与对比增强组织特征分析相比，对比增强解剖成像用于检测左心室血栓。
Contrast-enhanced anatomic imaging as compared to contrast-enhanced tissue characterization for detection of left ventricular thrombus.
作者信息
Weinsaft Jonathan W, Kim Raymond J, Ross Michael, Krauser Daniel, Manoushagian Shant, LaBounty Troy M, Cham Matthew D, Min James K, Healy Kirsten, Wang Yi, Parker Michele, Roman Mary J, Devereux Richard B
机构信息
Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, New York 10021, USA.
出版信息
JACC Cardiovasc Imaging. 2009 Aug;2(8):969-79. doi: 10.1016/j.jcmg.2009.03.017.
OBJECTIVES
This study sought to compare contrast-enhanced anatomic imaging and contrast-enhanced tissue characterization (delayed-enhancement cardiac magnetic resonance [DE-CMR]) for left ventricular (LV) thrombus detection.
BACKGROUND
Contrast echocardiography (echo) detects LV thrombus based on anatomic appearance, whereas DE-CMR imaging detects thrombus based on tissue characteristics. Although DE-CMR has been validated as an accurate technique for thrombus, its utility compared with contrast echo is unknown.
METHODS
Multimodality imaging was performed in 121 patients at high risk for thrombus due to myocardial infarction or heart failure. Imaging included 3 anatomic imaging techniques for thrombus detection (contrast echo, noncontrast echo, cine-CMR) and a reference of DE-CMR tissue characterization. LV structural parameters were quantified to identify markers for thrombus and predictors of additive utility of contrast-enhanced thrombus imaging.
RESULTS
Twenty-four patients had thrombus by DE-CMR. Patients with thrombus had larger infarcts (by DE-CMR), more aneurysms, and lower LV ejection fraction (by CMR and echo) than those without thrombus. Contrast echo nearly doubled sensitivity (61% vs. 33%, p < 0.05) and yielded improved accuracy (92% vs. 82%, p < 0.01) versus noncontrast echo. Patients who derived incremental diagnostic utility from DE-CMR had lower LV ejection fraction versus those in whom noncontrast echo alone accurately assessed thrombus (35 +/- 9% vs. 42 +/- 14%, p < 0.01), with a similar trend for patients who derived incremental benefit from contrast echo (p = 0.08). Contrast echo and cine-CMR closely agreed on the diagnosis of thrombus (kappa = 0.79, p < 0.001). Thrombus prevalence was lower by contrast echo than DE-CMR (p < 0.05). Thrombus detected by DE-CMR but not by contrast echo was more likely to be mural in shape or, when apical, small in volume (p < 0.05).
CONCLUSIONS
Echo contrast in high-risk patients markedly improves detection of LV thrombus, but does not detect a substantial number of thrombi identified by DE-CMR tissue characterization. Thrombi detected by DE-CMR but not by contrast echo are typically mural in shape or small in volume.
目的
本研究旨在比较对比增强解剖成像和对比增强组织特征分析（延迟增强心脏磁共振成像[DE-CMR]）在检测左心室（LV）血栓方面的效果。
背景
对比增强超声心动图（超声）基于解剖外观检测左心室血栓，而DE-CMR成像则基于组织特征检测血栓。尽管DE-CMR已被证实是一种准确的血栓检测技术，但其与对比增强超声相比的效用尚不清楚。
方法
对121例因心肌梗死或心力衰竭而有血栓形成高风险的患者进行多模态成像检查。成像包括3种用于血栓检测的解剖成像技术（对比增强超声、非对比增强超声、电影磁共振成像）以及DE-CMR组织特征分析作为参考。对左心室结构参数进行量化，以确定血栓的标志物以及对比增强血栓成像的附加效用预测指标。
结果
24例患者经DE-CMR检查发现有血栓。有血栓的患者梗死面积更大（通过DE-CMR）、室壁瘤更多，且左心室射血分数更低（通过磁共振成像和超声）。与非对比增强超声相比，对比增强超声的敏感性几乎提高了一倍（61%对33%，p<0.05），准确性也有所提高（92%对82%，p<0.01）。与仅通过非对比增强超声就能准确评估血栓的患者相比，从DE-CMR中获得额外诊断效用的患者左心室射血分数更低（35±9%对42±14%，p<0.01），从对比增强超声中获得额外益处的患者也有类似趋势（p=0.08）。对比增强超声和电影磁共振成像在血栓诊断上的一致性很高（kappa=0.79，p<0.001）。对比增强超声检测到的血栓患病率低于DE-CMR（p<0.05）。DE-CMR检测到但对比增强超声未检测到的血栓更可能呈壁状，或者位于心尖时体积较小（p<0.05）。
结论
高危患者使用超声造影可显著提高左心室血栓的检测率，但无法检测出DE-CMR组织特征分析所识别出的大量血栓。DE-CMR检测到但对比增强超声未检测到的血栓通常呈壁状或体积较小。
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