声学造影对心脏占位病变性质的鉴别诊断价值

Diagnostic value of contrast enhanced echocardiography in cardiac masses

目的 对心脏占位病变患者进行心脏声学造影检查,评估心脏声学造影对心脏占位病变性质进行鉴别诊断的价值和准确性.方法 前瞻性选取2013年3月至2018年5月于华中科技大学同济医学院附属同济医院就诊且超声心动图检查发现心脏占位性病变的患者66例,对其进行传统二维超声心动图检查和心脏声学造影成像.应用目测法观察造影图像上病灶和邻近心肌的增强程度,病灶内无增强者判断为血栓,病灶内呈部分增强但增强程度低于邻近心肌者判断为良性肿瘤,病灶内呈明显增强、其增强程度接近或高于邻近心肌者判断为恶性肿瘤.同时对造影图像进行时间-信号强度曲线定量分析,计算病灶和邻近心肌造影剂峰值强度的差值ΔA,并采用ROC曲线分析法计算ΔA鉴别诊断不同性质占位病变的敏感度、特异度和准确性.所有心脏占位病变的性质均经"金标准"方法确诊.结果 经"金标准"方法确诊,66例患者中15例为血栓、23例为良性肿瘤、28例为恶性肿瘤.心脏声学造影目测法鉴别心脏内血栓的敏感度、特异度和准确性分别为100%、100%、100%,鉴别良性肿瘤的敏感度、特异度和准确性分别为91%、100%、97%,鉴别恶性肿瘤的敏感度、特异度和准确性分别为100%、95%、97%.心脏声学造影定量分析法所测得的ΔA鉴别血栓与心脏肿瘤的ROC曲线下面积为0.978,截断值-3.21 dB时,其敏感度、特异度和准确性分别为93%、100%、95%;鉴别恶性肿瘤与血栓、良性肿瘤的ROC曲线下面积为0.997,截断值0.45 dB时,其敏感度、特异度和准确性分别为100%、97%、98%.结论 心脏声学造影通过反映心脏占位病变的血供特点,能够对血栓、良性肿瘤和恶性肿瘤进行鉴别,无论心脏声学造影目测法,还是定量分析法对于鉴别心脏占位病变的性质均具有较高的诊断价值.

Objective To investigate the value and accuracy of contrast enhanced echocardiography in the diagnosis of cardiac masses.Methods A total of 66 patients who were treated at Tongji Hospital of Huazhong University of Science and Technology from March 2013 to May 2018 were enrolled in the present study.Cardiac masses were discovered by echocardiography in each of the patients,and conventional echocardiography and contrast enhanced echocardiography were performed in all of the patients.The enhancement levels of cardiac masses and adjacent myocardium on contrast images were evaluated by visual inspection and quantitative analysis.On visual inspection,a cardiac mass with no enhancement was diagnosed as thrombus,a mass with partial and lesser enhancement than adjacent myocardium was diagnosed as benign tumor,while a mass with complete enhancement was diagnosed as malignant tumor.By quantitative analysis,the difference between a mass and adjacent myocardium(ΔA)was calculated using time-signal intensity curves.The sensitivity,specificity,and accuracy ofΔA in tissue characterization of cardiac masses were evaluated by ROC curve analysis.The final diagnoses of all cardiac masses were identified by validation methods.Results Using the gold standard methods,of the 66 patients,15 were diagnosed with thrombi,23 diagnosed with benign tumors,and 28 with malignant tumors.The sensitivity,specificity,and accuracy of visual inspection in differentiating thrombi,benign tumors,and malignant tumors were 100%,100%,and 100%,91%,100%,and 97%,and 100%,95%,and 97%,respectively.The sensitivity,specificity,and accuracy ofΔA in differentiating thrombi from other masses were 93%,100%,and 95%,respectively(cutoff value=-3.21dB,AUC=0.978).The sensitivity,specificity,and accuracy ofΔA in differentiating malignant tumors from other masses were 100%,97%,and 98%,respectively(cutoff value=0.45dB,AUC=0.997).Conclusion Both visual inspection and quantitative analysis of contrast enhanced echocardiography have a high sensitivity and specificity in differentiating between cardiac thrombi,benign tumors,and malignant tumors.