原发性心脏肿瘤（非粘液瘤）的影像学诊断

The Diagnostic Imaging of Primary Cardiac Tumors (No Myxoma included)

目的：研究与比较原发性心脏肿瘤的各种影像学特征性表现及其诊断价值。材料和方法：１９５７年至１９９４年间经手术病理证实原发性心脏肿瘤１７例。良性１１例（海绵状血管瘤２例、错构瘤２例、纤维瘤４例、纤维间皮瘤２例、脂肪组织浸润１例），恶性６例（平滑肌肉瘤２例、血管肉瘤４例）。影像学检查有：胸片（正侧位）及ＵＣＧ各１７例；ＣＴ２例；ＭＲ１４例；ＡＣＧ（电影或ＤＳＡ）９例；冠状动脉造影３例。结果：Ｘ线平片检查无特征性表现。ＵＣＧ征象为云絮状或团块状回声（敏感性１００％）。ＭＲＩ图像能显示肿块轮廓、大小、与心腔壁的关系及有无心包积液等，优于一般ＣＴ，ＡＣＧ（ＤＳＡ或Ｃｉｎｅ）能在动态下观察肿瘤对血液动力学的影响及与周围组织（如瓣膜、大血管等）的关系。结论：ＵＣＧ及ＭＲＩ对心脏肿瘤诊断敏感性高，且能同时显示心包及心肌的改变，能确诊，应作为首选和必需的检查方法。ＡＣＧ在准备手术的病例中应用。不同性质肿瘤之间鉴别困难。

To evaluate and compare the various characteristic manifestations of diagnostic imaging in primary cardiac tumors. Materials and Methods : 17 surgical pathologic proved cardiac tumor cases were collected including 11 benign ones: cavernous angiomas(2/17), Hamartomas(2/17),fibromas(4/17), fibromesotheliomas(2/17) and fatty infiltration(1/17) and 6 malignancies: leiomyosarcomas(2/17), angiosarcomas(4/17). All patients had examined by chest film (P-A and L) 17,UCG17,CT2,MR14,ACG (Cine or DSA)9, coronary angiography 3.Results:The chest films yielded no specificities. Typical UCG findings were 'cloud or mass like'echoes from heart chambers (sensitivity 100%) , MRI was able to clearly define the contour, size and relation with the cardiac chamber wall of the mass and also the presence of pericardiac effusion etc, so it's rather better than CT. AC G (DSA or Cine) can reveal the influence caused by the tumors on the hemodynamics and peripheral structures (valves and large vessels). Conclusion: UCG and MRI are highly effective in the diagnosis of cardiac masses, they also can show the changes of pericardium and myocardium,therefore they are necessary and for the best method of choice. AC G is only performed in patients going to be operated upon, but it is still difficult in differential diagnosis among different kinds of cardiac tumors.