三维超声与MRI在评估冠心病合并室壁瘤患者左心室功能中的临床比较

Clinical Comparison of Three-dimensional Ultrasound and MRI in Evaluating the Left Ventricular Function of Patients with Coronary Heart Disease Complicated with Ventricular Aneurysm

目的探讨三维超声与核磁共振成像(MRI)在评估冠心病(CHD)合并室壁瘤患者左心室功能中的临床价值,并进行比较。方法回顾性分析新乡医学院第三附属医院及郑州大学第二附属医院行外科手术治疗的40例CHD合并室壁瘤患者的临床资料,比较室壁瘤运动状态、大小、左心室功能三维超声和MRI检查结果。结果三维超声诊断室壁运动状态的符合率为39.67%;二维超声、三维超声、MRI术前左室射血分数(LVEF)、左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)所测值均存在显著差异(P<0.05);术后,三维超声与MRI、二维超声所测值无显著性差异(P>0.05),二维超声LVEDV、LVESV所测值较MRI所测值偏小(P<0.05);三维超声术前LVEF、LVEDV、LVESV所测值与MRI所测值间具有良好的相关性,r值分别为0.65、0.71、0.74(P<0.05);三维超声术后LVEF、LVEDV、LVESV所测值与MRI所测值间具有良好的相关性,r值分别为0.73、0.75、0.76(P<0.05)。结论三维超声在测定CHD合并室壁瘤患者左心室容积、功能方面更接近MRI所测值,但在判断室壁运动状态方面准确性较差,MRI可准确判断CHD合并室壁瘤患者左心室功能。

Objective To explore and compare the clinical values of three-dimensional ultrasound and magnetic resonance imaging(MRI)in evaluating the left ventricular function of patients with coronary heart disease(CHD)complicated with ventricular aneurysm.Methods The clinical data of 40 cases of patients with CHD complicated with ventricular aneurysm treated with surgery in the Third Affiliated Hospital of Xinxiang Medical College and the Second Affiliated Hospital of Zhengzhou University were analyzed retrospectively.The ventricular aneurysm motion,ventricular aneurysm size and the the left ventricular function examination results by three-dimensional ultrasound and MRI were compared.Results Preoperative MRI examination showed that there were 59 paradoxical motion segments and 62 non-motion ventricular wall segments among 40 patients,of which 13 segments were recoverable by preoperative determination and were in accordance with intraoperative diagnosis.And postoperative MRI showed there were wall thickening changes in the 13 segments.Three-dimensional ultrasound results showed that there were 29 paradoxical motion segments and 28 non-motion wall segments,of which 6 were recoverable.The coincidence rate of three-dimensional ultrasound was 39.67%in the diagnosis of wall motion.There were significant differences in the preoperative measured values of the left ventricular ejection fraction(LVEF),left ventricular end diastolic volume(LVEDV)and left ventricular end systolic volume(LVESV)by two-dimensional ultrasound,three-dimensional ultrasound and MRI(P<0.05),and there was no significant difference in the postoperative measured values by two-dimensional ultrasound,three-dimensional ultrasound and MRI(P >0.05),and the measured values of LVEDV and LVESV by two-dimensional ultrasound were lower than those by MRI(P<0.05).The preoperative measured values of LVEF,LVEDV and LVESV by three-dimensional ultrasound had a good correlation with the measured values by MRI,and the rvalues were 0.65,0.71,0.74(P<0.05).The postoperative measured values of LVEF,LVEDV and LVESV had a good correlation with the measured values by MRI,rvalues were 0.73,0.75,0.76 respectively(P<0.05).Conclusion The measured values of left ventricular volume,function by three-dimensional ultrasound were close to the measured values by MRI among patients with CHD complicated with ventricular aneurysm,but the former one is poor in determining the accuracy of ventricular wall motion state,and MRI can accurately determine the left ventricular function of patients with CHD complicated with ventricular aneurysm.