64层螺旋CT冠状动脉成像对冠心病诊断的应用价值

目的 通过探讨64层螺旋CT冠状动脉成像(64-SCTCA)对冠心病诊断的应用价值以明确临床上适于该项检查的人群.方法 回顾性分析285例接受64-SCTCA检查、并于4周内接受冠状动脉造影(CAG)检查的冠心病疑诊患者的临床资料.依照冠心病概率Duke模型,将受检者分为冠心病低危(n=80)、中危(n=92)和高危(n=113)3组,以CAG为"金标准",判断64-SCTCA诊断冠心病的准确性以及冠状动脉钙化、不同部位血管节段等因素对诊断准确性的影响.结果 64-SCTCA诊断冠心病的敏感性、特异性、阳性预测值、阴性预测值和诊断准确指\数分别为81.2%、93.3%、68.0%、96.6%和74.5%.冠心病概率Duke模型的低危组、中危组和高危组,其冠心病检出率分别为46.3%、72.8%和82.3%;64-SCTCA在低危组诊断冠心病的敏感性及阳性预测值明显低于中危组和高危组.对于冠状动脉Agatston钙化积分＞400分组,64-SCTCA诊断冠心病的敏感性(95.0%)明显高于0～100分组和101～400分组(77.4%和77.3%,P均＜0.05),特异性(82.2%)明显低于上述两组(94.0%和95.3%,P均＜0.05).其诊断远端血管病变的敏感性、阳性预测值均明显低于近、中段血管(P均＜0.05).结论 64-SCTCA主要适用于冠心病概率Duke模型临床分层的中危人群.其诊断准确性受冠状动脉钙化、病变部位、管腔直径等因素影响.     

定量组织速度成像与应变、应变率成像对冠脉不同狭窄程度心肌缺血的评估

目的:探讨定量组织速度成像(QVTI)、应变(S)及应变率(SR)成像对冠脉不同狭窄程度的患者心肌缺血程度的评估.方法:以冠脉造影为诊断标准,冠心病患者79例,正常对照组30例.所有入选者均测量基底段、中间段及心尖段收缩期峰值速度(Vs)、收缩期峰值应变(Ss)及其应变率(SRs),舒张早期峰值速度(Ve)及舒张晚期峰值速度(Va)、舒张早期峰值应变(Se)、舒张晚期峰值应变(Sa)及相应的应变率(SRe、SRa).结果:冠脉重度狭窄组患者的基底段、中间段的Vs、SRs、Ss、Ve及SRe,心尖段的SRs、Ve及SRe,基底段的Va及Sa均较对照组明显减低,差异有显著性(P<0.05).结论:QVTI与S、SR能定量评估冠脉病变狭窄程度>75%的患者心肌缺血状况,对早期诊断冠心病提供更多的信息.     

先天性心脏病的电子束CT诊断

目的　探讨电子束CT(EBCT)和超声心动图在先天性心脏病 (先心病 )诊断中的价值。资料与方法　搜集 34例分别经超声心动图和EBCT检查的先心病患者资料 ,其中 18例经心血管造影检查证实 ,2 1例有手术结果对照。结果　EBCT诊断符合率 82 .4 % ,超声诊断符合率 73.5 %。EBCT对心外大血管畸形诊断准确率为 97.9% ,明显优于超声心动图 (5 3.2 % )。而超声心动图对心内畸形的诊断准确率为 95 .9% ,高于EBCT(81.6 % )。对大血管与房室连接处的畸形二者的诊断准确率基本相同。结论　超声心动图与EBCT检查相结合 ,可大大提高对各种先心病的诊断准确率 ,减少有创的心血管造影检查     

Estimation of left ventricular volume and mass by magnetic resonance imaging: Comparison with quantitative biplane angiocardiography

Magnetic resonance imaging (MRI) is well suited for the delineation of cardiac anatomy. In this study an estimation of left ventricular volume and muscle mass by MRI was attempted, using an iron-shielded resistance magnet (Bruker) with 0.23 T. Images were obtained with ECG gating. For image-processing our own software program was used. Slice images were 8 mm thick and spaced 16 mm. Volumes were standardized for a “normal” LV. Muscle mass was calculated directly from the systolic image as the difference between inner and outer ventricular outline. There was a wide range of volumes and mass (100–300 ml, 200–500 g). For comparison and validation conventional biplane left ventriculography was used. Fourteen patients were studied with MRI, but satisfactory studies were obtained in only 7. Correlation of MRI and angiographic volumes was good (r=0.84). For left ventricular mass it was excellent (r=0.94). Ventricular walls and cavities were clearly outlined. Even minor details of anatomy were recognized. Limitations of MR study included a narrow space for the patient within the system and the long duration of data acquisition time. This paper is dedicated to Professor W. Wenz, Director of the Institute of Diagnostic Radiology, University of Freiburg, on the occasion of his 60th birthday.     

