对比超声心动图在心脏肿块评估中的作用：一项多中心研究。
The usefulness of contrast echocardiography in the evaluation of cardiac masses: a multicenter study.
机构信息
Department of Cardio-Thoracic Surgery, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, China.
Department of Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China.
出版信息
BMC Cardiovasc Disord. 2024 Jan 13;24(1):43. doi: 10.1186/s12872-024-03708-2.
BACKGROUND
Cardiac masses can encompass a variety of conditions, such as tumors, thrombi, vegetations, calcific lesions, and other rare diseases. Treatment and management of these types of cardiac masses differ considerably. Thus, accurately distinguishing among thrombi, benign tumors, and malignant tumors in the heart is of great importance. Contrast echocardiography (CE) has emerged as a promising technology. Although published guidelines suggest that CE can enhance image quality and assist in differentiating between benign and malignant lesions, most studies on CE diagnosis of cardiac masses are limited to case reports or retrospective/small-sample-sized prospective cohorts. This study aims to evaluate the diagnostic accuracy of CE in patients with suspected cardiac masses and address the insufficient evidence for differential diagnosis using CE.
METHODS
Between April 2018 and July 2022, a prospective multicenter study was conducted, which included 145 consecutive patients suspected to have cardiac masses based on transthoracic echocardiography. All patients underwent CE examinations. The echocardiographic diagnosis relied on qualitative factors such as echogenicity, boundary, morphology of the base, mass perfusion, pericardial effusion, and motility as well as quantitative factors such as the area of the masses and the peak intensity ratio of the masses to adjacent myocardium (A1/A2).
RESULTS
The final confirmed diagnoses were as follows: 2 patients had no cardiac mass, 4 patients had pseudomass, 43 patients had thrombus, 66 patients had benign tumors, and 30 patients had malignant tumors. The receiver operating characteristic (ROC) analysis indicated that an optimal A1/A2 cutoff value of 0.499 distinguished a cardiac tumor from a thrombus, with AUC, sensitivity, specificity, PPV, and NPV of 0.977, 97.9%, 90.7%, 95.9%, and 95.1%, respectively. The optimal A1/A2 cutoff value of 1.583 distinguished a cardiac tumor from a thrombus, with AUC, sensitivity, specificity, PPV, and NPV of 0.950, 93.3%, 93.9%, 87.5%, and 96.9%, respectively.
CONCLUSIONS
Combined with qualitative and quantitative analyses, CE has the potential to accurately differentiate among different types of cardiac masses.
背景
心脏肿块可包含多种病症，如肿瘤、血栓、赘生物、钙化病变和其他罕见疾病。这些类型的心脏肿块的治疗和管理有很大的不同。因此，准确区分心脏中的血栓、良性肿瘤和恶性肿瘤非常重要。对比超声心动图（CE）已成为一种很有前途的技术。虽然已发布的指南表明 CE 可以提高图像质量并有助于区分良性和恶性病变，但大多数关于 CE 诊断心脏肿块的研究仅限于病例报告或回顾性/小样本前瞻性队列。本研究旨在评估 CE 在疑似心脏肿块患者中的诊断准确性，并解决 CE 用于鉴别诊断的证据不足的问题。
方法
在 2018 年 4 月至 2022 年 7 月期间，进行了一项前瞻性多中心研究，该研究纳入了 145 例基于经胸超声心动图检查疑似心脏肿块的连续患者。所有患者均进行了 CE 检查。超声心动图诊断依赖于回声强度、边界、基底部形态、肿块灌注、心包积液和运动等定性因素，以及肿块面积和肿块与相邻心肌的峰值强度比（A1/A2）等定量因素。
结果
最终确诊的诊断如下：2 例患者无心脏肿块，4 例患者为假性肿块，43 例患者为血栓，66 例患者为良性肿瘤，30 例患者为恶性肿瘤。受试者工作特征（ROC）分析表明，A1/A2 最佳截断值为 0.499 时可区分心脏肿瘤和血栓，AUC、敏感性、特异性、PPV 和 NPV 分别为 0.977、97.9%、90.7%、95.9%和 95.1%。A1/A2 最佳截断值为 1.583 时可区分心脏肿瘤和血栓，AUC、敏感性、特异性、PPV 和 NPV 分别为 0.950、93.3%、93.9%、87.5%和 96.9%。
结论
CE 结合定性和定量分析，有可能准确区分不同类型的心脏肿块。
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