应用心脏电影磁共振成像评估无明显心血管症状的2型糖尿病患者左心室功能

目的 利用心脏电影磁共振成像(MRI)评估无明显心血管症状的2型糖尿病患者左心室结构及功能变化.方法 入选2005年11月至2006年1月至天津医科大学总医院糖尿病门诊就诊的2型糖尿病患者85例(2型糖尿病组)及同期健康体检者43名(正常对照组),采用单因素两样本组内随机设计方法进行研究.行左心室短轴位电影MRI,计算并比较左心室整体功能指标(包括舒张末期容积指数、收缩末期容积指数、每搏输出量指数、心脏指数、射血分数、舒张末期质量指数和收缩末期质量指数)、局部功能(舒张末期厚度、收缩末期厚度、室壁增厚率和室壁运动)和血液动力学指标(高峰射血率、高峰射血时间、高峰充盈率和高峰充盈时间).计量资料行独立样本成组t检验,性别构成采用x2检验.采用Logistic逐步回归分析评估性别、年龄、身高、体重、体重指数、病程和空腹血糖对左心室功能影响的显著性.结果 2型糖尿病组收缩末期容积指数低于正常对照组[分别为(22±8)、(25±5)ml/m2,t=2.265,P＜0.05],射血分数高于正常对照组(分别为59%±9%、56%±6%,t=-2.457,P＜0.05),室壁增厚,高峰充盈率低于正常对照组[分别为(282±73)、(321±99)ml/s,t=2.508,P＜0.05].Logistic逐步回归分析显示,空腹血糖对左心室功能受损的影响近乎有统计学意义(x2=3.781,P=0.052).结论 心脏电影MRI是左心室功能测量的"金标准",能可靠评价无明显心血管症状的2型糖尿病患者左心室功能改变.无明显心血管症状的2型糖尿病患者舒张功能障碍早于收缩功能障碍,控制空腹血糖水平对避免发生左心室功能受损可能具有意义.     

左心室早期几何重构研究

目的:探讨猪急性心肌梗死早期左心室几何重构基本规律。方法:中国小型猪12只,体重为18～20 kg,随机分成实验组(n=6)及对照组(n=6)。结扎左冠状动脉前降支等流量点,测定左心室心底和心尖部位血流动力学。结扎前、结扎后24小时、1周、4周磁共振成像测定左心室腔各个几何元素的变化。结扎后4周取出心脏标本,4％多聚甲醛固定1周,磷钨酸-苏木素等染色进行病理学观察。结果:结扎后1周、4周心脏收缩末期室间隔厚度及左心室侧后壁厚度、舒张末期左心室长轴长度、收缩末期左心室长轴截面积、收缩末期第二左心室长轴截面积、收缩末期左心室长轴周长显著增加(P<0．05)。左冠状动脉前降支结扎后4周,左心室主腔与第二左心室之间收缩压差异显著(P<0．05)。结论:急性心肌梗死早期,第二左心室的形成是左心室几何重构的主要特征;磁共振成像舒张末期左心室长轴长度,收缩末期左心室长轴的周长、面积显著延长,可作为评价左心室几何重构的重要指标。     

4D心脏磁共振与3D心脏磁共振评价正常左心室功能的对比研究

目的通过4D心脏磁共振(4D MR)法和3D心脏磁共振(3D MR)法检测正常人左心室功能的对比,评价4D MR法检测左心室功能的优势。方法采用4D MR法和3D MR法对9例正常志愿者的每搏输出量(SV)进行测量,并与相位对比磁共振法所测结果进行比较。结果 4D MR法、3D MR法测量左心室的收缩末期容积、舒张末期容积、SV无明显差别。4D MR法获取SV花费时间少,受操作者影响小。结论 4D MR法具有准确性和可重复性高、花费时间短、直观等优点,可作为临床心功能检查的主要方法。     

