心肌背向散射积分对川崎病心室壁缺血的评估价值

Value of integrated backscatter in detecting myocardial ischemia in Kawasaki children

目的 探讨心肌背向散射积分 (IBS)对小儿川崎病心室壁缺血的识别和预后评估价值。方法 2 0 0 0年 1月至 2 0 0 3年 12月深圳市儿童医院收治心脏超声显示冠状动脉管壁异常、心肌多普勒组织成像 (DTI)显示节段性运动减弱的川崎病患儿 4 1例 ,对其应用背向散射联机分析技术检测心室壁平均背向散射积分 (AII)和背向散射积分周期性变化幅度 (CVIB) ,分别比较室壁病变节段和非室壁病变节段相同区域急性期和恢复期AII、CVIB值以及心腔血液和心包校正AII值的差别 ,部分病例还做了单光子发射计算机断层摄片术 (SPECT)核素心肌灌注显像检查 ,并做对照分析。结果 4 1例川崎病患儿急性期左室各壁 6 2个缺血节段的平均AII值比恢复期显著增高 (t =2 89,P <0 0 1) ,CVIB值显著性降低 (t =2 12 ,P <0 0 5 ) ;急性期和恢复期均无缺血表现的左室各壁乳头肌水平AII值、CVIB值比较均无显著性差异 (P >0 0 5 ) ,并且IBS方法与DTI、SPECT检测结果比较有高度相关性。结论 心肌背向散射积分可以识别川崎病患儿心肌缺血性病变 。

Objective To investigate the clinical value of integrated backscatter characterization in identifying myocardial ischemia in Kawasaki children.Methods Integrated Backscatter(IBS) were used to measure average imaging intensity(AII) and cyclic variation of integrated backscatter(CVIB) in ventricular wall in 41 Kawasaki children with coronary wall lesion by echocardiography and regional wall motion abnormality(RWMA) by doppler tissue imaging(DTI),AII and CVIB of ischemic and non ischemic left ventricular segments were respectively measured at the acute stage and convalescence,the differentiation in AII,CVIB,pericardium calibrated AII and blood calibrated AII were respectively compared; 25 of 41 cases underwent 201 Ti single photon emitting computerized tomography(SPECT) test,the result was statistically analyzed.Results There is significant difference in AII and CVIB vaules in 62 ischemic segments of left ventricular walls at the acute stage and convalescence in 41 Kawasaki cases.AII increased significantly in ischemic status (t=2.89,P<0.01) while CVIB decreased significantly(t=2.12,P<0.05) at the acute phase in comparison with the same segment of left ventricular wall at the convalescence; but there was no difference in AII and CVIB at the normal regions of left ventricular wall at the papillary muscle level,and the increased AII were significantly correlated with DTI and SPECT results.Conclusion Integrated backscatter technique is very valuable for the detection of myocardial ischemia in Kawasaki disease,AII and CVIB is important parameters.