经胸超声心动图联合CT对缩窄性心包炎的诊断价值

Diagnostic Value of Transthoracic Echocardiography Combined with CT in Constrictive Pericarditis

目的探讨经胸超声心动图联合CT对缩窄性心包炎的诊断价值。方法选取我院收治的缩窄性心包炎患者50例作为研究对象。本组所有患者均接受GE公司生产的64排CT机及飞利浦公司生产的经胸超声心动图进行检查。所有患者均由同一手术团队给予治疗,术后组织送病理实验室检查。结果螺旋CT共检出41例缩窄性心包炎,诊断符合率82.00%,误诊率18.00%:⑴广泛性增厚24例,增厚率48.00%,增厚3例,增厚率6.00%,主要分布在心包隔面、右房室腹侧及左室后外份等,平均增厚(1.35±0.11)cm。⑵心包钙化改变10例,钙化率20.00%,腔狭小率24.00%。⑶心包钙化患者及非钙化患者的心脏血流动力学异常。经胸超声心动图检出46例缩窄性心包炎,诊断符合率92.00%,误诊率8.00%:⑴心房增大45例,增大率90.00%。⑵心外形异常9例,异常率18.00%,其中5例为心外形改变明显,占55.56%。4例改变不明显,占44.44%。⑶心包增厚36例,检出率72.00%,平均厚度(0.80±0.10)cm。⑷室间隔运动异常12例,占24.00%,M型表现为前隔舒张早期突然向前,继而突然向后,心尖四腔心切面后间隔有明显异常运动。⑸左室后壁运动低平9例,占18.00%,M型表现为舒张早期充盈后,舒张晚期运动平坦,失去逐渐向后运动,向后运动幅度小于等于1mm。⑹二尖瓣充盈频谱异常21例,占42.00%,E峰速度在呼气第1秒突然增大,较患者在吸气时速度增加25%~40%。经胸超声心动图联合CT检查缩窄性心包炎的诊断符合率高于单纯CT、经胸超声心动图诊断符合率(P<0.05)。结论经胸超声心动图及CT的缩窄性心包炎的影像学特点各异,联合二者诊断缩窄性心包炎能提高诊断正确性,值得推荐使用。

Objective To investigate the diagnostic value of transthoracic echocardiography combined with CT in constrictive pericarditis.Methods Fifty patients with constrictive pericarditis admitted to our hospital were selected,and all went the transthoracic echocardiography and CT examinations.The surgery was carried out simultaneously,and the postoperative tissue was sent to the pathological laboratory for examination.Results A total of 41 cases of constrictive pericarditis were detected by spiral CT,with a diagnostic coincidence rate of 82.00%and a misdiagnosis rate of 18.00%;a.24 cases had extensive thickening(48.00%),and 3 cases had limited thickening(6.00%)with an average thickening rate of(1.35±0.11).b.Pericardial calcification was changed in 10 cases,the calcification rate was 20.00%,and the narrowing rate was 24.00%.c.Cardiac hemodynamic abnormalities were found in both pericardial calcification and non-calcification patients.A total of 46 cases of constrictive pericarditis were detected by spiral CT,with a diagnostic coincidence rate of 92.00%and a misdiagnosis rate of 8.00%;a.45 cases(90.00%)had atrial enlargement.b.9 cases(18.00%)had an abnormal cardiac shape.Among them,5 cases(55.56%)had apparent cardiac shape change,and 4 cases(44.44%)had no noticeable change.c.The pericardial thickening was observed in 36 cases(72.00%)with an average thickness of(0.80±0.10)cm.d.12 cases(24.00%)had abnormal interventricular septal motion.e.The posterior wall motion of the left ventricle was low in 9 cases(18.00%).f.21 cases(42.00%)had abnormal mitral valve filling spectrum.The diagnostic coincidence rate of transthoracic echocardiography combined with CT in constrictive pericarditis was higher than that of single detection(P<0.05).Conclusion The imaging characteristics of transthoracic echocardiography and CT in the diagnosis of constrictive pericarditis are different,and the combination of the two can improve the diagnostic accuracy,which is worthy of recommendation.