电子束CT在心肌病诊断中的临床应用

EBCT in diagnosis on primary cardiomyopathy

目的 评价电子束CT(EBCT)对原发性心肌病诊断及分型的价值。方法 对15例经临床及影像学检查或手术病理证实的心肌病患者,进行EBCT扫描(包括冠状动脉平扫、心脏长轴及短轴电影扫描)。结果 按世界卫生组织/国际心脏病学联合会(WHO/ISFC)分类法,将心肌病分为扩张型、肥厚型和限制型三大类,EBCT所见:(1)扩张型(8例):左心室扩张7例,均有室壁运动普遍减弱,左心室舒张末期容积为(250±101)ml,左心室射血分数为(189±66)%;右心室扩张伴运动减弱1例。(2)肥厚型(5例):均有室间隔肥厚,达(165±23)mm,伴左心室壁或心尖部肥厚3例,2例伴有流出道狭窄。(3)限制型(2例):例1右心室心内膜增厚呈稍低密度阴影,室腔变小,心尖闭塞,室壁运动减弱,右房显著扩张并血栓形成;例2病变累及左右心室,伴左右房增大。结论 EBCT能全面反映各类型原发性心肌病的病理及功能改变,可作为确定心肌病诊断及分型的手段。

Objective ToevaluatethediagnosticvalueofelectronbeamCT (EBCT)inprimary cardiomyopathy(PCM) .Methods EBCTincludingcoronaryscanningandheartmoviestudywasperformedin 15patients.ThediagnosisofPCMwasestablishedbyclinicalandimagingfindingsor/andpathologicexamination . Results BECTfindingsrelatedtotheclassificationofPCMdrawnupbyWHO/ISFCwereasfollows:( 1)dilated PCM( 8cases) :dilatedleftventricle (LV)wasfoundin 7of 8casesanddilatedrightventricle (RV)inthe remainingone .HypokineticcontractionoftheLVwallwith ( 2 5 0± 10 1)mlLVEDVand ( 18.9± 6.6) %LVEF presentedinthepatientswithdilatedLV .( 2 )HypertrophicPCM ( 5cases) :Hypertrophicventricularseptum ( 16.5± 2 .3 )mmwasdemonstratedinallcases ,hypertrophyoftheLVwallortheapexin 3of 5cases ,and stenosisoftheLVoutflowtractin 2cases.( 3 )RestrictivePCM ( 2cases) :Thickeningofendocardiumwithlower densitythancardiacmuscle,reducedRV ,obliterationofapex,hypokineticcontractionoftheRVwall,and dilatationofrightatrium(RA)withparietalthrombusformationofRAwasidentifiedinonepatient.BoththeLVand theRVwereinvolved ,withenlargementofatrium .Conclusion ThefindingsofPCMonEBCTseemtoreflect pathologicandfunctionalchangesofPCM ,andmaybeusefulfordiagnosisandclassificationofPCM .