Boxt L M
Department of Radiology, Beth Israel Medical Center, New York, New York, USA.
Radiol Clin North Am. 1999 Mar;37(2):379-400. doi: 10.1016/s0033-8389(05)70100-7.
RV changes may be generalized into dilatation and hypertrophy. Increased preload results in ventricular dilatation. Increased afterload causes hypertrophy. Change in the shape of the RV resulting from increased afterload and myocardial hypertrophy induces tricuspid regurgitation, which superimposes changes of chamber dilatation onto those of hypertrophy. Sustained ventricular dilatation and hypertrophy frequently progresses to RV failure. In these cases, RV systolic function decreases in association with elevation of RV and right atrial diastolic pressure. Changes in the wall thickness and shape of the RV are variable, and depend upon the severity of the volume or pressure load presented, as well as its duration and rate of progression. Because the RV is an anterior cardiac structure, it occupies little of any heart border. Therefore, the sensitivity of plain film examination to RV disease is limited. Inferential diagnosis of RV disease can often be made based upon identification of other radiographic changes, notably the state of the pulmonary circulation, and the position of the heart in the chest. Conventional contrast right ventriculography may be used to assess the size and position of the RV, as well as associated acquired and congenital lesions that result in RV dysfunction. Due to the unusual shape of the RV cavity, however, and the unpredictable manner in which it dilates, accurate quantitative analysis by this technique is limited. Furthermore, the common association between RV disease and pulmonary hypertension limits the applicability of this imaging technique for evaluating patients with RV disease. Multiplanar MR imaging allows direct demonstration of changes in RV size and wall morphology. Furthermore, application of Simpson's rule to tomographic slices acquired at ventricular diastole and systole allows direct, accurate, and reproducible quantitative analysis of ventricular volume and myocardial mass, allowing radiographic assessment in patients for diagnosis, as well as longitudinally during medical management or after surgical treatment for congenital and acquired diseases that result in RV dysfunction.
右心室（RV）的变化可概括为扩张和肥厚。前负荷增加导致心室扩张。后负荷增加引起肥厚。后负荷增加和心肌肥厚导致的右心室形状改变会引发三尖瓣反流，这将心室扩张的变化叠加在肥厚的变化之上。持续性心室扩张和肥厚常进展为右心衰竭。在这些情况下，右心室收缩功能下降，同时右心室和右心房舒张压升高。右心室壁厚度和形状的变化各不相同，取决于所呈现的容量或压力负荷的严重程度、持续时间及其进展速度。由于右心室是心脏的前部结构，它在心脏边界中所占比例很小。因此，X线平片检查对右心室疾病的敏感性有限。右心室疾病的推断性诊断通常可基于对其他影像学变化的识别，特别是肺循环状态和心脏在胸部的位置。传统的右心室造影可用于评估右心室的大小和位置，以及导致右心室功能障碍的相关后天性和先天性病变。然而，由于右心室腔的特殊形状及其扩张方式不可预测，通过该技术进行准确的定量分析受到限制。此外，右心室疾病与肺动脉高压之间的常见关联限制了这种成像技术在评估右心室疾病患者中的适用性。多平面磁共振成像（MR成像）可直接显示右心室大小和壁形态的变化。此外，将辛普森法则应用于在心室舒张期和收缩期获取的断层切片，可对心室容积和心肌质量进行直接、准确且可重复的定量分析，从而在先天性和后天性疾病导致右心室功能障碍的患者诊断、药物治疗期间或手术治疗后进行纵向影像学评估。