应用心脏核磁共振成像评价高血压相关收缩性心力衰竭患者左心室形态改变

目的应用心脏核磁共振成像比较非缺血性心脏病心力衰竭患者中,合并高血压与未合并高血压患者的左心室形态改变。方法连续入选合并高血压且临床诊断考虑高血压为主要心力衰竭病因的患者20例作为心力衰竭合并高血压组;以同时期性别及左心室射血分数匹配的不伴有高血压的心力衰竭患者21例作为心力衰竭未合并高血压组。两组均行增强心脏核磁共振成像检查,比较其左心室舒张末期内径(LVDD)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室舒张末期容积指数(LVEDVI)、左心室收缩末期容积指数(LVESVI)及各室壁厚度的差异。结果心力衰竭合并高血压组与心力衰竭未合并高血压组患者LVEDV、LVEDVI、LVESV、LVESVI、LVDD等反映左心室扩张的指标比较,差异均无统计学意义(均P0.05);左心房和右心房面积、左心室质量指数、纤维化发生率比较,差异均无统计学意义(均P0.05)。心力衰竭合并高血压组患者平均最大室壁厚度较心力衰竭未合并高血压组更厚[(10.1±1.4)mm比(7.1±1.2)mm,P=0.001],各个室壁厚度均显著大于后者,其中前间隔和后间隔最大室壁厚度差异尤为显著。心力衰竭合并高血压组患者左心室质量[(182.1±56.0)g比(122.7±38.9)g,P0.001]显著高于心力衰竭未合并高血压组,但右心室运动异常[20.0%比71.4%,P=0.001]显著低于心力衰竭未合并高血压组,差异均有统计学意义。结论高血压相关的收缩性心力衰竭患者,左心室扩张程度与不伴有高血压的非缺血性心力衰竭患者相似,但其左心室壁厚度显著增高。给予心力衰竭合并高血压患者早期诊断及积极治疗,其心功能有可能改善。     

应用心脏磁共振成像评估冠状动脉慢性完全闭塞病变供血心肌活性研究

目的通过心脏磁共振成像(CMR)结果分析冠状动脉慢性完全闭塞(CTO)病变患者的心肌室壁运动和心肌存活情况及其与CTO血管的对应关系。方法入选2014年12月至2017年11月于北京安贞医院行冠状动脉造影确诊至少有1支血管存在CTO病变的患者128例,入院后均行CMR检查。将左心室划分为17个心肌节段,对每个心肌节段进行室壁运动及延迟强化透壁程度评分,并记录CMR测得的左心室射血分数(LVEF)、收缩末期容积(ESV)、舒张末期容积(EDV)。结果 149支CTO血管供应区域中,仅有11.5%的心肌节段透壁梗死,而58.6%的心肌节段不存在心肌梗死,延迟强化透壁程度≥75%的患者的LVEF最低,EDV及ESV最高。结论 CMR检出大多数CTO患者存在不同程度的室壁运动异常及心肌梗死。透壁性心肌梗死患者存在明显心功能下降及心室重构,但透壁性心肌梗死患者仅占很小一部分。     

心脏CT检查对肥厚型心肌病合并冠心病患者的诊断价值

目的:评估心脏CT检查在诊断肥厚性心肌病(hypertrophic cardiomyopathy,HCM)可疑合并冠心病患者中的价值。方法:60例患者入组本研究。心脏CT检查包括冠状动脉CT血管造影(CT angiography,CCTA)和延迟强化检查。以冠状动脉造影(coronary angiography,CA)和心脏磁共振检查(cardiovascular magnetic resonance,CMR)作为参考标准,分别检测CCTA和延迟强化检查在评估冠状动脉狭窄程度、左心室舒张末期室壁厚度、心功能和心肌纤维化的诊断准确性。结果:与CA比较,CCTA在检测冠状动脉狭窄程度方面的敏感性、特异性、阳性预测值及阴性预测值分别为100%、94.4%、92.3%及100%。在检测左心室舒张末期室壁厚度、心功能指标方面,CT与CMR有较好的相关性,但CT略低估以上指标。CMR延迟强化图像的对比噪声比优于CT(P0.01);CT测量的局灶性心肌纤维化范围与CMR结果相关性较好(P0.01)。结论:心脏CT一站式检查能够提供冠状动脉狭窄程度、心室形态、心功能及心肌活性方面的信息,有助于肥厚性心肌病可疑合并冠心病患者的鉴别诊断。     

