心力衰竭患者左室Tei指数与左室收缩功能的相关性分析

目的 探讨心力衰竭患者左室Tei指数、左室收缩功能指标二者相关性.方法 应用脉冲多普勒超声测量104例左心衰竭患者的左室Tei指数,运用实时三维超声心动图测量104例左心衰竭患者的左心室舒张末期容积(LV-EDV)、左心室收缩末期容积(LVESV)及射血分数(LVEF),分析心力衰竭患者Tei指数与LVEDV、LVESV及LVEF的相关性.结果 左心衰竭患者Tei指数与LVEDV和LVESV有较好的正相关性(r=0.634,P=0.000;r=0.788,P=0.000),与LVEF有较好的负相关性(r=-0.758,P=0.000).结论 左心衰竭患者左室Tei指数、左室收缩功能指标二者为密切相关,联合应用为准确评价左心衰患者左室整体功能提供有价值的信息.     

三平面组织同步成像定量评价冠心病患者左心室节段非同步运动

目的 探讨三平面组织同步成像技术定量评价冠心病患者左心室节段收缩非同步性运动及其与左心室收缩功能的关系.资料与方法 34例冠心病患者和35例正常对照者,应用三平面组织同步成像技术获得心尖四腔切面组织速度图,获取左心室6个壁共12个节段的收缩期达峰时间(Tp)、达峰速度(Vp),并计算Tp、Vp的标准差(Tp-SD、Vp-SD)及12个节段中任意2个节段Tp、Vp的最大差值( Tp-maxD、Vp-maxD).同时采用Simpson双平面法测量左室射血分数(LVEF)、左室舒张末期容积(LVESV)、左室收缩末期容积(LVEDV).结果 冠心病组LVEDV、LVESV较正常对照组增加,LVEF较正常对照组减小,差异均有统计学意义(P＜ 0.001).与正常对照组相比,冠心病组Tp、Tp-SD、Tp-maxD均明显延迟,Vp、Vp-SD、Vp-maxD均明显降低(P＜0.001);Tp与LVEF呈负相关(r=-0.559,P＜0.001);Vp与LVEF呈正相关(r=0.801,P＜ 0.001).结论 三平面组织同步成像可用于定量评价冠心病患者左心室非同步运动,Tp、Tp-SD、Tp-maxD、Vp、Vp-SD、Vp-maxD 可作为定量评价左室收缩运动同步性的有效指标,且左室运动同步性异常加重左室收缩功能异常.     

320排动态容积CT左心室功能检查重组方法优化的研究

目的对比研究优化重组法与常规重组法在评价左心室功能方面的准确性,为320排CT左心功能检查提供新的更快速可靠的重组方法。方法选取临床怀疑左心功能异常的患者65例,心率43~125次/min,接受320排CT左心功能检查,所得数据按R-R间期的0%~90%以2%为间隔获得相应左室舒张末期容积(LVEDV)及左室收缩末期容积(LVESV)所在时相值,统计出平均值后再直接以平均值为时相重组出数据获得左心室功能参数,并与传统以10%为间隔所获得的左心功能参数相比较,对比分析两种方法所获得的左心室功能参数:包括左室射血分数(LVEF)、LVEDV、LVESV、每搏输出量(LVSV)。结果 60次/min≤心率≤90次/min时,LVEDV在R-R间期所处的时相值为2.30%±1.26%,LVESV所处的时相值为44.03%±2.60%;以2%与44%为时相进行两点重组的方法与常规以10%为间隔的方法所获得的LVEF、LVEDV、LVESV及LVSV进行配对t检验显示,四组参数差异有统计学意义(t=-5.342~5.532,P=0.000~0.038<0.05);心率<60次/min及>90次/min共4例,无统计学意义。传统重组法后处理时间为(52.50±6.00)min,优化重组法后处理时间为(11.68±1.74)min。结论 320排动态容积CT左心功能检查在60次/min≤心率≤90次/min时按两点式(时相值为2%与44%)重组法较传统重组法更准确,并能明显减少数据的后处理时间,具有更重要的临床价值。     

