核素心室显像对急性心肌梗塞远期预后的预测价值

目的：探讨平衡法核素心室显像（ＥＲＮＶ）对急性心肌梗塞（ＡＭＩ）远期预后的预测价值。方法：对８９例于发病后４—６周行ＥＲＮＶ检查的ＡＭＩ患者进行了２３（１２—４２）个月的随访。参照病人预后，将其分为２组：第一组为出院后出现心脏猝死（ＳＣＤ）和（或）心力衰竭（ＮＦ）者（ｎ＝２０）；第二组为出院后无心脏事件者（ｎ＝６９）。并按年龄、性别进行１：２配对。对可能影响其远期预后的１７个参数进行了分析。结果：ＳＣＤ发生率为２．２％；去除年龄及性别因素，左室侧壁射血分数（ＬＡＴ－ＥＦ）、血清肌酸磷酸激酶同工酶（ＣＫ－ＭＢ）是判断ＡＭＩ远期预后的独立有效的危险因子；建立了一预后指数公式：Ｚ＝２．４７６（ＬＡＴ－ＥＦ）＋０．７６０（ＣＫ－ＭＢ），Ｚ越大，ＳＣＤ或ＨＦ发生率越高。结论：ＥＲＮＶ在ＡＭＩ远期预后的预测中有重要作用。     

选择性经皮冠脉腔内成形术逆转冠心病左室重构疗效观察25例

为探讨经皮冠脉腔内成形术（ＰＴＣＡ）能否逆转冠心病（ＣＨＤ）患者的左室重构（ＬＶＲＭ），对实施选择性ＰＴＣＡ的２５例冠心病患者，应用二维超声心动图（２ＤＥ）动态观察其围ＰＴＣＡ期左室射血分数（ＬＶＥＦ）、每搏量（ＳＶ）、左室舒张末容积（ＬＶＥＤＶ）及左室收缩末容积（ＬＶＥＳＶ）的演变。结果发现扩大的左室容积在围术期中明显缩小。其中１５例心肌梗死后有ＬＶＲＭ者７例，其术后ＬＶＥＳＶ首先回缩（Ｐ＜００５），随后ＬＶＥＳＶ及ＬＶＥＤＶ均显著缩小（均Ｐ＜００１）；而无ＬＶＲＭ者（ｎ＝８），ＬＶＥＳＶ及ＬＶＥＳＶ则无变化（均Ｐ＞００５）。无论有无ＬＶＲＭ，围术期ＬＶＥＦ及ＳＶ均无变化（均Ｐ＞００５）。提示在选择性ＰＴＣＡ围术期中，ＬＶＲＭ可明显减轻；也表明在反映ＬＶ功能的２ＤＥ指标中，ＬＶＥＳＶ及ＬＶＥＤＶ较ＬＶＥＦ及ＳＶ更敏感     

M型、二维及动态三维超声与核素测量冠心病左室收缩功能的对比研究

目的：探讨经胸超声尤其三维超声对冠心病的应用价值。方法：使用超声心动图五种方法检测了１４ 例冠心病左室ＥＤＶ、ＥＳＶ、ＳＶ和ＥＦ，并与核素（ＳＰＥＣＴ） 结果进行了比较分析。结果：①超声诸方法除Ｍ型外，各项测值与ＳＰＥＣＴ结果比较均无显著差异（Ｐ＞０．０５） ，而以３ＤＥ 测量误差值最小；②３ＤＥ 诸测值及Ｍ 型和２ＤＥ 诸方法除ＳＶ 测值外，均与ＳＰＥＣＴ高度相关（ Ｐ＜０ ．０１） ，尤以３ＤＥ相关性最好；③２ＤＥ诸方法所测值与３ＤＥ无显著差异（ Ｐ＞０．０５），尤以ＳＩＭＰＳＯＮ和Ａ－ Ｌ法测值与３ＤＥ最为接近。结论：超声心动图诸方法除Ｍ 型外测定冠心病左室收缩功能有较好的准确性和可信度，应首选３ＤＥ，在无３ＤＥ检测条件时，尽可能采用ＳＩＭＰＳＯＮ和Ａ－ Ｌ法，而弃用Ｍ 型法。     

