MRI与超声心动图对COPD患者右室功能变化的评估价值

Estimated Value of MRI and Echocardiogram in Right Ventricular Function Changes in Patients with COPD

目的评估磁共振(MRI)及超声心动图在慢性阻塞性肺疾病(COPD)患者继发右心室功能不全中的诊断价值。方法遴选我院2017年2月至2018年2月确诊为COPD且疑似继发右心室功能改变的118例患者为研究对象,均采用MRI电影成像法(Cine MRI)和实时三维超声心动图(RT-3DE)检查,分析其影像图特点和右心功能参数[射血分数(RVEF)、每搏输出量(SVRV)、收缩末期容积(ESVRV)、舒张末期容积(EDVRV)],评估两种检测方法的一致性。结果 cine MRI检查示108例患者右心室功能改变,影像学可见右肺动脉干增粗,右心室扩大,室壁增厚,右心室肌质量早期增加,晚期减弱,可见三尖瓣及肺动脉瓣返流;RT-3DE检查示105例患者右心室功能改变,影像学可见右心室内径增大,室壁增厚,左心室受压,右心室流出道内径增大,右肺动脉内径或肺动脉干增大,还可见三尖瓣大量返流;cine MRI与RT-3DE测得的RVEF、SVRV、ESVRV、EDVRV差异性不显著(P>0.05),两者评估COPD患者继发右心室功能不全的一致率为95.76%(Kappa=75.96%,P<0.05)。结论cine MRI与RT-3DE都能较准确评估COPD患者右心功能改变情况,二者评估一致性较高,且影像检查图像具有一定的特征性,均具有较高临床应用价值。

Objective To evaluate the diagnostic value of magnetic resonance imaging(MRI)and echocardiogram in secondary right ventricular dysfunction in patients with chronic obstructive pulmonary disease(COPD).Methods A total of 118 patients diagnosed as COPD and suspected secondary right ventricular function changes from February 2017 to February 2018 in our hospital were enrolled in this study.All patients were given Cine magnetic resonance imaging(Cine MRI)and real-time threedimensional echocardiography(RT-3 DE).The image features and right heart function parameters[right ventricular ejection fraction(RVEF),right ventricular stroke volume(SVRV),right ventricular end-systolic volume(ESVRV),right ventricular end-diastolic volume(EDVRV)]were analyzed,and the consistency of two detection methods was assessed.Results Cine MRI examination showed 108 cases of right ventricular function changes,and imaging showed thickening of right pulmonary artery,right ventricular enlargement,thickening of ventricle wall,early increase and late decrease of right ventricular muscle mass,and regurgitation of tricuspid and pulmonary valve.RT-3 DE examination showed 105 cases of right ventricular function changes,and imaging showed increase of right ventricular diameter,wall thickening,left ventricular pressure,increase of right ventricular outflow tract diameter,increase of right pulmonary artery diameter or pulmonary artery,and significant regurgitation of tricuspid.There was no significant differences in the RVEF,SVRV,ESVRV and EDVRV measured by Cine MRI and RT-3 DE(P >0.05),and the consistency rate of the two methods for secondary right ventricular dysfunction in COPD patients was 95.76%(Kappa=75.96%,P<0.05).Conclusion Both Cine MRI and RT-3 DE can accurately assess the changes of right heart function in patients with COPD.The two methods have high consistency in evaluation,and the imaging shows examination images have certain characteristics,and have high clinical application value.