心脏超声造影诊断心脏占位性病变的价值

Usefulness of contrast eehocardiography in diagnosing space-occupying lesions of the heart

目的探讨心脏超声造影鉴别心脏占位性病变性质的价值。方法对38例心脏占位性病变患者（其中28例有金标准诊断结果）行SonoVue超声造影检查，根据病变部位造影剂增强状况将其诊断为血栓、良性肿瘤或恶性肿瘤。心脏超声造影定量分析比较病变区域及毗邻心肌造影剂峰值强度。结果心脏超声造影目测半定量分析诊断血栓8例，良性肿瘤8例，恶性肿瘤12例，其中2例富血供的良性肿瘤（1例心脏副神经节瘤、1例心脏横纹肌瘤）误诊为恶性肿瘤，其余诊断与金标准一致。16例病变造影定量分析诊断良性肿瘤或血栓10例，恶性肿瘤6例，与目测半定量分析诊断结果一致，其中2例误诊病例同前。结论心脏超声造影目测半定量分析可通过心脏占位性病变内的造影剂增强状况准确判断病变血供状态，从而协助判断其性质。

Objective To assess the usefulness of contrast echocardiography in differential diagnosing space-occupying lesions of the heart. Methods Contrast echocardiography was assessed for 38 patients of space-occupying lesion of the heart （SOLH）. Contrast enhancement of SOLH was assessed visually, comparing with that in the adjacent myocardium： significant contrast enhancement, intensity higher than or equal to the adjacent myocardium; mild or partial contrast enhancement, intensity lower than the adjacent myocardium,or no contrast enhancement. Respectively, malignant tumors, benign tumors, and thrombus were diagnosed. Twenty-eight patients among the 38 cases had gold standard diagnosis. The consistency between visual assessment diagnosis and gold standards were compared with Kappa statistic. Results Visual semi-quantitative diagnosis of contrast echocardiography： thrombus, benign tumors and malignant tumors were diagnosed for 8,8 and 12 cases, separately. Except two highly vascular benign tumors （1 rhabdomyoma and 1 paraganglioma） were misdiagnosed as malignant tumors,the rest 26 cases matched gold standard diagnosis. Quantitative analysis of contrast echocardiography, 16 cases were suitable for quantitative analysis, 10 cases were diagnosed as benign tumors or thrombus （quantitative analysis could not differentiate the two）, the rest 6 cases were diagnosed as malignant tumors. Quantitative analysis got the same 2 misdiagnosis as visual semi-quantitative diagnosis. Kappa value on visual semi-quantitative diagnosis of contrast echocardiography comparing with gold standard diagnosis was 0. 892. Conclusions The characteristics of vascularity of SOLH can be accurately determined by the contrast enhancement level in diseased region through visual semi-quantitative analysis with contrast echocardiography. Contrast echocardiography can be mainly used in SOLH except thrombus that has been clearly diagnosed, especially for patients with on going or fore-past malignancy in other organs.