Reinmüller R, Gürgan M, Erdmann E, Kemkes B M, Kreutzer E, Weinhold C
Department of Radiology, Klinikum Grosshadern, University of Munich, Germany.
J Thorac Imaging. 1993 Spring;8(2):108-21. doi: 10.1097/00005382-199321000-00004.
Eighty patients with pericardial constriction confirmed by catheter data were studied by CT (n = 79), MR imaging (n = 24), or both. To determine the validity of these imaging methods for subsequent treatment, 30 patients' studies were evaluated retrospectively (1980-1984) and 50 (1985-1991) prospectively. Twenty patients from the first group and 30 patients from the second group underwent pericardiectomy. By systematic analysis of CT scans and MR images it was possible to characterize the morphology of pericardial constriction (n = 80); to identify global (n = 27), right-sided (n = 46), left-sided (n = 2), annular (n = 2), effusive (n = 2), and epicardial (n = 1) forms of pericardial constriction; and to define parameters of myocardial atrophy and fibrosis (n = 17). Seventeen patients had myocardial atrophy, fibrosis, or both. Seven of them underwent pericardiectomy; all died of acute myocardial failure (100%). Four (9.3%) of 43 patients without myocardial atrophy or fibrosis died as a consequence of other complications. The method of thoracotomy and periepicardiectomy was continuously adjusted to the preoperative CT and MR findings. Thus, the clinical use of CT and MR imaging in patients with known or suspected pericardial constriction is based on (a) exclusion of patients with restrictive hemodynamics from diagnostic thoracotomy, (b) preoperative determination of the method of thoracotomy and extent of pericardiectomy, and (c) exclusion of patients with myocardial atrophy or fibrosis from pericardiectomy.
80例经导管检查确诊为心包缩窄的患者接受了CT（n = 79）、磁共振成像（MR成像，n = 24）检查或两者均接受了检查。为了确定这些成像方法对后续治疗的有效性，对30例患者的研究进行了回顾性评估（1980 - 1984年），对50例患者（1985 - 1991年）进行了前瞻性评估。第一组中的20例患者和第二组中的30例患者接受了心包切除术。通过对CT扫描和MR图像的系统分析，能够对心包缩窄的形态进行特征描述（n = 80）；识别心包缩窄的整体型（n = 27）、右侧型（n = 46）、左侧型（n = 2）、环形（n = 2）、渗出型（n = 2）和心外膜型（n = 1）；并确定心肌萎缩和纤维化的参数（n = 17）。17例患者存在心肌萎缩、纤维化或两者皆有。其中7例接受了心包切除术；均死于急性心肌衰竭（100%）。43例无心肌萎缩或纤维化的患者中有4例（9.3%）死于其他并发症。开胸和心包外膜切除术的方法根据术前CT和MR检查结果不断调整。因此，CT和MR成像在已知或疑似心包缩窄患者中的临床应用基于：（a）将存在限制性血流动力学的患者排除在诊断性开胸手术之外；（b）术前确定开胸方法和心包切除术的范围；（c）将存在心肌萎缩或纤维化的患者排除在心包切除术之外。
