心肌淀粉样变性的MRI与超声心动图诊断价值

MRI and echocardiography in the diagnosis of cardiac amyloidosis

目的 探讨心肌淀粉样变性的MRI与超声心动图诊断价值.方法 回顾性分析11例经病理活检证实的心肌淀粉样变性患者的MR和超声心动图检查结果.结果 MRI和超声心动图示心肌淀粉样变性患者中,11例均存在不同程度的左心室、室间隔轻度增厚,5例房间隔轻度增厚,7例左心室心肌质量增加,7例左心房增大,6例左心室射血分数减低,10例舒张功能减低,多伴随心包积液、胸腔积液.8例MRI延迟增强显示特征性的弥漫性、广泛性心内膜下至透壁性延迟强化.6例超声心动图显示心肌回声增强,呈磨玻璃样改变,并可见散在颗粒样斑点状强回声.结论 超声心动图具有较好的初步诊断价值,延迟增强MRI能为心肌淀粉样变性诊断及鉴别诊断提供更为全面、丰富的信息.

Objective To assess the values of MRI and echocardiography for the diagnosis of cardiac amyloidosis （CA）. Methods Eleven cases with CA proved pathologically performed MRI and echocardiography, the findings were analyzed retrospectively. Results The characteristic features of cardiac amyloidosis on MRI and echocardiography were：diffuse slight myocardial thickening of the left ventricular wall and interventricular septum （11 cases ）, slight myocardial thickening of the interatrial septum （5 cases）, increased left ventricular mass （7 cases）, enlarged left atrium （ 7 cases）, impaired ventricular systolic and diastolic function （10 cases ）, pleural and pericardial effusions （11 and 9 cases ）.Echocardiography showed that myocardium was hyperechoic and presented as ground glass with some spotty hyperechoes in 6 cases. MRI revealed a distinct diffuse delayed enhancement of subendocardial and entire myocardium in 8 cases. Conclusion Doppler echocardiography is the first-choice imaging technique and cardiac magnetic resonance imaging can provide more information for the diagnosis of CA.