组织速度成像评估左心室等容收缩期心肌收缩协调性

目的:探讨原发性扩张型心肌病(DCM)左室等容收缩期心肌收缩协调性的意义.材料和方法:测定14例DCM患者和22例正常人左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)和左室射血分数(LVEF).于组织速度成像(TVI)模式下测量QRS波起始点至左室18个节段心肌Vic的时限(TQ-IC),计算同节段6壁间最大差值(Inter-△TQ-IC)、同壁内3节段间最大差值(Intra-ATQ-IC)、18节段间最大差值(Max-ΔTQ-IC)及18节段平均值(Mean-TQ-IC).计算左室Tei指数.结果:与正常人相比,DCM LVEDV、LVESV、Tei指数增大,LVEF减小,Intra-ΔTQ-IC、Inter-ΔTQ-IC、Max-ΔTQ-IC和Mean-ΔTQ-IC延长.DCM Max-ΔTQ-IC、Mean-ΔTQ-IC与LVEDV、LVESV、LVEF、Tei指数有良好相关性.结论:DCM左室等容收缩期存在非同步收缩运动,且与左室结构和功能关系密切.     

超声心动图评价早产儿动脉导管关闭前后左心结构与功能变化

目的应用常规超声心动图和实时三维超声心动图(RT-3DE)评价早产儿动脉导管关闭前后左心结构与功能的变化。资料与方法选取出生72 h后动脉导管持续开放的早产儿60例,其中出生体重<1000 g的超低出生体重儿30例,出生体重1000~1500 g的极低出生体重儿30例。布洛芬治疗动脉导管关闭3~6 d后复查。用超声心动图测算患儿动脉导管关闭前后左心房内径(LAD)、左心室舒张末期内径(LVEDD)、二尖瓣舒张早期血流峰值速度(E)与舒张晚期血流峰值速度(A)比值(E/A)、二尖瓣环舒张早期运动峰值速度(E′)与舒张晚期运动峰值速度(A′)比值(E′/A′)、E/E′、Tei指数、左心室舒张末期容积(LVEDV)、左心室舒张末期容积指数(LVEDVI)、左心室心肌质量指数(LVMI)、左心室射血分数(LVEF)以及左心室各节段射血分数。分析相关参数变化以及与动脉导管内径、分流速度的相关性。结果极低出生体重儿与超低出生体重儿组动脉导管关闭后LAD、LVEDD、E/E′、Tei指数、LVEDV、LVEDVI及LVMI明显减低(P<0.05),E/A、E′/A′明显增高(P<0.05);LVEF、左心室各节段射血分数无明显变化(P>0.05);两组患儿LAD、LVEDD、LVEDV与动脉导管内径呈正相关(r=0.574、0.642、0.661,P<0.05),LVMI与动脉导管分流速度呈正相关(r=0.264,P<0.05)。结论两组早产儿动脉导管关闭后左心内径缩小,左心室功能较闭合前改善。早产儿动脉导管内径、动脉导管分流速度是影响左心结构与功能的重要因素。     

256层螺旋CT双时相重建评估左心室收缩功能的可行性研究

目的：通过与超声心动图检查对比,评估256层螺旋C T冠状动脉成像双时相重建评估左心室收缩功能可行性。方法回顾性分析临床怀疑冠心病62例患者的冠脉C T影像学及超声心动图检查资料。采用多时相重建（间隔5％R-R间期）及双时相重建（同步记录心电图波形选择时相进行重建分析,即Q波峰开始时相定义为舒张末期,T波升支中点开始扫描时相定义为收缩末期）分析分别获得左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）、左心室每搏输出量（LVSV）、左心室射血分数（LVEF）,并与超声心动图检查结果分别进行对比。所有数据运用 MedCalc V11.4.2统计软件处理,P ＜0．05具有统计学差异。结果62例患者均顺利完成检查。双时相及多时相分析所得左心室功能各参数与超声心动图检查结果均具有良好一致性。两种方法均与超声心动图检查具有良好相关性（0．838＜ r ＜0.997）,但运用Bland-Altman分析发现与CT多时相分析相比,双时相重建分析LVEDV、LVESV、LVSV、LVEF值与超声心动图结果之间差异更小（CT双时相-超声差值分别为（6．9±8．9）ml/m2、（0．9±2．6）ml/m2、（6．0±9．0）ml/m2、（1．1±3．6）％;CT多时相-超声LVEDV、LVESV、LVSV、LVEF差值分别为（-7．2±16．5）ml/m2、（5．4±13．1）ml/m2、（-12．6±17．2）ml/m2、（-8．5±10．9）％。结论冠脉CT双时相左心室收缩功能重建分析结果与超声心动图结果具有良好相关性,能够满足临床对左心室收缩功能分析的需要,值得进一步研究与应用。     

