Uenishi Eliza K, Caldas Márcia A, Tsutsui Jeane M, Abduch Maria C D, Sbano João C N, Kalil Filho Roberto, Mathias Wilson
Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil.
Heart Institute (InCor), University of Sao Paulo Medical School and Fleury Group, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, 05403-000, Brazil.
Cardiovasc Ultrasound. 2015 May 2;13:23. doi: 10.1186/s12947-015-0018-3.
Diagnosis of cardiac masses is still challenging by echocardiography and distinguishing tumors from thrombi has important therapeutical implications. We sought to determine the diagnostic value of real-time perfusion echocardiography (RTPE) for cardiac masses characterization.
We prospectively studied 86 patients, 23 with malignant tumors (MT), 26 with benign tumors (BT), 33 with thrombi and 6 with pseudotumors who underwent RTPE. Mass perfusion was analyzed qualitatively and blood flow volume (A), blood flow velocity (β), and microvascular blood flow (A x β) were determined by quantitative RTPE.
Logistic regression models showed that the probability of having a tumor increased by 15.8 times with a peripheral qualitative perfusion pattern, and 34.5 times with a central perfusion pattern, in comparison with the absence of perfusion. Using quantitative RTPE analysis, thrombi group had parameters of blood flow lower than tumor group. A values for thrombi, MT, and BT were 0.1 dB (0.01-0.22), 2.78 dB (1-7) and 2.58 dB (1.44-5), respectively; p < 0.05, while A x β values were 0.0 dB/s(-1) (0.01-0.14), 2.00 dB/s(-1) (1-6), and 1.18 dB/s(-1) (0.52-3), respectively; p < 0.05. At peak dipyridamole stress, MT had greater microvascular blood volume than BT [A = 4.18 dB (2.14-7.93) versus A = 2.04 dB (1.09-3.55); p < 0.05], but no difference in blood flow [Axβ = 2.46 dB/s(-1) (1.42-4.59) versus Axβ = 1.55 dB/s [1] (0.51-4.08); p = NS]. An A value >3.28 dB at peak dipyridamole stress predicted MT (AUC = 0.75) and conferred 5.8-times higher chance of being MT rather than BT.
RTPE demonstrated that cardiac tumors have greater microvascular blood volume and regional blood flow when compared with thrombi. Dipyridamole stress was useful in differentiating MT from BT.
心脏肿物的超声心动图诊断仍具有挑战性，区分肿瘤与血栓具有重要的治疗意义。我们旨在确定实时灌注超声心动图（RTPE）对心脏肿物特征的诊断价值。
我们前瞻性研究了86例患者，其中23例为恶性肿瘤（MT），26例为良性肿瘤（BT），33例为血栓，6例为假肿瘤，均接受了RTPE检查。对肿物灌注进行定性分析，并通过定量RTPE测定血流量（A）、血流速度（β）和微血管血流量（A×β）。
逻辑回归模型显示，与无灌注相比，外周定性灌注模式下肿瘤的发生概率增加15.8倍，中央灌注模式下增加34.5倍。通过定量RTPE分析，血栓组的血流参数低于肿瘤组。血栓、MT和BT的A值分别为0.1dB（0.01 - 0.22）、2.78dB（1 - 7）和2.58dB（1.44 - 5）；p < 0.05，而A×β值分别为0.0dB/s⁻¹（0.01 - 0.14）、2.00dB/s⁻¹（1 - 6）和1.18dB/s⁻¹（0.52 - 3）；p < 0.05。在双嘧达莫负荷峰值时，MT的微血管血容量大于BT [A = 4.18dB（2.14 - 7.93）对A = 2.04dB（1.09 - 3.55）；p < 0.05]，但血流无差异 [A×β = 2.46dB/s⁻¹（1.42 - 4.59）对A×β = 1.55dB/s [1]（0.5
