Auffermann W, Wichter T, Breithardt G, Joachimsen K, Peters P E
Institut für Klinische Radiologie, Universität Münster, Germany.
AJR Am J Roentgenol. 1993 Sep;161(3):549-55. doi: 10.2214/ajr.161.3.8352102.
Arrhythmogenic right ventricular disease (ARVD) is increasingly found in young adults with ventricular arrhythmias and is characterized by ventricular tachycardia originating within the right ventricle and regional or diffuse abnormalities in the contraction of the right ventricle. Until now, the gold standard for the detection of global and regional abnormalities of the right ventricular wall has been angiography combined with biopsy. The purpose of the current study was to compare MR imaging with angiography for assessing the location and extent of morphologic and functional abnormalities in patients with ARVD.
Electrocardiographically gated spin-echo and cine gradient-echo MR imaging of the heart was performed in 36 consecutive patients with biopsy-proved ARVD. Patients were prospectively separated into two groups according to the results of invasive electrophysiologic tests (18 with inducible ventricular tachycardia during invasive electrophysiologic studies [ARVD 1] and 18 without inducible ventricular tachycardia [ARVD 2]) and compared with 11 control subjects. Global and regional morphology and function of the right ventricle were assessed with MR imaging, and those findings were compared with angiographic findings.
Right ventricular ejection fraction was significantly lower in patients with ARVD 1 than in patients with ARVD 2 or in control subjects. Regional abnormalities of the right ventricular wall also were more pronounced in patients with ARVD 1 than in patients with ARVD 2. Signal-intensity increases corresponding to fatty replacement shown by biopsy were seen in 33% of patients with ARVD 1 and in 11% of patients with ARVD 2. Abnormal regions of the right ventricular wall seen on MR images corresponded to angiographic findings in 86% of patients. Comparison with control subjects showed that patients with ARVD 1 had a significant delay in diastolic relaxation of the right ventricle.
Our results show that MR imaging can be used to assess morphologic alteration, tissue abnormalities, and global as well as regional dysfunction of the right ventricle in patients with ARVD. It may become a useful clinical tool for diagnosing and grading ARVD and a worthy substitute for angiography and biopsy in the follow-up of patients with ARVD.
致心律失常性右心室疾病（ARVD）在患有室性心律失常的年轻人中越来越常见，其特征是起源于右心室的室性心动过速以及右心室收缩的局部或弥漫性异常。到目前为止，检测右心室壁整体和局部异常的金标准一直是血管造影结合活检。本研究的目的是比较磁共振成像（MR成像）与血管造影在评估ARVD患者形态学和功能异常的位置及范围方面的差异。
对36例经活检证实为ARVD的连续患者进行了心脏的心电图门控自旋回波和电影梯度回波MR成像检查。根据侵入性电生理检查结果将患者前瞻性地分为两组（18例在侵入性电生理研究中可诱发室性心动过速的患者[ARVD 1组]和18例不可诱发室性心动过速的患者[ARVD 2组]），并与11名对照受试者进行比较。通过MR成像评估右心室的整体和局部形态及功能，并将这些结果与血管造影结果进行比较。
ARVD 1组患者的右心室射血分数显著低于ARVD 2组患者或对照受试者。ARVD 1组患者右心室壁的局部异常也比ARVD 2组患者更明显。活检显示对应脂肪替代的信号强度增加在33%的ARVD 1组患者和11%的ARVD 2组患者中可见。MR图像上所见的右心室壁异常区域在86%的患者中与血管造影结果相符。与对照受试者比较显示，ARVD 1组患者右心室舒张期松弛明显延迟。
我们的结果表明，MR成像可用于评估ARVD患者右心室的形态改变、组织异常以及整体和局部功能障碍。它可能成为诊断和分级ARVD的有用临床工具，并且在ARVD患者的随访中是血管造影和活检的有价值替代方法。