实时三维超声心动图评价左室收缩功能及同步性与心电活动的关系

目的应用实时三维超声心动图评价不同患者左室收缩功能及收缩同步性的价值,探讨不同步性与心电活动的关系。资料与方法应用GEViVid7.0采集40例心衰患者(A组)、40例心衰高危因素患者(B组)和30例健康志愿者(C组)的左室全容积图像。采用左室16节段时间-容积曲线分析后,计算左室16节段、12节段达到最小收缩容积的时间(Tmsv)的标准差(SD)和最大差值(Dif):即Tmsvl6-SD、Tmsvl6-Dif、Tmsv12-SD、Tmsv12-Dif;获取左室舒张末容积(LVEDV)、收缩末容积(LVESV)、左室射血分数(LVEF)。常规体表心电图获取P-R间期、QRS波宽度。结果①A、B两组LVEDV、LVESV、LVEF及收缩不同步性指标与C组各组间比较,差异均有显著性意义(P<0.05);②A组LVEF与收缩不同步性指标有良好的负相关性,以Tmsvl6-SD%相关性最高,(r=-0.721,P<0.001);Tmsvl6-SD%与QRS宽度呈弱相关(r=0.314,P=0.049),并且有27.5%的患者QRS<120ms,但存在左室机械不同步;③B组Tmsvl6-SD%与LVEF、QRS宽度之间无相关性。结论实时三维超声心动图能真实反映左室收缩功能及收缩同步性,能客观揭示机械不同步性与心电活动的关系,为慢性心力衰竭的防治提供简便、有效、可靠的依据。     

实时三维超声心动图检查联合三维斑点追踪技术在年龄>60岁心房颤动患者心室功能评估中的应用价值

目的 探讨实时三维超声心动图（RT-3DE）联合三维斑点追踪（3D-STI）技术对年龄>60岁心房颤动患者心室功能的评估价值。方法 选取146例我院2020年8月至2021年8月就诊的心房颤动患者作为研究组，另选取73名同期健康体检者作为对照组，所有患者入院后采用射频消融术进行治疗，均于术前、术后3 d、14 d、30 d行RT-3DE、3D-STI检查，比较对照组及研究组术前及术后3 d、14 d、30 d RT-3DE检查参数[左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、左心室射血分数（LVEF）、左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）]、3D-STI检查应变参数[左心室整体环向应变（GCS）、左心室整体面积应变（GAS）、左心室整体长轴应变（GLS）、左心室整体径向应变（GRS）]，并分析术前RT-3DE检查参数与3D-STI检查应变参数相关性。结果 与对照组比较，研究组术前LVEDD、LVESD、LVEDV、LVESV水平较高，LVEF水平较低（P<0.05）；与对照组比较，研究组术前GCS、GRS较小，GLS较大...     

发病时间对选择性经皮冠脉腔内成形术围术期左室功能的影响

 为观察冠心病发病时间对选择性PTCA围术期左室功能的影响,应用二维超声心动图(2DE),对成功地实施选择性经皮冠脉腔内成形术(FIVA)的25例患者,动态观察其围术期左室射血分数(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.发现发病≤2 a者围术期LVEF增加(P<0.05),LVEDV及LVESV缩小(分别P<0.05及P<0.01),SV无变化(P>0.05);发病>2 a者虽有LVEDV及LVESV减少(均P<0.05),但LVEF及SV无变化(均P>0.05).提示较早实施选择性PTCA者左室功能改善较明显;反映左室功能改善的2DE指标中,LVEDV及LVESV较LVEF及SV敏感.     

双源CT与超声心动图评估左心功能的比较研究

目的：比较双源CT（Dual—source CT,DSCT）和超声心电图对左心功能的评估,探讨DSCT在定量评估左心功能方面的;住确性及可行性。方法：对31例临床确诊或疑似冠状动脉粥样硬化心脏病患者行双源CT冠状动脉成像和超声心电图检查．分别测得左心室收缩末期容积、舒张末期容积及左室射血分数值,并进行统计学分析。结果：双源CT和超声心电图所测得的各组左心功能数据相关性高（r值=0．70～0．87）。结论：双源CT冠状动脉成像检查不但可以分析冠状动脉疾病．同时也可以定量评估左心功能。     

Endometriosis: Appearance and detection with conventional and contrast-enhanced fat-suppressed spin-echo techniques