急性ST段抬高性前壁心肌梗死患者的右心室功能分析

目的:评价急性前壁ST段抬高性心肌梗死直接经皮冠状动脉成形术(PCI)患者的右心室收缩和舒张功能变化。方法:分析46例急性前壁ST段抬高性心肌梗死患者[前降支近端完全闭塞者24例(前降支近端闭塞组),前降支远端急性闭塞者22例(前降支远端闭塞组)]直接PCI和35例冠状动脉造影"正常"患者(对照组)的临床、冠状动脉造影和心电图资料。采用二维心脏超声分别测定入选患者的右心室舒张末期容积(RVEDV),右心室收缩末期容积(RVESV),右心室射血分数(RVEF),平均肺动脉压(MPAP),左心室舒张末期容积(LVEDV),左心室收缩末期容积(LVESV),左心室射血分数(LVEF)和心脏指数(CI)。结果:与对照组相比,前降支远端闭塞组的平均肺动脉压无显著性差异(P>0.05),而右心室舒张末期容积和收缩末期容积增大,右心室射血分数降低;左心室舒张末期容积和收缩末期容积增加,左心室射血分数、心脏指数减低(P均<0.01)。与前降支远端闭塞组比较,前降支近端闭塞组的左心室舒张末期容积和收缩末期容积增加(P<0.01),心脏指数和左心室射血分数减少(P<0.01),右心室舒张末期容积收缩末期容积和平均肺动脉压增加(P<0.05～0.01),右心室射血分数降低(P<0.01)。多元线性回归分析表明前降支近端闭塞与右心室射血分数降低(R2=0.38,P<0.01)、右心室舒张末期容积增加(R2=0.410,P<0.01)有较好的相关性。2周后,前降支近端和远端闭塞组的右心室舒张末期容积、右心室收缩末期容积、平均肺动脉压和右心室射血分数无明显差异,而前降支近端闭塞患者的左心室舒张末期容积和收缩末期容积增大,左心室射血分数和心脏指数较低(P均<0.01)。结论:提示前降支近端闭塞可能伴右心室前壁部分心肌梗死导致右心室收缩和舒张功能障碍。     

冠状动脉粥样硬化对心脏舒张功能的影响

目的:探讨冠状动脉粥样硬化对心脏舒张功能的影响。方法:随机选取2014-09至2017-08疑诊为冠心病并行冠状动脉造影(CAG)的患者600例,根据冠状动脉狭窄程度分为:对照组(无狭窄)150例,冠状动脉粥样硬化组(狭窄50%)150例,冠心病组(狭窄≥50%)300例。所有患者均行超声心动图及左心室造影检查,测定左心室舒张功能、冠状动脉容积及压力。对比三组心脏舒张功能。结果:与对照组比,冠状动脉粥样硬化组和冠心病组的左心室舒张末期容积、左心房容积指数、左心室舒张时间常数均较高(P均0.05),冠状动脉粥样硬化组和冠心病组的左心室舒张早期快速充盈的充盈峰/左心室舒张晚期快速充盈的充盈峰值(E/A)、左心室压力上升最大速度、左心室压力下降最大速度、舒张期前1/3充盈分数、舒张期后1/3充盈分数均较降低(P均0.05),冠心病组的左心室射血分数较低(P0.05)。三组间两两比较,E/A1.2的患者比例差异均显著(P均0.01)。多因素Logistic回归分析:Gensini评分是心脏舒张功能减退的独立危险因素(OR=1.93,95%CI:1.31～2.68,P=0.01)。与对照组比,冠状动脉粥样硬化组和冠心病组的冠状动脉舒张末期容积(CEDV)、冠状动脉收缩末期容积(CESV)、冠状动脉压力下降最大速度(C-dp/dtmax)、冠状动脉压力上升最大速度(C+dp/dtmax)均较低(P均0.05);与冠状动脉硬化组比,冠心病组的CEDV、CESV、C-dp/dtmax、C+dp/dtmax均较低(P均0.05)。Spearman相关性分析:Gensini评分与C-dp/dtmax呈负相关(r=-0.43,P0.01)。结论:冠状动脉粥样硬化患者在没有心脏收缩功能改变时,心脏舒张功能就已明显减低。冠状动脉狭窄程度与冠状动脉舒张功能减低明显相关。     

