对肥厚型非梗阻性心肌病患者右心室功能的影响

目的探讨应用实时三维超声心动图(RT-3DE)结合二维斑点追踪技术(2D-STI)评价运动前后肥厚型非梗阻性心肌病(HNCM)患者右心室功能。方法选取32例HNCM患者和与之性别、年龄相符的35例对照组。分别于运动前后测量右心室参数:三尖瓣舒张早、晚期血流峰值速度E峰、A峰(TV-E峰、TV-A峰);组织多普勒显像测得三尖瓣环收缩期峰值速度、舒张早期速度(TV-Sm、TV-Em);2D-STI方法测量右心室整体长轴应变(RVGLS);RT-3DE技术测得右心室舒张末期容积(RVEDV)、右心室收缩末期容积(RVESV)、右心室每搏量(RVSV)、右心室射血分数(RVEF)以及三尖瓣环收缩期位移(TAPSE)、右心室面积变化率(RVFAC)。并将容积参数结合体表面积(BSA)进行标化得到右心室舒张末期容积指数(RVEDVi)、右心室收缩末期容积指数(RVESVi)、右心室每搏量指数(RVSVi)。结果运动后对照组与HNCM组常规参数TAPSE、RVFAC、TV-E峰、TV-A峰、三维参数RVEDVi、RVESVi、RVEF差异均无统计学意义(P>0.05);运动后对照组与HNCM组...     

组织速度成像评估正常人右心室节段心肌运动时间的变化特点

目的:探讨组织速度成像评估正常人右室节段心肌运动时间的变化特点.方法:65例正常人入选本研究.离线分析入选者右室游离壁、后壁、室间隔处的基底段、中间段的组织速度曲线,测量等容收缩期(Tic)、射血期(Ts)、等容舒张期(Tir)、舒张早期(Te)、心房收缩期(Ta)持续时间,计算各间期占1个心动周期百分比的6节段平均值作为右室整体参数(Tic/RR′、Ts/RR′、Tir/RR′、Te/RR′、Ta/RR′).依据公式计算右室整体Tei指数.结果:正常人右室心肌运动时间具有一定的规律性,Tic/RR′、Ts/RR′、Tir/RR′、Te/RR′、Ta/RR′与Tei指数均具有一定相关性,其中以Tic/RR′、Ts/RR′、Tir/RR′与Tei指数相关性最好.结论:正常人右室心肌长轴运动时间具有规律性,Tic/RR′、Ts/RR′、Tir/RR′是评估右心室整体功能的良好指标.     

Visualizing tissue compliance with MR imaging

We propose a method for visualizing the mechanical properties of tissue based on the use of periodic mechanical compression in conjunction with phase-contrast MR imaging. A specialized mechanical transducer was used to provide programmable compression pulses to the surface of compliant phantoms. These compression pulses were synchronized to a spin-echo sequence with motion-sensitizing gradients to generate phase information reflecting spin displacement throughout the phantom. This sequence was tested with two agarose gel phantoms. The first was a cylinder containing three parallel layers of varying compliance and the second was composed of a semirigid sphere suspended in a uniform layer of decreased elastic modulus. Images showed complex patterns of motion throughout the phantom, which correlated with expected motion behavior of the phantom structures. This indicates that the biomechanical properties of tissues may be elucidated through the use of motion-sensitized MR imaging and suggests that a form of image contrast relating to tissue elasticity may be feasible.     