多层螺旋CT冠状动脉造影的扫描技术及临床应用

目的：探讨多层螺旋CT冠状动脉造影的成像技术及临床应用价值。方法：对68例[包括40例无明显心脏疾患的志愿者，25例冠心病患者，2例经皮冠冠状动脉成形术（PTCA）术后5个月和1例主动脉瓣膜置换术后的患者]进行了多层螺旋CT冠状动脉造影（multi-slice spiral CT coronary angiography,MSSCTCA)并行冠状动脉三维重建，其中25例冠心病患者并进行了选择性冠状动脉造影检查，以此为金标准，比较MSSCTCA对冠状动脉病变的检出率（未作冠状动脉造影的，只是用于评价多层螺旋CT对冠脉各支的显示能力，如显示哪几支、显示长度，示涉及有否冠状动脉疾患的显示）。结果：MSSCTCA对冠状动脉近中段显示清晰，显示率可达90％以上；对冠状动脉狭窄检出率为87．5％。结论：MSSCTCA可作为冠状动脉粥样硬化疾患的筛选手段及冠状动脉术后复查的首选方法。     

Persisting myocardial sinusoids of both ventricles as an isolated anomaly: Echocardiographic,angiographic, and pathologic anatomical findings

The persistence of myocardial sinusoids in both ventricles as an isolated anomaly is described. A 21-year-old patient had progressive heart failure considered as cardiomyopathy of obscure etiology. Two-dimensional echocardiography demonstrated channel-like structures in the thickened myocardium of both hypokinetic ventricles. Angiography showed a honeycomblike inner contour in both ventricles. Autopsy proved the diagnosis of persistent sinusoids in a thickened myocardium.     

Congenital tricuspid insufficiency

This is a case report of a 16-year-old male with moderate mitral disease, probably rheumatic, and with severe tricuspid insufficiency, which at surgery appeared to be a congenital malformation of the tricuspid valve (absence of the anterior leaflet). A tricuspid heterograft was successfully inserted. The symptoms of congenital tricuspid insufficiency are discussed, and this entity is differentiated from other causes of tricuspid insufficiency.     

主动脉弓离断的临床X线表现（附7例分析）

目的探讨先天性主动脉了断（ＩＡＡ）的临床Ｘ线特点及Ｘ线平片诊断价值。材料和方法回顾性分析７例（男３例,女４例,年龄３０天～１１岁,平均４岁）经心血管造影（ＡＣＧ）和（或）手术证实的ＩＡＡ患儿的临床、Ｘ线和ＡＣＧ表现及相互关系。结果７例全属Ａ１型,无Ｂ、Ｃ型,均合并心内畸形,术前Ｘ线平片符合诊断３例。主要的Ｘ线征象有：①气管居中（７例）;②主动脉结消失（７例）;③主动脉弓低位征（２例）;④升主动脉发     

肺动脉异常起源于升主动脉的病理分型

目的 肺动脉异常起源升主动脉的病理分型及胚胎发生机制探讨。方法 5例肺动脉异常起源于升主动脉，作心血管造影（ACG)及磁共振(MRI)检查。结果 5例病例中3例为右肺动脉异常起源于升主动脉；2例为左肺动脉异常起源于升主动脉，4例属近端型，1例远端型。结论 肺动脉异常起源于升主动脉为少见的先天性心脏病，病理分型有二种，一种右肺动脉异常起源于升主动脉，占肺动脉异常起源升主动脉的绝大部分；另一种为左肺动脉异常起源升主动脉，此种类型少见，又可根据肺动脉起源离主动脉瓣及无名动脉的距离分近端型及远端型二种亚型。二种类型的胚胎发生学的解释不尽相同。肺动脉异常起源于升主动脉以前称为半永存动脉干，从胚胎角度讲与永存动脉干不同，故目前不提倡用半永存动脉干这个术语。     

二维超声对术前法乐氏四联症左室容量及收缩功能的评价

运用二维超声心动图和左室Ｘ线造影方法，评价９０例法乐氏四联症的左室容量和左室时血分数，各测值与年龄相匹配的４０例正常人对照。研究结果表明，二维超声心动图的Ｓｉｍｐｏｎ’ｓ和面积长度法的左室容量测值与左室Ｘ线造影面积长度法相应测值比较，它们之间呈高度相关，但二维超声的面积长度法测值较低于左室造影测值，法乐氏四联症患者的左室容量明显低于正常对照组，而左室射血分数与正常组对照无明显差异。结论，二维超声定量评价法乐氏四联症患者的左室容量时．以Ｓｉｍｐｓｏｎ’ｓ法更准确，面积长度法则轻度低估，术前法乐氏四联症患者的左室射血分数正常。