磁共振心脏成像对冠状动脉血管内成形术后血运重建疗效的评价

目的探讨磁共振（MRI）心脏成像对冠状动脉血管内成形术（PTCA）及支架置入术后心肌存活疗效的评价。方法对27例临床诊断为冠心病拟行冠状动脉造影的患者,术前行MRI心脏多技术扫描,记录射血分数、舒张末期容积、收缩末期容积、每搏输出量、心输出量、心肌厚度等;在PTCA及支架置入术后1周至1年内再次行MRI检查,复查心肌运动、功能、心肌灌注改善情况。结果术后1年时间内舒张末期容积有改善,但差异无统计学意义（P〉0．05）;收缩末期容积在术后1周内无明显变化,在1周至1年时间内有显著改善,差异有统计学意义（P〈0．05）;射血分数在术后1周内即有显著改善,差异有统计学意义（P〈0．05）。结论MRI心脏扫描成像可从心脏形态、运动、心肌灌注等方面对冠状动脉支架置入术后患者心肌存活疗效及随访起指导作用。     

核素心肌灌注显像对左心衰竭患者临床治疗的指导价值研究

目的分析核素心肌灌注显像对左心衰竭患者临床治疗的指导价值。方法选取2012年3月—2015年3月汉中市中心医院收治的左心衰竭患者80例,均行核素心肌灌注显像,对检查结果阳性患者行冠状动脉造影检查并根据冠状动脉造影检查结果决定是否进行经皮冠状动脉介入治疗术(PCI)。比较不同缺血范围患者及冠状动脉支架植入术患者手术前后左心室容积,包括负荷舒张末期容积、静息舒张末期容积、负荷收缩末期容积、静息收缩末期容积。结果核素心肌灌注显像结果显示阳性患者63例,冠状动脉造影检查结果显示43例患者存在不同程度的血管狭窄,其中行PCI者35例。缺血面积较大患者负荷舒张末期容积、静息舒张末期容积、负荷收缩末期容积、静息收缩末期容积较大(P0.05)。Pearson相关分析结果显示,缺血面积与负荷舒张末期容积、静息舒张末期容积、负荷收缩末期容积、静息收缩末期容积均呈正相关(P0.05)。PCI患者术后负荷舒张末期容积、静息舒张末期容积、负荷收缩末期容积、静息收缩末期容积均低于术前(P0.05)。结论核素心肌灌注显像有助于明确左心衰竭患者的病因,对患者临床治疗方案的制定具有重要指导价值。     

Effects of Chronic Alcohol Abuse and HIV Infection on Brain Phosphorus Metabolites