Radionuclide imaging of soft tissue neoplasms

Two classes of radiopharmaceuticals may be used for imaging tumors of the musculoskeletal system. The first is comprised of soft tissue or tumor specific agents such as gallium-67, bleomycin, and radionuclide-labeled antibodies, which may be useful for detecting and localizing these tumors. The other class of tracer is comprised of those with avidity for bone. The 99mTc-labeled-phosphate skeletal imaging compounds have been found to localize in a variety of soft tissue lesions, including benign and malignant tumors. In 1972, Enneking began to include bone scans in the preoperative evaluation of soft tissue masses. Later, he and his associates reported that these scans were useful in planning operative treatment of sarcomas by detecting involvement of bone by the tumors. Nearly all malignant soft tissue tumors take up bone-seeking radiopharmaceuticals, and bone involvement was indicated in two-thirds of the scans we reviewed. About half of benign soft tissue lesions had normal scans, but the other half showed uptake within the lesion and a few also showed bone involvement. Careful, thorough imaging technique is essential to proper evaluation. Multiple, high-resolution static gamma camera images in different projections are necessary to adequately demonstrate the presence or absence of soft tissue abnormality and to define the precise relationship of the tumor to the adjacent bone.     

Adrenal tissue characterization using MR imaging

Using a superconducting magnet operating at 0.35 T, the authors investigated the adrenal tissue characterization potential of magnetic resonance (MR) in 28 patients with 33 adrenal masses. There were 13 adrenal adenomas (12 non-hyperfunctioning, one aldosteronoma), nine adrenal metastases, four pheochromocytomas, two neuroblastomas, two adrenal lymphomas, two myelolipomas, and one adrenal cortical carcinoma. Spin-echo pulse sequences were obtained at TR 0.5, 2.0 sec and TE 28, 56 msec. Both qualitative (visual assessment) and quantitative (absolute signal intensity, intensity ratios, T1, T2) data were used for tissue characterization. The results suggest that non-hyperfunctioning adrenal adenomas can be distinguished from non-adenomas using both qualitative and quantitative data: 16/19 non-adenomas were visually hyperintense compared with liver at TR 2.0 sec, TE 56 msec, while none of the non-hyperfunctioning adenomas was relatively hyperintense at any pulse sequence used. Of the quantitative data, the intensity ratios of adrenal lesion/liver at TR 0.5 sec, TE 56 msec were most useful in diagnosis: all adenomas had ratios less than 0.83, while 19/20 non-adenomas had ratios exceeding this value. It is concluded that MR has considerable promise in adrenal tissue characterization.     

冠状动脉周围脂肪影像学的研究进展

作为一种内分泌器官,心包脂肪组织与冠状动脉疾病(CAD)的发生、发展紧密相关。冠状动脉周围脂肪组织(PCAT)是一种特殊类型的脂肪组织,与相邻的血管壁相互作用,能以旁分泌方式调节心血管生物学功能,也可对来自血管壁的信号做出反应改变其表型。PCAT无创影像分析有助于识别高风险的心血管病患者,对CAD的临床诊疗有重要意义。本文综述冠状动脉周围脂肪无创影像学的研究进展及其临床应用价值。     

Soft tissue tumors: post-treatment imaging

As the radiologic evaluation of soft tissue masses has changed dramatically with the advent of MR imaging, the effect of MR imaging is even more striking in the assessment of patients after treatment. In cases of local tumor recurrence, MR imaging has become the standard of care. Using a few basic principles, even small local recurrences can be detected accurately, and recurrence can be distinguished from postoperative or post-treatment change. This review presents a fundamental approach to the evaluation of patients, following treatment for soft tissue tumors and highlighting MR imaging.     

Histology and imaging of soft tissue sarcomas

Imaging and histology are two complementary morphological techniques which play a fundamental role in the diagnosis and management of soft tissue sarcomas. Imaging allows to identify some pseudosarcomatous benign lesions such as myositis ossificans, intramuscular hemangioma, angiomyolipoma, intramuscular lipoma, giant cell tumour of tendon sheath, desmoid tumour and elastofibroma. There is no formal criterion for diagnosing a sarcoma on magnetic resonance imaging (MRI) but malignancy is strongly suspected with the presence of necrosis and vascular, bone or joint invasion. Imaging may also suggest some histological types of sarcoma such as well-differentiated liposarcoma, dedifferentiated liposarcoma, synovial sarcoma or extraskeletal osteosarcoma. Imaging is also extremely helpful in determining the appropriate kind of sampling to carry out and in guiding the performance of a microbiopsy. The appearance observed on imaging should always be taken into consideration for the interpretation of the microbiopsy by the pathologist.     

