Oren R M, Grover-McKay M, Stanford W, Weiss R M
Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City 52242.
J Am Coll Cardiol. 1993 Sep;22(3):832-8. doi: 10.1016/0735-1097(93)90199-b.
The purpose of this study was to determine the accuracy of cine computed tomography in the diagnosis of constrictive pericarditis.
Constrictive pericarditis is characterized by abnormalities of both cardiac structure and function. Accurate diagnosis requires detection of both a thickened pericardium and abnormal ventricular diastolic filling. At present, no one diagnostic technique has demonstrated sufficient accuracy in this setting. Cine computed tomography is a relatively new cardiac imaging mode with very high time and spatial resolution that has the potential to accurately diagnose constrictive pericarditis.
Twelve consecutive patients were retrospectively identified who had catheterization findings suggestive of constrictive physiology, had undergone a cine computed tomographic examination and had pathologic data that delineated the status of the pericardium. Group 1 (with constrictive pericarditis; n = 5) had surgical confirmation of thickened pericardium and improved clinically after pericardiectomy. Group 2 (no constrictive pericarditis; n = 7) had cardiomyopathy with normal pericardium. Seven normal volunteers (Group 3) were also studied. Cine computed tomograms were obtained for the entire heart (8-mm slices, 17 frames/s, nonionic contrast medium). Pericardial thickness was measured at 10 degrees intervals at three ventricular levels in each subject. The rapidity of diastolic filling was assessed by calculating the percent filling fraction in early diastole.
Pericardial thickness was 10 +/- 2 mm (mean +/- SD) in Group 1, 2 +/- 1 mm in Group 2 and 1 +/- 1 mm in Group 3 (p < 0.05, constrictive pericarditis vs. no constrictive pericarditis). Left ventricular filling fraction was 83 +/- 6% in Group 1, 62 +/- 9% in Group 2 and 44 +/- 5% in Group 3. Right ventricular filling fraction was 93 +/- 5% in Group 1, 62 +/- 14% in Group 2 and 35 +/- 6% in Group 3 (p < 0.05, Group 1 vs. Groups 2 and 3). Both indexes provided a clear-cut distinction between patients with and without constriction.
Cine computed tomography simultaneously provides both anatomic and physiologic data that allow accurate preoperative diagnosis of pericardial constriction.
本研究旨在确定电影计算机断层扫描在缩窄性心包炎诊断中的准确性。
缩窄性心包炎具有心脏结构和功能异常的特征。准确诊断需要检测增厚的心包和异常的心室舒张期充盈。目前，在这种情况下，尚无一种诊断技术显示出足够的准确性。电影计算机断层扫描是一种相对较新的心脏成像模式，具有非常高的时间和空间分辨率，有可能准确诊断缩窄性心包炎。
回顾性确定了连续12例患者，这些患者的导管检查结果提示有缩窄性生理改变，接受了电影计算机断层扫描检查，并且有描述心包状况的病理数据。第1组（患有缩窄性心包炎；n = 5）通过手术证实心包增厚，心包切除术后临床症状改善。第2组（无缩窄性心包炎；n = 7）患有心肌病且心包正常。还研究了7名正常志愿者（第3组）。对整个心脏进行电影计算机断层扫描（8毫米切片，每秒17帧，非离子型造影剂）。在每个受试者的三个心室水平以10度间隔测量心包厚度。通过计算舒张早期充盈分数来评估舒张期充盈的速度。
第1组心包厚度为10±2毫米（平均值±标准差），第2组为2±1毫米，第3组为1±1毫米（p < 0.05，缩窄性心包炎与无缩窄性心包炎）。第1组左心室充盈分数为83±6%，第2组为62±9%，第3组为44±5%。第1组右心室充盈分数为93±5%，第2组为62±14%，第3组为35±6%（p < 0.05，第1组与第2组和第3组）。这两个指标在有缩窄和无缩窄的患者之间提供了明确的区分。
电影计算机断层扫描同时提供解剖学和生理学数据，有助于术前准确诊断心包缩窄。
