心脏MRI在三尖瓣下移畸形诊断中的价值  

The value of cardiac MRI in diagnosis of Ebstein anomaly

作　　者：程维琴 李嘉华 黄美萍[3] 庄建[2] 钟小梅[4] 贾乾君[4] 刘辉[4] 梁长虹[4] 

机构地区：[1]南方医科大学第二临床医学院,广州510515 [2]广东省华南结构性心脏病重点实验室广东省心血管病研究所广东省人民医院广东省医学科学院心外科 [3]广东省华南结构性心脏病重点实验室广东省心血管病研究所广东省人民医院广东省医学科学院介入导管室 [4]广东省人民医院广东省医学科学院放射科

出　　处：《中华放射学杂志》2018年第3期166-171,共6页Chinese Journal of Radiology

基　　金：国家自然科学基金-广东联合基金重点支持项目(U1401255);“十一五”国家科技支撑计划(2006BA101A08);“十二五”国家科技支撑计划(2011BAI11B22);广东省科技计划(20138031800006);广州市科技计划(201510010255)

摘　　要：目的探讨心脏MRI在三尖瓣下移畸形（EA）诊断中的价值。方法回顾性搜集2014年2月至2017年4月20例手术确诊的20例EA患者，分析所有患者术前的心脏MRI、经胸二维超声心动图（2D TTE）及手术资料，包括三尖瓣瓣叶改变、Carpentier分型、各房室大小和功能、心肌延迟强化、右心与左心容积比及体外循环时间等。采用R×C列表卡方检比较心脏MRI、2D TTE及手术所见对下移瓣叶数、瓣叶发育情况的差异，单样本方差分析比较3种方法测量隔瓣下移距离的差异。以手术结果作为参考标准，计算心脏MRI、2D TTE对瓣叶发育不良的诊断准确率。独立样本t检验比较强化组与无强化组的右心与左心容积比及手术相关资料间的差异。结果（1）心脏MRI、2D TTE及手术结果对EA隔瓣下移距离的测量、各瓣叶是否下移及Carpentier分型的判断等解剖结构的显示差异均无统计学意义。MRI、2D TTE显示的瓣叶发育不良相当于术中所见重度发育不良，而对术中轻中度发育不良病例无法识别，MRI、2D TTE对瓣叶发育不良的总诊断准确率分别为41.3%（19/46）、34.7%（16/46）。（2）功能右心室容积指数缩小1例，正常8例，扩大11例；功能右心室射血分数下降15例。左心室容积指数缩小6例，正常13例，扩大1例；左心室射血分数下降14例。（3）心肌延迟强化8例，无心肌延迟强化12例。强化组的右心与左心容积比（7.12±4.06）高于无强化组（3.84±2.10），差异具有统计学意义（t=－2.37，P〈0.05）。但强化与无强化组的体外循环时间、主动脉阻断时间、气管插管时间、ICU滞留时间以及术后住院时间差异均无统计学意义。结论 心脏MRI能较准确评估三尖瓣瓣叶下移、各房室形态结构的改变，定量评估左、右室功能状态，为临床诊断及评估严重程度提供参考。Objective To evaluate the value of cardiac MRI in the diagnosis of Ebstein anomaly （EA）.Methods Twenty patients from February 2014 to April 2017 with EA confirmed by surgery were enrolled into this study. The analysis in all patients was made according to preoperative cardiac MRI, 2D TTE and surgical data, including the changes of tricuspid valve leaflets, Carpentier classification, the size and function of atrioventricle, late Gadolinium enhancement, the total right/left-volume index and cardiopulmonary bypass time,etc.The numbers of apicaldisplaced leaflets and development condition of all the leaflets were compared using the R×C χ2 among the three groups.With surgical results as the reference standard, the diagnostic accuracy of the two groups for the development condition of all the leaflets were evaluated. One-way ANOVA was performed to compare the differences of the apicaldisplaced distance of septal leaflet, using these three methods. Comparisons of the total right/left-volume index, surgery-related data between patients with or without late gadolinium enhancement were performed by independent t test.Results （1） The results in anatomicalstructures, such as distance of apicaldisplacedseptal leaflet, displacement of each leaflet and the Carpentier classification, showed nostatistical difference among MRI, 2D TTE and operational findings. The leaflet dysplasia defined by MRI and 2D TTE areequivalent to surgically defined severe dysplasia, and surgically defined mild to moderate dysplasia can＇t be identified by the former two methods. The overall diagnostic accuracy of MRI and 2D TTE to identify leaflet dysplasia were 41.3%（19/46） and 34.7%（16/46）, respectively.（2） Functional right ventricular volume index decreased in 1 case, normal in 8 cases, increased in 11 cases;functional right ventricula rejection fraction decreased in 15 cases. Six patients＇ left ventricular volume index decreased, 13 remained in normal range, 1 showed increased;left ventricula rejection fraction decreased in

关 键 词：三尖瓣下移畸形 磁共振成像 解剖结构 心室功能 

分 类 号：R445.2[医药卫生—影像医学与核医学] R541.1[医药卫生—诊断学]