放射性核素显像评价心肌梗塞对心功能影响的探讨

以４０例正常人为对照，用放射性核素显像研究５０例急性或陈旧性心肌梗塞（ＭＩ）病人的左室ＭＩ部位、心肌梗塞面积（ＭＩＳ）及其对左、右心室功能的影响．方法：以左、右室射血分数（ＬＶＥＦ、ＲＶＥＦ）、最大射血率（ＰＥＲ）及最大充盈率（ＰＦＲ）作为心功能指标，用角度法测算ＭＩＳ．根据左室ＭＩ部位不同分为Ⅰ组（前壁及心尖部）、Ⅱ组（侧壁）和Ⅲ组（下壁及后壁）．并进行统计学分析．结果：Ⅰ组及Ⅱ组中ＬＶＥＦ重度下降者分别为８１．５％和６０．０％，Ⅰ组及Ⅲ组中ＲＶＥＦ重度下降者分别为２０．０％和５７．２％．Ⅰ组及Ⅱ组中ＭＩＳ与ＬＶＥＦ呈负相关（ｒ＝-０．６８），Ⅲ组中ＭＩＳ与ＲＶＥＦ呈负相关（ｒ＝-０．５１）．其中２０例大面积ＭＩ（ＭＩＳ５３．８３％±９．７４％）病人ＭＩＳ与ＬＶＥＦ呈负相关（ｒ＝-０．７２），而与ＲＶＥＦ呈正相关（ｒ＝０．６４）．结论：了解ＭＩ部位及ＭＩＳ可对心功能作出较为客观的估价．同时，了解心功能状态可初步估算ＭＩＳ的大小，有利于诊断和治疗疾病及判断病情的预后．关键词     

DSA判断法乐四联症肺动脉狭窄和左心功能

目的：研究法乐四联症患者肺动脉狭窄和左心功能与手术关系。材料和方法：采用ＤＳＡ２４００型数字减影血管造影机（ＤＳＡ）测量了６３例法乐四联症患者心血管造影图像,并与手术结果进行对照分析。结果：肺动脉指数（ＰＡＩ）、ＭｃＧｏｏｎ比值、左心室射血指数（ＳＶＩ）与术后右心室／左心室压力比值呈负相关。结论：ＰＡＩ＞１５０ｍｍ２／ＢＳＡ,ＭｃＧｏｏｎ比值＞１．８,ＳＶＩ＞３０ｍｌ／ｍ２可作为法乐四联症心内修复术选择的定量指标。     

~(99m)Tc-MIBI心肌断层显像和超声心功能评价急性心肌梗塞溶栓血管再通时间的疗效

目的：探讨溶栓治疗血管再通时间的疗效及其有效时间窗。材料和方法：经静脉溶栓治疗后其梗塞相关血管（ＩＲＡ）有再灌注的急性心肌梗塞（ＡＭＩ）患者７１例，其中距发病≤６ｈＩＲＡ再通组５７例，＞６ｈＩＲＡ再通组１４例。患者均于发病２～３周行９９ｍＴｃ－ＭＩＢＩ心肌断层显像测定ＡＭＩ梗塞范围指数（梗塞面积与心室总面积之比，及二维超声测定左室射血分数（ＬＶＥＦ）。结果：距发病≤６ｈＩＲＡ再通组的梗塞范围指数和ＬＶＥＦ分别为０．３２６±０．０７５和０．５８２±０．０９７，距发病＞６ｈＩＲＡ再通组的梗塞范围指数和ＬＶＥＦ分别为０．３７３±０．０７１和０．５０８±０．０７７。两组间梗塞范围指数和ＬＶＥＦ均有显著差异。结论：ＡＭＩ患者静脉溶栓治疗ＩＲＡ早开通比晚开通者的心梗范围缩小，心功能得到更好保护。     