We examined the effects of human immunodeficiency virus (HIV) infection and chronic alcohol consumption on cerebral phosphorus metabolites to determine if chronic alcohol abuse is a risk factor for the progression of neurological effects of HIV infection. We studied 15 HIV- alcoholics, 8 HIV- light/nondrinkers, 32 HIV+ alcoholics, and 41 HIV+ light/nondrinking men, with both HIV+ groups having similar CD4 lymphocyte counts. We used localized 31-phosphorus magnetic resonance spectroscopy after magnetic resonance imaging to examine two brain volumes in superior white matter and subcortical gray matter. Chronic alcohol consumption was associated with reduced white matter concentrations of phosphodiester (PDE) and phosphocreatine (PCr). Also in the white matter, acquired immune deficiency syndrome (AIDS) and AIDS-related complex (ARC) were associated with reduced concentrations of PDE and PCr, compared with both HIV- and clinically asymptomatic HIV+ subjects. Because no alcohol-by-HIV interactions were detected, the effects of HIV infection and alcohol abuse were cumulative. This is reflected in a successive decrease of white matter PDE and PCr concentrations in the order HIV- light/nondrinkers/HIV- alcoholics/HIV+ light/nondrinkers/HIV+ alcoholics. Subcortical gray matter PDE concentrations were lower in ARC/AIDS alcoholics than in HIV-light/nondrinking individuals. These findings suggest altered brain phospholipid metabolites and energy metabolites with alcohol abuse and HIV infection. They demonstrate that the adverse metabolic effects of HIV on the brain are augmented by chronic alcohol abuse.     

Magnetic Resonance Angiography in Paced Complex Heterotaxy Syndrome with Fontan Conduit Obstruction and Venovenous Collateral Decompression

Imaging of complex congenital heart diseases (CHDs) in children is challenging. This article reviews the complementary role of high temporal and high spatial resolution magnetic resonance (MR) angiographic imaging techniques in evaluation of a patient with complex congenital cardiovascular disease and related postsurgical complications. A 4‐year‐old female patient with complex CHD and multiple previous palliative surgical procedures underwent MR angiography to evaluate the cause of refractory hypoxia. High‐resolution MR angiography demonstrated the complex postsurgical cardiovascular anatomy and also assisted in the evaluation of cavopulmonary shunt patency and secondary venovenous shunt formation. Time‐resolved MR angiography evaluated pulmonary perfusion and demonstrated a significant pulmonary arteriovenous malformation. This information guided physicians in planning further managements, which resulted in a satisfactory clinical outcome.     

Comprehensive Evaluation of a Patient with Kawasaki Disease and Giant Coronary Aneurysms with Cardiac Magnetic Resonance

In patients with Kawasaki disease (KD) and coronary artery aneurysms (CAAs), serial evaluation with multiple imaging modalities is recommended to guide risk stratification and management. We present the case of a 7‐year‐old boy with a history of KD and multiple giant CAAs who developed thrombosis in one of the aneurysms. We illustrate how cardiac magnetic resonance is unique in allowing a comprehensive assessment in patients with severe KD and how it may affect their management.     

Alcohol and the human brain: a systematic review of different neuroimaging methods

Background: Imaging techniques have been in widespread use in the scientific community for more than 3 decades. They facilitate noninvasive, in vivo studies of the human brain in both healthy and diseased persons. These brain‐imaging techniques have contributed significantly to our understanding of the effects of alcohol abuse and dependence on structural and functional changes in the human brain. A systematic review summarizing these contributions has not previously been conducted, and this is the goal of the current paper. Methods: The databases PubMed, PsycINFO, and PSYNDEX were searched using central key words. Fulfilling the inclusion criteria were 140 functional and structural imaging studies, together comprising data from more than 7,000 patients and controls. The structural imaging techniques we considered were cranial computerized tomography and various magnetic resonance imaging–based techniques, including voxel‐based morphometry, deformation‐based morphometry, diffusion tensor magnetic resonance imaging, and diffusion‐weighted magnetic resonance imaging. The functional methods considered were magnetic resonance spectroscopy, positron emission tomography, single photon emission computed tomography, and functional magnetic resonance imaging. Results: Results from studies using structural imaging techniques have revealed that chronic alcohol use is accompanied by volume reductions of gray and white matter, as well as microstructural disruption of various white matter tracts. These changes are partially reversible following abstinence. Results from functional imaging methods have revealed metabolic changes in the brain, lower glucose metabolism, and disruptions of the balance of neurotransmitter systems. Additionally, functional imaging methods have revealed increased brain activity in the mesocorticolimbic system in response to alcohol‐themed pictures relative to nondrug‐associated stimuli, which might be of predictive value with regard to relapse. Conclusions: There has been tremendous progress in the development of imaging technologies. Use of these technologies has clearly demonstrated the structural and functional brain abnormalities that can occur with chronic alcohol use. The study of the alcoholic brain provides an heuristic model which furthers our understanding of neurodegenerative changes in general, as well as their partial reversibility with sustained abstinence. Additionally, functional imaging is poised to become an important tool for generating predictions about individual brain functioning, which can then be used as a basis for personalized medicine.     

