双源CT功能成像对肥厚型心肌病的诊断价值

Diagnostic Value of Hypertrophic Cardiomyopathy by Dual-source CT Functional Imaging

目的:探讨双源CT(DSCT)在肥厚型心肌病(HCM)诊断中的临床应用价值。方法:回顾性分析10例确诊为HCM患者、13例正常人的临床资料和DSCT表现。结果:10例HCM患者DSCT均明确诊断,其中非对称性肥厚9例,对称性肥厚1例;1例呈梗阻性HCM。HCM组室间隔、前壁、心尖部厚度均大于对照组,侧壁、后壁厚度和对照组未见统计学差异。舒张末期左室最厚处室壁厚度与同层后壁厚度的比值(心尖部室壁厚度/基底部后壁厚度)大于1.5。LVIDd、LVID和LVOTd小于对照组,LADd大于对照组。正常人平均室壁增厚率约(57.88 5.09)%,HCM组肥厚处心肌室壁增厚率降低,约(20.10±4.89)%。HCM组左室MM、EF大于对照组,EDV、ESV小于对照组。1例HCM患者冠状动脉存在粥样斑块,狭窄程度约85%;7例存在冠状动脉心肌桥,均发生在前降支。结论:DSCT实现了对HCM的解剖形态学、功能学及冠状动脉病变的"一站式"评估,在HCM诊断中具有广阔的临床应用前景。

Objects： To evaluate the clinical application value in the assessment of HCM by dual-source CT （DSCT）. Methods： The clinical dada and DSCT imaging of 10 cases with confirmed HCM and 13 normal controls were analyzed retrospectively. Results： 10 cases of HCM including asymmetric HCM （n = 9）, symmetric HCM （n = 1） were clearly diagnosed by DSCT, and one of asymmetric HCM was accompanied by LVOT. The thickness of interventricular septum, anterior wall and apical in the HCM group were significantly greater than in the control group, while there were no significant differences in the thickness of free and posterior wall between them. The ratio of maximum wall thickness of the Left ventricular wall or apex to the PWTd in end-diastole was greater than 1.5 in the HCM group. LVIDd, LVIDs and LVOTd in the HCM group were smaller than in the control group, on the contrary, LADd in the HCM group was greater than in the control group. WT in the control group was about （57.88 ± 5.09）%, while it reduced to （20.10 ± 4.89）% of the thickened segments in HCM group. Both MM and EF in the HCM group were greater than in the control group, instead, both EDV and ESV in the HCM group were smaller than in the control group. One case had atheromatous plaque and the degree of coronary artery stenosis was approximately 85%; 7 cases had myocardial bridge （MB） and all of the MB at LAD. Conclusions： DSCT is a promising modality to assess HCM, which can provide one-stop noninvasive evaluation of cardiac morphology, function, as well as coronary artery anatomy.