Alzheimer病与血管性痴呆的SPECT

目的：研究脑ＳＰＥＣＴ在诊断及鉴别Ａｌｚｈｅｉｍｅｒ病（ＡＤ）和血管性痴呆（ＶＤ）方面的作用。材料和方法：分别选择符合《精神障碍诊断和统计手册》第４版（ＤＳＭ—ＩＶ）中ＡＤ或ＶＤ诊断标准的患者各１７例和１２例，进行ＳＰＥＣＴ检查，兼作ＣＴ（或ＭＲＩ），并作神经心理测定及其它相关量表评分。将ＡＤ、ＶＤ和ＳＰＥＣＴ结果，以及ＳＰＥＣＴ和ＣＴ（或ＭＲＩ）的结果进行比较。结果：ＡＤ的ＳＰＥＣＴ以颞、顶叶低灌注为典型表现，ＶＤ以局灶性低灌注为主。在右颞下回和右枕叶，ＡＤ组ＳＰＥＣＴ放射性计数比值显著低于ＶＤ组（Ｐ＜０．０５，Ｐ＜０．０１），而在左顶叶显著高于ＶＤ组（Ｐ＜０．０５）。两组左半球的放射性计数比值普遍低于右半球，但ＶＤ的左右不对称性明显重于ＡＤ，以左顶叶最为突出（Ｐ＜０．０１）。ＭＲＩ结果与ＳＰＥＣＴ有较多的一致性。各量表评分除Ｈａｃｈｉｎｓｋｉ缺血指数外，均无显著差异。结论：ＳＰＥＣＴ在诊断和鉴别ＡＤ与ＶＤ方面有一定实用价值     

心肌收缩分数（CF）在心功能评价及心肌梗塞面积预测中的应用

对１２例正常人、４８例冠心病患者进行了９９ｍＴｃ－ＭＩＢＩ平面门控心肌显像，探讨了三种计算左室心肌收缩分数（ＬＶＣＦ）的方法，并与心血池显像的左室射血分数（ＬＶＥＦ）做了相关分析，结果表明：计数法计算ＬＶＣＦ重复性最好，面积法次之，轴缩短法最差；三者与ＬＶＥＦ的相关关系依上顺序递减．相关系数分别为０．８６、０．７３和０．６２．同时研究了ＬＶＣＦ与心肌断层显像（ＳＰＥＣＴ）测定的心肌梗塞范围分数（ＤＦ）的相关性，计数法ＬＶＣＦ与ＤＦ间具有明显负相关（ｒ＝－０．８９），并能通过回归公式预测．结果表明：平面门控心肌显像能较客观地评价左心功能及心肌病变范围，弥补普通平面显像的不足，值得进一步探讨与应用．     

高原肺水肿患者血清内源性洋地黄因子的变化及其意义

用放射免疫法测定了２０例高原肺水肿（ＨＡＰＥ）患者血清内源性洋地黄样因子（ＥＤＦ）浓度，并与１４例刚入高原健康人对比，结果表明：多数（１５／２０）患者血清ＥＤＦ浓度明显增高（Ｐ＜０．０５），少数患者（５／２０）明显降低（Ｐ＜０．０５）而保持平原值水平；ＥＤＦ浓度与ＰａＯ＿２、左心功能的敏感指标ＰＥＰ／ＬＶＥＴ比值呈明显负相关。对其在ＨＡＰＥ的发生发展中的作用进行了初步探讨。     

