基于心脏磁共振、超声心动图检查及多排螺旋CT评估肺动脉高压患者病情  

Condition evaluation by CMR,UCG and MDCT in patients with pulmonary artery hypertension

作　　者：郭晓娟[1] 马展鸿[1] 刘明熙[1] 刘敏[2] 蒋涛[1] 缪冉[3] 杨媛华[4] 龚娟妮[4] GUO Xiaojuan;MA Zhanhong;LIU Mingxi;LIU Min;JIANG Tao;MIAO Ran;YANG Yuanhua;GONG Juanni(Department of Radiology,Beijing Chaoyang Hospital,Ca pital Medical University,Beijig 100020,China;Department of Radiology,China-Japan Friendship Hospital,Beijing 100029,China;Department of Basic Laboratory,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;De partment of Pulmonary and Critical Care Medicine,Beijing Chaoyang Hospital,Capital Medical Unirersity,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院放射科,北京100020 [2]中日友好医院放射科,北京100029 [3]首都医科大学附属北京朝阳医院基础实验室,北京100020 [4]首都医科大学附属北京朝阳医院呼吸与危重症科,北京100020

出　　处：《实用放射学杂志》2020年第5期718-721,731,共5页Journal of Practical Radiology

基　　金：北京自然科学基金资助项目(7182149);国家自然科学基金面上项目(81871328).

摘　　要：目的基于心脏磁共振(CMR),超声心动检查(UCG)及多排螺旋CT(MDCT)的右心形态、功能学参数,筛选出评价肺动脉高压(PAH)患者病情的可靠指标.方法前瞻性选取PAH患者31例,通过CMR、UCG及MDCT测量反映右心功能的指标.所有患者均行右心导管检查(RHC)测定肺血流动力学参数.采用Pearson或Spearman相关系数进行影像学与血流动力学参数的相关性分析.结果CMR测量的右室射血分数(RVEF)(r=-0.44,P=0.01),标化右室心肌质量(VMI)(r=0.53,P=0.002),UCG-RVEF(r=-0.43,P=0.02),CT所得脊柱室间隔夹角(Cobb角)(r=0.41,P=0.03),右室游离壁厚度(RVWT)(r=0.56,P=0.005)与平均肺动脉压均呈不同程度中度相关.CMR-RVEF(r=-0.65,P<0.001),VMI(r=0.57,P=0.001),UCG-RVEF(r=-0.41,P=0.02),Tei指数(r=0.46,P=0.03),CT所得右室舒张末期内径(r=0.54,P=0.006),Cobb角(r=0.61,P=0.001),RVWT(r=0.59,P=0.003)与肺血管阻力均呈不同程度中高度相关.结论在评估PAH患者病情方面,CMR所得右心功能参数价值最高,尤以射血分数(EF)最佳,优于MDCT-Cobb角和UCG所得参数.Objective To screen out reliable imaging indexes for evaluating the condition in pulmonary artery hypertension(PAH)patients basing on right ventricular function and morphology parameters derived from cardiac MR(CMR),ultrasonie cardiogram(UCG)and multidetector CT(MDCT).Methods Thirty-one patients with PAH were prospectively enrolled.CMR。UCG and MDCT were used to obtain the indicators of right ventricular function.All patients underwent right heart catheterization(RHC)to get hemodynamie parameters.The correla tion of imaging parameters with hemodynamics was analyzed respectively by Spearman or Pearson correlation analysis.Results Mean pulmonary arterial pressure had moderate correlation with CMR right ventricular ejection fraction(RVEF)(r=-0.44,P=0.01),CMR-VMI(r=0.53,P=0.002),UCG RVEF(r=-0.43,P=0.02),CT-Cobb angle(r=0.41,P=0.03),right ventricular free wall thickness(RVWT)(r=0.56,P=0.005).Pulmonary vascular resistance index had moderate to high correlation with CMR-RVEF(r=-0.65,P<0.001),CMR VMI(r=0.57,P=0.001),UCG-RVEF(r=-0.41,P=0.02),Tei index(r=0.46,P=0.03),CT-right ventricular diastole maximum diameter(r=0.54,P=0.006),CT-Cobb angle(r=0.61,P=0.001),RVWT(r=0.59,P=0.003),respectively.Conclusion Right ventricular function parameters derived from CMR are the most valuable to assess PAH patients'conditions especially ejeetion fraction(EF),which is better than MDCT-Cobb angle and those derived from UCG.

关 键 词：肺动脉高压 心脏磁共振 超声心动图检查 计算机体层成像 

分 类 号：R543.2[医药卫生—心血管疾病] R445.2[医药卫生—内科学]