Suspected pelvic endometrlosis was prospectively evaluated in 31 women with T1- and T2-weighted conventional spin-echo (CSE) magnetic resonance imaging alone and in combination with Tl-weighted fat-suppressed (TIPS) and gadolinium-enhanced TIPS (Gd-TlFS) spin-echo techniques. Images were grouped for interpretation and comparison as follows: (a) CSE alone, (b) CSE/T1FS. and (c) CSE/T1FS/ Gd-TlFS. All patients underwent surgery within 3 months of imaging, and 21 patients were found to have endometrlosis: 59 endometriomas (26 large and 33 small) and 51 sites of implants were seen. With CSE images, 23 large and six small endometriomas were detected. With CSE/T1FS images, 25 large and 14 small endometriomas were identified. With CSE/ TIFS/Gd-TlFS Images, 24 large and 14 small endometriomas were detected and ill-defined areas of enhancement were noted in 22 sites throughout the pelvis. These corresponded to endometriotic implants seen at surgery in 14 sites. The sensitivity, specificity, and accuracy, respectively, for the detection of endometriosis were 76%, 60%, and 71% for CSE, 86%, 50%, and 74% for CSE/T1FS, and 81%, 50%, and 71% for CSE/TlFS/Gd-TlFS images. No significant differences (P > 0.1) between image combinations for correctly identifying patients with and without endometriosis were seen. The difference in sensitivity between CSE and CSE/T1FS and between CSE and CSE/TlFS/Gd-TlFS images for detecting small endometriomas was significant (P=.03).     

MR imaging of muscle and tender points in fibromyalgia

Fibromyalgia is a syndrome manifested by chronic, diffuse muscu-loskeletal aching and soreness, palpable muscle tender points, and other symptoms. Standardized clinical diagnostic criteria have recently been developed. Skeletal muscle has been postulated as the end organ in this disease. Biochemical, histologic, electromyographic, and conventional radiographic studies have demonstrated no definitive abnormality. This study sought to establish whether magnetic resonance (MR) imaging could demonstrate any abnormality in these patients. Eighteen patients were entered in the study, 14 of whom were able to complete their examinations. T1 -weighted, T2-weighted, gradient-echo, and STIR (short-tau inversion-recovery) sequences were performed in all patients, with selected patients examined with T1weighted, gadopentetate dimeglu-mine-enhanced sequences. The trapezius and suboccipital regions were imaged in patients who, clinically, had active fibro-myalgia. No abnormalities could be detected. The authors conclude that the conventional MR imaging used in this study was unable to depict any primary skeletal muscle abnormality in fibromyalgia.     

Carotid and vertebral artery blood flow in left- and right-handed healthy subjects measured with MR velocity mapping

The goal of the study was to establish normal carotid artery flow rates in left-handed and right-handed individuals as a standard against which patients with carotid artery disease could be compared. Antegrade and retrograde flow were measured in the ascending aorta, in the right and left common, internal, and external carotid arteries, and in the vertebral arteries of 12 healthy subjects. Five subjects were right-handed, five left-handed, and two ambidextrous. Measured flow rates were as follows: common carotid arteries, 360–557 mL/min (mean [± standard deviation], 465 mL/min ± 52); internal carotid arteries, 132–367 mL/min (mean, 265 mL/min ± 60); external carotid arteries, 113–309 mL/min (mean, 186 mL/min ± 51); vertebral arteries from 133–308 mL/min (mean, 244 mL/min ± 43); and cerebral circulation, 546–931 mL/min (mean, 774 mL/min ± 134). All right-handed subjects had higher flow rates in the left internal carotid artery than in the right, and all left-handed subjects had higher flow rates in the right internal carotid artery (P =.007). There were no significant differences in left and right common carotid artery flow rates between left- and right-handed subjects. The standard deviation of a single measurement was 5%. The flow rates were similar to those obtained previously with other techniques and could be used as a normal standard.     

Treatment of biliary leaks and fistulae by simultaneous percutaneous drainage and diversion

Although biliary fistulae and bilomas are often adequately managed with percutaneous drainage, persistent bile duct leaks are difficult to control. The primary surgical goal in this situation is to decompress the biliary system through diversion of bile flow to facilitate healing of the defect in the bile ducts. We report 3 patients with large biliary duct defects who underwent percutaneous transhepatic cholangiography which demonstrated the site of the biliary leakage. Then, extrapolating the aforementioned surgical tenet to these patients, all 3 were successfully treated with interventional radiologic techniques: simultaneous percutaneous transhepatic biliary diversion to control biliary flow and percutaneous biloma drainage to facilitate closure of the cavity.     

CT Arthrography and Virtual Arthroscopy in the Diagnosis of the Anterior Cruciate Ligament and Meniscal Abnormalities of the Knee Joint

Objective

To determine the diagnostic accuracy of CT arthrography and virtual arthroscopy in the diagnosis of anterior cruciate ligament and meniscus pathology.

