Bomma Chandra, Dalal Darshan, Tandri Harikrishna, Prakasa Kalpana, Nasir Khurram, Roguin Ariel, Piccini Jonathan, Dong Jun, Mahadevappa Mahesh, Tichnell Crystal, James Cynthia, Lima Joao A C, Fishman Elliot, Calkins Hugh, Bluemke David A
Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Am J Cardiol. 2007 Jul 1;100(1):99-105. doi: 10.1016/j.amjcard.2007.02.064. Epub 2007 May 21.
The purpose of this study was to report 1 center's experience with multidetector computed tomography (MDCT) in the evaluation of patients suspected to have arrhythmogenic right ventricular (RV) dysplasia/cardiomyopathy (ARVD/C). RV dilatation/dysfunction is 1 of the most important criteria for establishing the diagnosis of ARVD/C. Cardiac magnetic resonance imaging (MRI) is the most preferred imaging modality for the diagnosis of ARVD/C. However, many patients with suspected ARVD/C have implantable cardioverter-defibrillators, prohibiting the use of MRI. Thirty-one patients (19 men; mean age 41 +/- 12 years) referred for evaluation of known or suspected ARVD/C had a complete reevaluation including contrast-enhanced cardiac MDCT at the center. Two patients underwent both cardiac MRI and MDCT. Seventeen of 31 patients met Task Force criteria for ARVD/C and were confirmed to have ARVD/C. Multidetector computed tomographic images were analyzed for qualitative and quantitative characteristic findings of ARVD/C. Increased RV trabeculation (p <0.001), RV intramyocardial fat (p <0.001), and scalloping (p <0.001) were significantly associated with the final diagnosis of ARVD/C. RV volumes, RV inlet dimensions, and RV outflow tract surface area were increased in patients with ARVD/C compared with patients who did not meet the criteria. RV and left ventricular functional analysis was performed in 2 patients. In conclusion, cardiac MDCT has a strong potential to detect many qualitative and quantitative abnormalities of the right ventricle in patients with ARVD/C. Limitations include implantable cardioverter-defibrillators and motion artifacts, along with well-known radiation and contrast-induced reaction.
本研究的目的是报告一家中心在使用多排螺旋计算机断层扫描（MDCT）评估疑似致心律失常性右心室（RV）发育不良/心肌病（ARVD/C）患者方面的经验。RV扩张/功能障碍是确立ARVD/C诊断的最重要标准之一。心脏磁共振成像（MRI）是诊断ARVD/C最优选的成像方式。然而，许多疑似ARVD/C的患者植入了植入式心脏复律除颤器，这禁止使用MRI。31例（19例男性；平均年龄41±12岁）因已知或疑似ARVD/C前来评估的患者在该中心接受了包括对比增强心脏MDCT在内的全面重新评估。2例患者同时接受了心脏MRI和MDCT检查。31例患者中有17例符合ARVD/C工作组标准并被确诊为ARVD/C。对多排螺旋计算机断层扫描图像进行分析，以寻找ARVD/C的定性和定量特征性表现。RV小梁增多（p<0.001）、RV心肌内脂肪增多（p<0.001）和扇贝样改变（p<0.001）与ARVD/C的最终诊断显著相关。与不符合标准的患者相比，ARVD/C患者的RV容积、RV入口尺寸和RV流出道表面积增加。对2例患者进行了RV和左心室功能分析。总之，心脏MDCT在检测ARVD/C患者右心室的许多定性和定量异常方面具有很大潜力。局限性包括植入式心脏复律除颤器和运动伪影，以及众所周知的辐射和造影剂引起的反应。