Demonstration of calf abnormalities by magnetic resonance imaging in polyarteritis nodosa

Summary A 36-year-old Caucasian woman presenting with persisting painful calves after a flu-like illness was diagnosed as having polyarteritis nodosa. Magnetic resonance imaging of the lower legs showed abnormal signal intensity of the outer muscle groups with sparing of the central located muscles. The good clinical response to oral prednisone was supported by improvement of MRI.     

病毒性心肌炎磁共振成像诊断的初步探讨

研究磁共振成像(MRI)在病毒性心肌炎(VMC)中的表现及价值,从而提供一种无创性的诊断手段.本文对VMC患者19例和正常志愿者5例行MRI检查.心电门控、自旋回波技术.采用T1加权像、T2加权像及Gd-DTPA增强后T1加权像.以心室心肌区异常高信号改变为阳性,各断面心肌区信号均匀一致为阴性.结果:5例正常志愿者均无阳性发现,VMC组中有12例在增强以后的T1加权像有阳性发现,其中2例在T2加权像有同样的改变.增强后5min、10min、15min阳性率无显著差异.炎症病灶呈局灶,散在分布.部分病程长的患者仍有阳性发现.MRI敏感性好.Gd-DTPA安全有效,故MRI作为心肌炎诊断的无创性手段有巨大潜力.     

Pulmonary Regurgitation: Determining Severity by Echocardiography and Magnetic Resonance Imaging

Objective. Pulmonary regurgitation (PR) is common after repair of congenital heart disease involving the right ventricular outflow tract. Because PR results in chronic right ventricular volume overload and associated morbidity and mortality, accurate assessment of its severity is important. The aim of this study was to compare echocardiography with the gold standard of PR quantitation by magnetic resonance imaging (MRI) in a young population with repaired congenital heart disease. Design/Methods. Patients with congenital heart disease who had undergone right ventricular outflow tract reconstruction and/or pulmonary valve replacement and had an MRI within 3 months of an echocardiogram formed the study group. Echocardiographic indices were compared with MRI‐determined pulmonary regurgitant fraction (PRF) to determine the most accurate measurements to quantitate PR. Results. Of the 69 MRI/echocardiography pairs in 64 patients, 53 data sets were complete and used in the analysis. For the prediction of MRI PRF ≥20%, PR jet width/annulus ratio ≥0.5 demonstrated excellent sensitivity (94%), specificity (100%), positive predictive value (PPV 100%), and negative predictive value (NPV 82%). For the prediction of MRI PRF ≥40%, jet width/annulus ratio ≥0.7 and diastolic flow reversal in the branch pulmonary arteries showed useful sensitivity (92%), specificity (68%), PPV (76%), and NPV (88%). Conclusion. Pulmonary regurgitation jet width/annulus ratio combined with diastolic flow reversal is the most valuable echocardiographic measure for assessing PR severity after right ventricular outflow tract reconstruction or pulmonary valve replacement; however, this surrogate measure does not replace the importance of MRI evaluation.     

脑白质疏松患者的影像学表现与认知损害

脑白质疏松(leukoaraiosis,LA)是一组多病因引起的临床综合征,属于脑小血管病的类型之一.研究表明,LA常可导致不同程度的认知损害.近年来,随着影像学技术的发展,有关脑白质疏松患者影像学表现与认知损害相关性的研究逐渐增多,并得出了一些新的结论,使我们对LA临床意义的认识进一步加深.文章对脑白质疏松患者影像学表现与认知损害相关性研究进展进行综述.