心肌声学造影定量分析对心脏血栓和良性肿瘤的诊断价值  

The Value of Myocardial Contrast Echocardiography Quantitative Analysis in Diagnosing Cardiac Thrombus and Benign Mass

作　　者：熊叶 周燕翔 曹省[1] 陈金玲[1] 周青[1] Xiong Ye;Zhou Yanxiang;Cao Sheng;Chen Jinling;Zhou Qing(Department of Ultrasound,Renmin Hospital of Wuhan University,Wuhan,Hubei 430060,China)

机构地区：[1]武汉大学人民医院超声影像科,武汉市430060

出　　处：《中国超声医学杂志》2021年第6期645-648,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的探讨心肌声学造影定量分析对心脏血栓和良性肿瘤的诊断价值。方法回顾性分析于我院就诊的心脏血栓和良性肿瘤患者79例,所有患者均行二维超声心动图检查,其中29例因诊断困难进一步行心肌声学造影检查。对造影患者,采用目测法定性分析,病灶无增强为血栓,部分增强为良性肿瘤,使用时间-强度曲线进行定量分析,获取分别反映病灶和邻近心肌微血管血容量、血流速度和血流量的定量参数A、β和A*β,计算A_(病灶)/A_(心肌)、β_(病灶)/β_(心肌)和A*β_(病灶)/A*β_(心肌),使用ROC曲线获得鉴别血栓的最佳截断值。结果共纳入研究对象79例,经“金标准”方法诊断,其中血栓50例,良性肿瘤29例。二维超声心动图诊断血栓和良性肿瘤的准确度分别为77%、73%。心肌声学造影定性分析诊断血栓和良性肿瘤的灵敏度分别为87%、100%,特异度分别为100%、87%,准确度分别为87%、88%。心肌声学造影定量分析A_(病灶)/A_(心肌)、β_(病灶)/β_(心肌)、A*β_(病灶)/A*β_(心肌)在血栓和良性肿瘤间差异均有统计学意义(P<0.05),当A_(病灶)/A_(心肌)为0.48、β_(病灶)/β_(心肌)为0.53和A*β_(病灶)/A*β_(心肌)为0.25时,是从心脏良性病灶中鉴别血栓的最佳截断值,灵敏度分别为93%、93%、87%,特异度均为100%,准确性分别为97%、97%、93%,其中以β_(病灶)/β_(心肌)的诊断效能最好。结论心肌声学造影定量分析可用于诊断心脏血栓和良性肿瘤,对定性分析予以辅助诊断,进一步提高诊断准确度,具有较高的诊疗价值。Objective To discuss the value of myocardial contrast echocardiography quantitative analysis in diagnosing cardiac thrombi and benign masses. Methods A total of 79 patients with cardiac thrombi or benign masses were retrospectively analyzed. All patients underwent two-dimensional echocardiography, 29 of whom underwent further myocardial contrast echocardiography due to diagnostic difficulties. Myocardial contrast echocardiography qualitative analysis was performed by visually: a mass with no enhanced was diagnosed as thrombus, while a mass with partially enhanced was diagnosed as benign mass. Time-intensity curve was used to measure the value of A, β and A*β of the cardiac mass and adjacent myocardium, then calculated the ratio of Amass/Amyocardial, βmass/βmyocardial and A*βmass/A*βmyocardial, respectively. Using ROC curve to calculate the best cutoff values for differentiating thrombus from benign mass. Results Using the gold standard methods, of the 79 patients, 50 were diagnosed with thrombi, 29 diagnosed with benign masses. The accuracy of two-dimensional echocardiography in diagnosing thrombi and benign masses were 77% and 73%, respectively. The sensitivity, specificity and accuracy of myocardial contrast echocardiography qualitative analysis in diagnosing thrombi and benign masses were 87% and 100%, 100% and 87%, and 87% and 88%, respectively. The Amass/Amyocardial, βmass/βmyocardial and A*βmass/A*βmyocardial of myocardial contrast echocardiography quantitative analysis showed statistically significant differences between thrombi and benign masses(P<0.05). Amass/Amyocardial=0.48, βmass/βmyocardial=0.53 and A*βmass/A*βmyocardial=0.25 were the best cut-off values for differentiating thrombi from benign masses, with the sensitivity, specificity and accuracy were 93%, 93%, and 87%, 100%, 100%, and 100%, and 97%, 97%, and 93%, respectively, of which βmass/βmyocardial had the best diagnostic efficacy. Conclusions Myocardial contrast echocardiography quantitative analysis can be used to diagnosis c

关 键 词：超声心动图 心肌声学造影 血栓 良性肿瘤 

分 类 号：R540.45[医药卫生—心血管疾病] R732.1[医药卫生—内科学]