纤维连接蛋白降解片段（MAD2）单抗的制备及肝细胞癌患者血浆含量检测

应用杂交瘤技术制备了纤维连接蛋白（FN）降解片段MAD2的单克隆抗体（McAb)；建立了ＭＡＤ２检测的双抗体夹心ＥＬＩＳＡ法；对２２７例肝细胞癌（ＨＣＣ）、７６例肝转移癌（ＨＭＣ）、９８例消化道癌（ＡＣＣ）、１５６例慢性肝病（ＣＬＤ）患者和４８例健康人体血浆ＭＡＤ２含量进行测定。结果显示，制备的ＭＡＤ２ ＭcAb属ＩgG1，与ＦＮ无交叉反应；ＨＣＣ组血浆ＭＡＤ２含量均值与ＣＬＤ组、ＨＭＣ组、ＡＣＣ组和正常对照组比较差异有显著性意义（分别Ｐ＜0.01）,以HCC患者的最低MAD2值作临界值时，仅13.5%CLD、6.6%HMC和4.1?C超过此值，而健康人体血浆MAD2含量均低于临界值；65例血清AFP正常的HCC患者其血浆平均MAD2值仍明显高于非HCC肿瘤、CLD患者和正常对照。结合以前的结果，进一步表明，血浆MAD2检测可作为HCC诊断的新标志物，并可与AFP相互补充；ＭＡＤ２ ＭcAb的制备使MAD2的检测变得易行。     

Assessment of left ventricular wall motion using 16-channel multislice computed tomography: comparison with left ventriculography

Purpose Using the raw data from coronary computed tomography (CT) angiography, multislice CT (MSCT) can be used to evaluate cardiac function. However, the accuracy of left ventricular (LV) wall motion assessment by MSCT has not been thoroughly investigated. We investigated whether 16-channel MSCT could accurately assess LV wall motion by comparing its results with those of conventional biplane left ventriculography (LVG). Materials and methods The study included 20 patients with various kinds of heart disease. All patients underwent both contrast-enhanced MSCT and biplane LVG. Using a retrospective electrocardiography-gating technique, 10 phases over one cardiac cycle were extracted. The left ventricle was divided into seven segments according to the American Heart Association classification. Wall motion was scored as follows: 1, normal; 2, mild to moderate hypokinesis; 3, severe hypokinesis; 4, akinesis; 5, dyskinesis; and 6, aneurysm. The scores obtained by MSCT were compared with those obtained by LVG. The wall motion scores were analyzed using the chi-squared independence test (6 × 6 contingency table). Results Wall motion could be assessed in all segments of the 20 patients using interactive multiplanar animation. Among a total of 140 segments in 20 patients, scores in 118 were concordant between MSCT and LVG (118/140, 84.3%). Conclusion The 16-MSCT can accurately assess LV wall motion.     

Accuracy and repeatability of left ventricular systolic and diastolic function measurements using an ambulatory radionuclide monitor

The accuracy and repeatability of a new ambulatory radionuclide detector (VEST) for left ventricular systolic (ejection fraction) and diastolic (peak filling rate) measurements were assessed. Seventeen patients underwent equilibrium radionuclide angiography immediately before and immediately after a VEST study. The accuracy was evaluated at the beginning and at the end of the VEST studies. Limits of agreement for the ejection fraction were –1%: 2% at the beginning of the VEST study and –4% at the end. Limits of agreement for the peak filling rate were –0.6: 0.6 at the beginning of the VEST study and –0.7: 0.5 at the end. For both measurements the limits of agreement were well within the clinical range. Repeatability was evaluated in a second group of 11 patients who underwent VEST studies in 2 separate days. The coefficient of repeatability (twice the standard deviation of the differences between the 2 studies) was 13 for the ejection fraction and 0.4 for the peak filling rate. Thus, the VEST is an accurate and repeatable method to measure both the ejection fraction and peak filling rate. Offprint requests to: L. Pace, Sanseverino 5/A, 1-80128 Napoli, Italy     

