致心律失常性右室心肌病的MRI诊断价值

MRI diagnosis of arrhythmogenic right ventricular cardiomyopathy

目的探讨心脏MRI检查在致心律失常性右室心肌病(arrhythmogenic right ventricular cardiomyopathy,ARVC)诊断中的应用价值。方法收集2005年1月至2008年5月在我院就诊的9例ARVC患者。所有患者行MRI检查,使用美国GE SIGNA 1.5T超导磁共振成像仪及8通道心脏线圈,行MR多序列、多方位、多功能成像技术检查。采用"白血技术"作四腔心,心脏短轴及左右室长轴位电影磁共振成像(cine MRI)。采用"黑血技术"即双反转恢复快速自旋回波(Doub1e-IRFSE)和三反转恢复快速自旋回波(Triple-IRFSE)序列行短轴及右室长轴扫描。结果本研究9例患者右室壁均有不同程度变薄,右室腔扩大8例。1例见室间隔略厚,左室腔扩大2例。其中3例在DIRFSE序列右室心肌出现灶状高信号,而在TIRFSE序列中,出现不规则岛状或连续中断影像。部位包括右室心尖部6例、膈面4例、前壁4例、漏斗部4例,其中1例累及乳头肌。右室流出道扩张2例,局部反向搏动、室壁瘤2例。结论心脏MRI检查能反映出结构及功能的改变,清晰地显示患者病变的性质、程度及范围,是目前诊断ARVC的一项最具特异性和敏感性的无创性检查方法,对于临床上怀疑该病的患者应常规行该项检查。

Objective To discuss the utility of MRI in evaluating arrhythmogenic right ventricular cardio- myopathy （ARVC）. Methods Nine patients of ARVC who received treatment in our hospital from January 2005 to May 2008, were retrospectively analyzed. They all underwent MRI by using GE signa 1.5 Tesla CV/I MR system. White blood technique （Fast cine sequence） were performed in short axis view, four-chamber view, and long axis view of two ventricles. Black blood techniques （ Double IRFSE and Triple IRFSE） were performed in short axis view and long axis view of the fight ventricle. Results MRI displayed thinning of the right ventricular （RV） wall （9 cases）, dilatation of the RV （8 cases）, fat signal intensity of the RV wall in DIRFS and irregular insula or continuity breaking in TIRFSE （3 cases） , dilatation of the left ventricle （LV） （2 cases）, a bit thickening of ventricular septum （ 1 case）, enlargement of the outflow of the RV （2 cases）, and ventricular wall aneurysm formation （2 cases）. Their positions involved apex of the fight ventricle （6 cases）, facies diaphragmatica （4 cases）, anterior ventricle （4 cases）, infundibulum （4 cases） and the papillary muscle of the RV （ 1 case）. Conclusion Cardiac MRI is the most specific and sensitive examination technique in diagnosing of ARVC, which can present structural and functional changes and the quality, degree, range of the disease. We recommend cardiac MRI if ARVC is suspected.