左室心腔造影对心脏占位的鉴别诊断价值

The diagnostic value of left ventricular opacification in patients with suspected cardiac space occupying lesion

目的应用左室心腔造影技术提高心肌与心腔之间的对比度,在怀疑心脏占位时进行进一步诊断。方法选取二维超声心动图怀疑心脏占位的患者25例纳入观察组,均受近场伪影和声窗限制、气体干扰或因患者肥胖等原因而导致二维超声图像显示不清。患者行左室心腔造影检查后,对图像进行整理分析。10例无心脏疾病的受检者作为正常对照组,比较观察组常规二维心动图、心腔造影左心功能测量值。结果观察组25例患者造影过程中无任何不适表现,心腔超声造影均成功。其中7例排除心脏占位的诊断,3例判断为近场伪像所致,3例判断为心内自发显影,1例判断为室间隔肥厚型心肌病;18例患者提示为心内血栓,其中诊断的最小血栓为心梗后心尖部7 mm×8 mm低回声新鲜血栓;观察组二维图像与心腔造影射血分数(EF)测量值差异无统计学意义(P>0.05),但心腔造影心室舒张末期容积(EDV)和心室收缩末期容积(ESV)均较二维图像增大(均P<0.05)。同时25例患者中6例造影后能清晰观察到心腔内的涡流现象,提示心腔高凝状态。对照组10例均成功显影,且患者造影过程中无任何不适表现。结论左室心腔造影技术可以提高心脏超声图像的清晰度,准确地判断有无心脏占位,并且可以更加准确地判断心腔大小的改变,为心脏占位提供诊断信息。

Objective To improve the contrast between the myocardium and the cardiac cavity by left ventricular opacification and to diagnosis the suspected cardiac space occupying.Methods 25 patients with suspected cardiac space occupying by two-dimensional echocardiography were selected into the observation group.All patients were limited by near-field artifacts and sound window,gas interference or unclear display of two-dimensional echocardiography due to obesity.After left ventricular opacification,the images were sorted and analyzed.10 subjects without heart disease served as the normal control group.The left ventricular function measured by routine two-dimensional echocardiography and cardiography were compared in the observation group.Results In the observation group,25 patients had no discomfort during the contrast-enhanced,and the contrast-enhanced echocardiography was successful.Among them,7 cases excluded the diagnosis of cardiac space occupying,3 cases were judged to be caused by near-field artifacts,3 cases were judged to be spontaneous intracardiac development,and 1 case was judged to be ventricular septal hypertrophic cardiomyopathy;18 patients were diagnosed as intracardiac thrombus,and the smallest thrombus diagnosed was 7 mm×8 mm hypoechoic fresh thrombus at the apex of the heart after myocardial infarction.In the observation group,there was no significant difference between ejection fraction(EF)value measured by two-dimensional image echocardiography and cardiography(P>0.05),but the ventricular end diastolic volume(EDV)and ventricular end systolic volume(ESV)of cardiography were larger than those of two-dimensional echocardiography(P<0.05).At the same time,6 of the 25 patients could clearly observe the vortex phenomenon in the cardiac cavity after angiography,indicating the hypercoagulable state of the cardiac cavity.All 10 cases in the control group were developed successfully,and there was no discomfort in the course of angiography.Conclusions Left ventricular contrast echocardiography can improve the clarity of cardiac ultrasound images,accurately judge the presence or absence of cardiac space occupying,and more accurately judge the change of cardiac cavity size,so as to provide diagnostic information for cardiac space occupying.