评价室壁瘤患者左室整体和局部收缩与舒张功能受损情况

目的:利用放射性核素心室造影技术评价前壁心肌梗死后室壁瘤形成对左心室整体和局部的收缩及舒张功能的影响。材料和方法:患者分为对照组(G0)15名,单纯前壁心肌梗死组(G1)29名,前壁心肌梗死并发室壁瘤组(G2)15名。运用放射性核素心室造影检查技术测定心功能指标:①左室整体收缩功能参数:LVEF、TPE、PER、1/3EF、1/3ER。②左室整体舒张功能参数:TPF、PFR、1/3FF、1/3FR。③左室局部收缩功能参数:LVREF (6个节段)。④左室局部舒张功能参数:LVR1/3FF(6个节段)。结果:①左室整体收缩功能参数,在LVEF、PER、1/3EF、1/3ER中,G2较G1和G0有明显下降(P<0.001)。②左室整体舒张功能参数,PFR、1/3FF、1/3FR,G2比G1和G0有明显下降(P<0.001)。③左室局部收缩功能参数,LVREF在所有1-6节段G2较G1和G0有明显下降(P<0.01)。④左室舒张功能参数,LVR1/3FF在所有1-6节段G2较G1和G0有明显下降(P<0.01)。结论:左心室壁瘤的形成对左心室整体和局部的收缩和舒张功能已经构成了严重的损害。     

Reference values for quantitative left ventricular and left atrial measurements in cardiac computed tomography

To assess reference values for left ventricular (LV) and left atrial (LA) dimensions, global LV function, and LV-myocardial mass for cardiac CT. We examined 120 subjects undergoing a coronary angiography using 64-slice and dual-source CT. All individuals had a low cardiovascular risk, normal ECG, negative biomarkers, and a normal cardiac CT examination. All subjects had a negative medical history of cardiovascular disease both on admission and at clinical 6-month follow-up. The following measurements were obtained: septal wall thickness (SWT), posterior wall thickness (PWT), LV inner diameter (LVID), LA anterior posterior diameter (LAD(sys)), end-systolic volume (ESV), and end-diastolic volume (EDV), LV-myocardial mass (LVMM). We found significant gender-related differences for all LV dimensions (SWT(sys), SWT(dia),PWT(sys),PWT(dia),LVID(sys),LVID(dia)). LAD(sys) showed no significant difference between males and females. Significant differences were found for global LV functional parameters including ESV, EDV, and SV, whereas no significant differences were found for the EF. LV-myocardial mass parameters showed significant gender-related differences. No significant correlation was found between any of these parameters and age. All data were transferred to percentile ranks. This study provides gender-related reference values and percentiles for LV and LA quantitative measurements for cardiac CT and should assist in interpreting results.     

Dual-standard reference values of left ventricular volumetric parameters by multidetector CT angiography

BackgroundThe papillary and trabecular muscles constitute a significant percentage of left ventricular mass and volume. The influence of the papillary and trabecular muscles on left ventricular parameters has not been described with multidetector CT angiography.ObjectiveThe aims of this study are (1) to derive reference values for left ventricular volumetric parameters both including and excluding the papillary and trabecular muscles and (2) to establish the optimal segmentation method for measuring these values.MethodsA total of 179 subjects (mean age, 55.4 ± 9 years; 102 women) without heart disease and at low risk of cardiovascular disease who underwent CT angiography were selected. Left ventricular volumes, myocardial volume, and ejection fraction were measured with epicardial and 2 endocardial trace methods, including and excluding trace for the papillary and trabecular muscles. Values of all parameters obtained by both endocardial trace methods were compared.ResultsSignificant difference between both trace groups for all parameters on both sexes was found (P < .001). Significant differences in precision error of remeasurement were found in the including trace (3.6%) compared with the excluding trace (4.7%; P < .05) and in the epicardial trace (2.2%) compared with both endocardial traces (P < .001).ConclusionThe left ventricular parameters measured by CT angiography were influenced significantly by the trace method by including or excluding the papillary and trabecular muscles. The dual-standard reference values of left ventricular parameters were established, and the optimal segmentation methods were definite in considering the heart size and image quality studied with retrospective and prospective CT angiography.     

