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血液系统疾病患者心脏并发症的CT和MRI评估:图谱综述

CT and MRI evaluation of cardiac complications in patients with hematologic diseases: a pictorial review.

作者信息

Kim Tae Yun, Jung Jung Im, Kim Yoo Jin, Kim Hwan Wook, Lee Hae Giu

机构信息

Departments of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea.

Division of Hematology, Department of Internal Medicine, Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

出版信息

Int J Cardiovasc Imaging. 2015 Dec;31 Suppl 2:159-67. doi: 10.1007/s10554-015-0610-5. Epub 2015 Feb 5.

Abstract

Cardiac complications with hematologic diseases are not uncommon but it is difficult to diagnose, due to non-specific clinical symptoms. Prompt recognition of these potentially fatal complications by cardiac computed tomography (CT) or cardiac magnetic resonance imaging (MRI) may help to direct clinicians to specific treatments according to causes. Thrombosis is often related to central venous catheter use and is usually located at the catheter tip near the atrial wall. Differentiation of thrombosis from normal structure is possible with CT and, distinction of a thrombus from a tumor is possible on a delayed enhancement MRI with a long inversion time (500-600 ms). Granulocytic sarcoma of the heart is indicated by an infiltrative nature with involvement of whole layers of myocardium on CT and MRI. MRI with T2* mapping is useful in evaluating myocardial iron content in patients with hemochromatosis. Diffuse subendocardial enhancement is typically observed on delayed MRIs in patients with cardiac amyloidosis. T1 mapping is an emerging tool to diagnose amyloidosis. Myocardial abscess can occur due to an immunocompromised status. CT and MRI show loculated lesions with fluid density and concomitant rim-like contrast enhancement. Awareness of CT and MRI findings of cardiac complications of hematologic diseases can be helpful to physicians for clinical decision making and treatment.

摘要

血液系统疾病的心脏并发症并不少见,但由于临床症状不具特异性,诊断较为困难。通过心脏计算机断层扫描(CT)或心脏磁共振成像(MRI)及时识别这些潜在致命并发症,可能有助于指导临床医生根据病因进行针对性治疗。血栓形成常与中心静脉导管的使用有关,通常位于靠近心房壁的导管尖端。CT可实现血栓与正常结构的区分,而在具有长反转时间(500 - 600毫秒)的延迟增强MRI上,可区分血栓与肿瘤。心脏粒细胞肉瘤在CT和MRI上表现为浸润性,累及心肌全层。T2* 成像的MRI有助于评估血色素沉着症患者的心肌铁含量。心脏淀粉样变性患者在延迟MRI上通常可见弥漫性心内膜下强化。T1成像 是诊断淀粉样变性的一种新兴工具。免疫功能低下状态可能导致心肌脓肿。CT和MRI显示有液性密度的局限性病变,并伴有边缘样强化。了解血液系统疾病心脏并发症的CT和MRI表现,有助于医生进行临床决策和治疗。

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