心内膜心肌纤维化症的MRI诊断

目的评价ＭＲＩ对心内膜心肌纤维化症（ＥＭＦ）的诊断价值和限度。材料与方法对９例经影像学（包括超声心动图、心导管、Ｘ线心血管造影以及放射性核素显像）诊断、或（和）病理证实（５例）的ＥＭＦ患者，行心电图门控心脏自旋回波和梯度回波电影ＭＲＩ扫描。结果ＥＭＦ分为右室型（ＲＶＥＭＦ）、左室型（ＬＶＥＭＦ）和双室型（ＢＶＥＭＦ）三个亚型，ＭＲＩ所见为：（１）右室型（６例）：右室心内膜显著增厚呈较高信号，右室腔缩小变形，流入道短缩，心尖闭塞而流出道扩张，室壁运动减弱，电影ＭＲＩ（３例）显示有中至大量三尖瓣返流。右心房高度扩大，腔静脉亦显著扩张。（２）左室型（１例）：左室心尖圆钝，心内膜凸凹不平、显著增厚，呈“异常肌束”改变，电影ＭＲＩ可见中等量以上的二尖瓣返流，左室壁运动减弱。左心房显著扩大，肺静脉和主肺动脉扩张。（３）双室型（２例）：兼有二心室受累的改变，但以一侧受累为主。其中１例合并右室心尖附壁血栓，表现为Ｔ１ＷＩ球形高信号，Ｔ２ＷＩ为中等度略高信号。结论ＥＭＦ的ＭＲＩ所见具有相当的特征性，ＭＲＩ可以作为确定ＥＭＦ诊断的手段

MRI diagnosis of endomyocardial fibrosis

Purpose To evaluate the diagnostic value and limitation!of MRI in endomyocardial fibrosis (EMF). Materials and methods Nine patients underwent MRI with ECG gated spin echo(SE) and gradientecho(GE) cine techniques.The diagnosis of EMF was made by imaging findings including echocardiography,cardiac catheterization, angiocardiography as well as radionuclide imaging, or/ and pathologic examination (5 cases). Results The patients were divided into three subtypes: RVEMF,LVEMF and BVEMF. The findings of EMF on MRI were as follows:(1)RVEMF(6 cases): Thickening of endocardium with moderately high signal intensity, right ventricle(RV) was smaller and deformed, including obliteration of apex, shortening of inflow tract and dilatation of outflow tract, with hypokinetic contraction of the RV wall. Moderate to marked degree of tricuspid regurgitation was depicted by cine MRI .The right atrium and vena cava were remarkably dilated.(2)LVEMF (1 case):Obtuse apex, thickened endocardium and multiple outpouching wall of Left ventricle(LV) were seen, and mitral regurgitation and hypokinetic wall of LV were also dipicted on cine MR imaging, with marked enlargement of left atrium and dilatation of pulmonary artery and vein. (3)BVEMF (2 cases): Both findings of RVEMF and LVEMF were present with one ventricle as the dominant one. In one case, there was mural thrombus located in the apex of RV. Conclusion The findings of EMF on MR imaging are quite characteristic, and can be used as modality for diagnosis of EMF.