Left-sided appendicitis revealing a common mesentery: A Case Report

Intestinal malrotation is a congenital rotational anomaly that results of abnormal rotation of the gut, said to occur in 1 in 6000 live births. Common mesentery predisposes to volvulus of the midgut and internal hernias due to the left position of the cecum and appendix. The association of this anomaly with acute left appendicitis is rarely reported in the literature. Occurrence of acute appendicitis on common mesentery is a source of diagnosis difficulties, which may lead to a surgical management delay. We report a case of a 10-year-old boy, admitted for a left-sided iliac pain whose radiological investigations confirmed a left acute appendicitis associated with complete common mesentery. The child underwent laparoscopic surgery with simple post-operative follow-up.     

Non-invasive measurement of left ventricular volumes and function by gated positron emission tomography

To date cardiac positron emission tomography (PET) studies have focussed on the measurement of myocardial blood flow, metabolism and receptors while left ventricular (LV) function and dimensions have been derived from other modalities. The main drawback of this approach is the difficulty of data co-registration, which limits clinical interpretation. The aim of this study was to evaluate whether it is possible to measure absolute cardiac volumes, and consequently LV function parameters such as ejection fraction, and wall motion with gated PET. Nineteen patients underwent a PET scan and planar radionuclide ventriculography (MUGA) within 9±9 days. A 9-min scan (16 gates/cardiac cycle) was acquired after inhalation of 3 MBq/ml of oxygen-15 labelled carbon monoxide at the rate of 500 m1/min over 4 min using a multislice PET camera. Noise reduction was performed on the gated image to enhance the definition of the ventricles before reslicing to the short-axis view. A threshold value was used to detect the edge of the LV at each gate. LV volumes at each gate were estimated by summing the volume of voxels within the LV boundary. PET measurements of LV volumes were as follows: LV end-diastolic volume ranged from 72 to 233 ml and LV end-systolic volume ranged from 24 to 203 ml. Phantom experiments supported the validity of this approach for estimating volumes. LV ejection fraction measured with MUGA was 38.4%±16.3% (range 15%–71%) and that measured with PET was 39.6%±17.7% (range 9%–72%) (P=NS). The LV ejection fraction measurements were highly correlated (r ²=0.824). These results indicate that: (1) absolute enddiastolic and end-systolic volumes can be quantified using gated PET and (2) LV ejection fraction can be accurately measured by gated PET simultaneously with the other physiological PET parameters.     

实时三维超声心动图应用于房颤患者左心耳功能评价的价值

目的探讨实时三维超声心动图应用于房颤患者左心耳(left atrial appendage,LAA)功能的评价功能。方法选择2015年9月~2019年2月在本院住院患者188例,根据心律情况分为观察组(房颤)100例与对照组(窦性心律)88例,采用常规超声检查记录左心房(left atrium,LA)指标,采用实时三维超声心动图评定LAA功能并进行相关性分析。结果观察组的LAD值显著高于对照组(P<0.05),而LAEF与LAFI值显著低于对照组(P<0.05)。LAA含有丰富的梳状肌、肌小梁,形态各异,凹凸不平,分叶数目不等,两组左心耳分叶数目对比差异无统计学意义(P>0.05)。观察组的LAA-OL、LAA-OS、LAA-H、LAA-V值显著高于对照组(P<0.05)。在观察组中,直线相关分析显示LAA-OL、LAA-OS、LAA-H、LAA-V与LAD呈现正相关性,与LAEF与LAFI呈现负相关性(P<0.05)。结论实时三维超声心动图可准确评估房颤患者的LA容积与LAA功能,对判定患者病情与预测预后都具有重要价值。