心脏黏液瘤多模态成像特点及诊断模式  

Multimodality imaging for diagnosis of cardiac myxoma

作　　者：林静茹 孙洋[2] 李晓宁[3] 陶瑾[1] 王海苹 刘梦怡 王建德[1] 权欣[1] 李晓妮[1] 朱振辉[1] 王浩[1] 吴伟春[1] Lin Jingru;Sun Yang;Li Xiaoning;Tao Jin;Wang Haiping;Liu Mengyi;Wang Jiande;Quan Xin;Li Xiaoni;Zhu Zhenhui;Wang Hao;Wu Weichun(Department of Echocardiography,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Pathology,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Ultrasound,Dezhou People's Hospital of Shandong Province,Dezhou 253000,China;Department of Radiology,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院超声影像中心,100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院实验诊断中心病理科,100037 [3]德州市人民医院超声科,山东德州253000 [4]中国医学科学院北京协和医学院国家心血管病中心阜外医院放射影像科,100037

出　　处：《中华医学超声杂志（电子版）》2021年第5期472-481,共10页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：中国医学科学院心血管重点实验室建设项目(2019PT310025);北京市科学技术委员会首都临床特色应用研究与成果推广(Z171100001017213)。

摘　　要：目的探究心脏黏液瘤(CM)多模态成像特点及其多模态诊断模式。方法回顾性研究2016年7月至2019年8月在阜外医院行二维经胸超声心动图检查初诊为CM的178例患者,以病理结果为金标准,将研究对象分为CM组和非CM组,根据超声心动图特点将CM组划分为典型CM组和非典型CM组。分析归纳各组患者的临床特征,二维经胸超声心动图、多层螺旋计算机断层摄影术(MSCT)和心脏磁共振成像(CMR)特点,采用t检验、χ^(2)检验或Fisher确切概率法比较组间差异。结果178例初诊为CM的患者中有160例患者行手术治疗和病理检查(89.9%),病理证实CM患者150例,10例为非CM患者:低度恶性纤维黏液肉瘤1例,未分化多形性肉瘤1例,血管肉瘤1例,血管瘤2例,脂肪瘤2例,血栓3例。二维经胸超声心动图、MSCT、CMR诊断准确性分别为93.8%、96.3%、100%。典型CM组合并高血压和心房颤动的比例低于非典型CM组(25.4%vs 53.1%;2.5%vs 18.8%),差异具有统计学意义(χ^(2)=8.978、9.027,P均=0.003);典型CM组左心房前后径、二尖瓣舒张早期峰值流速显著大于非典型CM组[(39.21±6.34)mm vs(35.92±5.72)mm;(1.59±1.67)m/s vs(0.90±0.25)m/s],差异具有统计学意义(t=2.357、2.040,P=0.020、0.043);二维经胸超声心动图成像显示,非典型CM组平均长径显著小于典型CM组[(34.81±17.43)mm vs(45.99±16.73)mm],瘤蒂或基底宽度显著大于典型CM组[(13.02±7.28)mm vs(9.97±4.73)mm],差异具有统计学意义(t=3.324、-2.506,P=0.001、0.014),非典型CM的分布、附着部位、形态、活动度、瘤蒂存在情况以及房室瓣口梗阻情况与典型CM比较差异均具有统计学意义(P均<0.05);MSCT成像显示CM以低密度为主,中等混杂密度比例和存在强化的比例高于典型CM,但差异无统计学意义(P均>0.05);CMR成像显示非典型CM T1、T2加权像信号强度与典型CM类似(P均>0.05)。非CM占位平均长径小于典型CM,但差异没有统计学意义(P>0.05),平均短径与典Objective To investigate the multimodality imaging features of cardiac myxoma(CM and explore the multimodality diagnosis model of CM.Methods One hundred and seventy-eight patients who were initially screened for CM by two-dimensional transthoracic echocardiography at Fuwai Hospital from July2016 to August 2019 were retrospectively included in our study.Using pathological results as the gold standard,the subjects were divided into either a CM group or a non-CM group.The CM group was further divided into a typical CM subgroup and an atypical CM subgroup according to the characteristics of echocardiography.The clinical characteristics and the imaging features of echocardiography,multi-slice computed tomography(MSCT),and cardiac magnetic resonance imaging(CMR)were compared between groups by t-test,chi-squared test,or Fisher’s exact test.Results Of the 178 patients with an initial diagnosis of CM,160(89.9%)underwent surgical treatment and pathological examination(89.9%);150 patients were diagnosed with CM,1 with low-grade fibromyxoid sarcoma,1 with undifferentiated pleomorphic sarcoma,1 with angiosarcoma,2 with hemangioma,2 with lipoma,and 3 with thrombosis.The diagnostic accuracies of echocardiography,MSCT,and CMR were 93.8%,96.3%,and 100%,respectively.The proportions of patients with hypertension and atrial fibrillation in the typical CM subgroup were significantly lower than those of the atypical CM subgroup(25.4%vs 53.1%,χ^(2)=8.978,P=0.003;2.5%vs 18.8%;χ^(2)=9.027,P=0.003);the left atrial anteroposterior diameter and the early diastolic peak flow velocity of the mitral valve were significantly higher in the typical CM subgroup than in the atypical CM subgroup[(39.21±6.34)mm vs(35.92±5.72)mm,t=2.357,P=0.020;(1.59±1.67)m/s vs(0.90±0.25)m/s;t=2.040;P=0.043].The average long diameter of atypical CM was significantly smaller than that of typical CM[(34.81±17.43)mm vs(45.99±16.73)mm;t=3.324,P=0.001],and the width of tumor pedicle or base was significantly larger than that of typical CM[(13.02±7.28)mm vs(9.97

关 键 词：心脏黏液瘤 超声心动图 多层螺旋计算机断层摄影术 心脏磁共振成像 多模态成像 

分 类 号：R445.1[医药卫生—影像医学与核医学] R732.1[医药卫生—诊断学]