Magnetic resonance imaging of soft tissue tumors

This article outlines the ability of MR imaging in staging, grading, tissue characterization, and posttherapeutic surveillance of soft tissue tumors. Well-known staging parameters, such as extent, relationship with adjacent structures, and detection of intralesional necrosis, are used in the MR protocol for locoregional staging. Bone scintigraphy and high-resolution CT scan of the lungs are best methods for ruling out metastatic spread. A variety of (solitary or combinations of) grading parameters are described in the radiological literature. The role of MR imaging is to afford recognition of these lesions that need further aggressive work-up, excluding all others. Despite controversial reports, the definite role of MR imaging in grading of soft tissue tumors seems to become established. As for grading, a lot of individual imaging characteristics used for tissue characterization have low sensitivity, but combinations of parameters (age, site, signal intensities) are more useful and often allow to predict a specific diagnosis or to narrow down the list of differential diagnoses. Local recurrences of soft tissue tumors are frequent and can be detected accurately by an easy-to-use MR algorithm.     

Cardiac tissue Doppler imaging in sports medicine

The differentiation of training-induced cardiac adaptations from pathological conditions is a key issue in sports cardiology. As morphological features do not allow for a clear delineation of early stages of relevant pathologies, the echocardiographic evaluation of left ventricular function is the technique of first choice in this regard.Tissue Doppler imaging (TDI) is a relatively recent method for the assessment of cardiac function that provides direct, local measurements of myocardial velocities throughout the cardiac cycle. Although it has shown a superior sensitivity in the detection of ventricular dysfunction in clinical and experimental studies, its application in sports medicine is still rare. Besides technical factors, this may be due to a lack in consensus on the characteristics of ventricular function in relevant conditions.For more than two decades there has been an ongoing debate on the existence of a supernormal left ventricular function in athlete's heart. While results from traditional echocardiography are conflicting, TDI studies established an improved diastolic function in endurance-trained athletes with athlete's heart compared with controls.The influence of anabolic steroids on cardiac function also has been investigated by standard echocardiographic techniques with inconsistent results. The only TDI study dealing with this topic demonstrated a significantly impaired diastolic function in bodybuilders with long-term abuse of anabolic steroids compared with strength-trained athletes without abuse of anabolic steroids and controls, respectively.Hypertrophic cardiomyopathy is the most frequent cause of sudden death in young athletes. However, in its early stages, it is difficult to distinguish from athlete's heart. By means of TDI, ventricular dysfunction in hypertrophic cardiomyopathy can be disclosed even before the development of left ventricular hypertrophy. Also, a differentiation of left ventricular hypertrophy due to hypertrophic cardiomyopathy or systemic hypertension is possible by TDI.Besides the evaluation of different forms of left ventricular hypertrophy, the diagnosis of myocarditis is also of particular importance in athletes. Today, it still requires myocardial biopsy. The analysis of focal disturbances in myocardial velocities might be a promising non-invasive method; however, systematic validation studies are lacking.An important future issue for the implementation of TDI into routine examination will be the standardisation of procedures and the establishment of significant reference values for the above-mentioned conditions. Innovative TDI parameters also merit further investigation.     

Magnetic resonance imaging of peripheral soft tissue hemangiomas

Ten patients with soft tissue hemangiomas outside the central nervous system were studied with MR imaging. Eight patients were studied at 1.5 Tesla (T) with T₁-weighted and triple echo T₂-weighted sequences. Two additional patients were imaged on a 0.5-T system. The MR images were correlated with images from other modalities. Histologie diagnosis was obtained in all cases. It was found that prolonged T₂-weighted imaging together with standard spin echo T₁ and T₂ pulse sequences is a good substitute for contrast-enhanced CT and arteriographic evaluation of soft tissue hemangiomas.