Materials and Methods

Thirty-eight consecutive patients who underwent CT arthrography and arthroscopy of the knee were included in this study. The ages of the patients ranged from 19 to 52 years and all of the patients were male. Sagittal, coronal, transverse and oblique coronal multiplanar reconstruction images were reformatted from CT arthrography. Virtual arthroscopy was performed from 6 standard views using a volume rendering technique. Three radiologists analyzed the MPR images and two orthopedic surgeons analyzed the virtual arthroscopic images.

Results

The sensitivity and specificity of CT arthrography for the diagnosis of anterior cruciate ligament abnormalities were 87.5%-100% and 93.3-96.7%, respectively, and those for meniscus abnormalities were 91.7%-100% and 98.1%, respectively. The sensitivity and specificity of virtual arthroscopy for the diagnosis of anterior cruciate ligament abnormalities were 87.5% and 83.3-90%, respectively, and those for meniscus abnormalities were 83.3%-87.5% and 96.1-98.1%, respectively.

Conclusion

CT arthrography and virtual arthroscopy showed good diagnostic accuracy for anterior cruciate ligament and meniscal abnormalities.     

Lymphoepithelial cyst of the pancreas: radiological and pathological findings

We report a case of a rare lymphoepithelial cyst of the body of the pancreas that developed in a woman complaining of constipation for 15 years. Ultrasonography revealed a homogeneous isoechoic lesion, while CT demonstrated a polycystic homogeneous mass with central scar and calcification. Cytological investigation of a CT-guided biopsy permitted diagnosis of lymphoepithelial cyst. The patient was operated on and had an uneventful recovery. The histological finding was of a cyst wall lined with keratinised squamous epithelium surrounded by lymphoid tissue with reactive follicular hyperplasia. The radiological findings and differential diagnosis are discussed. Correspondence to: D. Regge     

Hepatic abscess caused by Brucella US,CT and MRI findings: case report and review of the literature

The authors describe the findings detected by ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) in a 42-year-old patient with a hepatic abscess due to brucellosis. This localization by Brucella (hepatic brucelloma) is quite rare and very often is asymptomatic. A review of the medical literature shows only 40 cases of an hepatic abscess due to brucellosis. The findings demonstrated by US, CT and MRI can offer important diagnostic elements, albeit not specific, which should, together with a positive serologic test, confirm the diagnosis.     

MR detection of quantitative and structural changes in human aortic aneurysms

Collagen is a major component of the extracellular matrix and a determinant of the elastic behavior of the human aorta. To investigate the changes found in aneurysmal degeneration, the authors studied the solid-state hydrogen-1 nuclear magnetic resonance line shape of collagen in aneurysms and normal human aortas. A three-component decomposition of the free induction decay was performed, with collagen characterized by a T2 of about 18 μsec. The second moment of the collagen line shape was found to be increased in aneurysms (5.3 vs 4.8 G²), while, correspondingly, the T2 of collagen was lower in aneurysms (16.3 vs 17.7μsec). This corresponds to a modification of collagen structure and molecular motion. Collagen concentration was lower in nondiseased aortic walls (9.4% vs 7.3%). These results are discussed in reference to the contradictory conclusions in the current literature. The increase in collagen and the modification of its structure and molecular motion are explained by the need to resist an increasing tangential tension due to increased aortic diameter and diminished wall thickness in aneurysms and by intercalation or site binding in the helices or electric dipolar interactions in the less mobile side groups.     

Accuracy and precision of MR velocity mapping in measurement of stenotic cross-sectional area,flow rate,and pressure gradient

Reliability of magnetic resonance (MR) velocity mapping to assess severity of stenosis was assessed in vitro. Steady flow at different flow rates through five stenoses with a central orifice area ranging from 17 to 176 mm² was measured with velocity mapping performed perpendicular to the stenotic jet. Besides determination of the stenotic cross-sectional area and flow rate, the pressure gradient was calculated with the modified Bernoulli equation and compared with manometer measurements. Cross-sectional areas were measured with an accuracy of ?76%, a precision of ?91%, and an error of ?19 mm². Flow rates had an accuracy of ?72%, a precision of ?94%, and an error of ?1.4 L/min. The modification of the Bernoulli equation limited its reliability to stenoses with areas of 35-113 mm². Pressure gradients were calculated with an accuracy of ?80%, a precision of ?88%, and an error of ?15 mm Hg. The method was applied in a single patient with aortic stenosis and gave estimates that agreed with those obtained by heart catheterization.