Hirsch R, Kilner P J, Connelly M S, Redington A N, St John Sutton M G, Somerville J
Grown-up Congenital Heart Unit, Royal Brompton National Heart and Lung Hospital, London, UK.
Circulation. 1994 Dec;90(6):2937-51. doi: 10.1161/01.cir.90.6.2937.
The inability to obtain complete diagnoses with transthoracic echocardiography in many adults with congenital heart disease provided the incentive to evaluate prospectively the individual and combined roles of magnetic resonance imaging (MRI) and transesophageal echocardiography (TEE) as "second-line" techniques for unresolved diagnostic problems.
Eighty-five patients were studied; 81 had MRI with a 0.5-T magnet to obtain spin-echo images, cine-MRI, and flow-velocity maps. Seventy-nine patients had TEE (37 biplane). A simple score (range, 0 to 1) was used for quantification of the results of MRI and TEE alone, for their comparison (in the 75 patients who had both), and for assessment of their combination. MRI, TEE, or their combination achieved a score of at least 0.75 in 18 of 25 diagnostic categories. A summary of the scores showed that for intracardiac anatomy. MRI scored 0.34, TEE scored 0.71 (P < .0001), and MRI plus TEE scored 0.84 (P < .003); for extracardiac anatomy, MRI scored 0.76, TEE scored 0.23 (P < .0001), and MRI plus TEE scored 0.84 (P = NS); and for hemodynamics and function, MRI scored 0.58, TEE scored 0.41 (P < .05), and MRI plus TEE scored 0.67 (P = NS). Total scores were MRI, 0.52; TEE, 0.50 (P = NS); and MRI plus TEE, 0.80 (P < .0001). MRI and TEE were inadequate for collateral and coronary arteries and pulmonary vascular resistance. Cine-MRI and flow-velocity maps comprised 43% of the MRI scores. Biplane TEE was better than single plane (scores of 0.59 versus 0.42, P < .0001).
MRI and TEE are important and complementary "second-line" investigations for congenital heart disease. Analysis of their performance in a wide range of diagnostic categories provides guidelines for their judicious application. Where both are available, diagnostic catheterizations are either obviated or simplified.
许多患有先天性心脏病的成年人无法通过经胸超声心动图获得完整诊断，这促使人们前瞻性地评估磁共振成像（MRI）和经食管超声心动图（TEE）作为解决未确诊问题的“二线”技术的单独及联合作用。
对85例患者进行了研究；81例患者接受了0.5T磁共振成像以获取自旋回波图像、电影MRI和流速图。79例患者接受了TEE检查（37例为双平面）。使用一个简单评分（范围为0至1）对单独的MRI和TEE结果进行量化，用于两者比较（在75例同时接受两种检查的患者中）以及评估它们的联合效果。在25个诊断类别中的18个类别中，MRI、TEE或它们的联合评分至少达到0.75。评分总结显示：对于心内解剖结构，MRI评分为0.34，TEE评分为0.71（P <.0001），MRI加TEE评分为0.84（P <.003）；对于心外解剖结构，MRI评分为0.76，TEE评分为0.23（P <.0001），MRI加TEE评分为0.84（P =无显著性差异）；对于血流动力学和功能，MRI评分为0.58，TEE评分为0.41（P <.05），MRI加TEE评分为0.67（P =无显著性差异）。总评分分别为：MRI为0.52；TEE为0.50（P =无显著性差异）；MRI加TEE为0.80（P <.0001）。MRI和TEE对于侧支血管、冠状动脉和肺血管阻力的评估不足。电影MRI和流速图占MRI评分的43%。双平面TEE优于单平面TEE（评分分别为0.59和0.42，P <.0001）。
MRI和TEE是先天性心脏病重要且互补的“二线”检查方法。分析它们在广泛诊断类别中的表现可为明智应用提供指导。在两种检查方法都可用的情况下，可避免或简化诊断性心导管检查。
