Application and progress of cardiac magnetic resonance imaging in the detection of left atrial/left atrial appendage thrombosis in patients with atrial fibrillation
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摘要: 左心房/左心耳血栓是心房颤动最严重的并发症，不但影响心脏输出功能，而且栓子脱落后随血液循环至全身各处可致重要动脉栓塞，尤其是脑动脉栓塞可致急性脑卒中。心脏磁共振成像作为一种新的非侵入性检查已受业界广泛关注，能动态观察心房、心耳运动功能及血流动力学情况，且有较高的左心房/左心耳血栓检出率，有望替代经食道超声在诊断左心房/左心耳血栓在临床中的应用。Abstract: Left atrial/left atrial appendage (LA/LAA) thrombosis is the most serious complication of atrial fibrillation. It not only affects the cardiac output function, but also leads to important arterial embolization following the shedding of emboli with blood circulation to all parts of the body, especially to acute brain stroke. Cardiac magnetic resonance imaging (CMR) has received widespread attention as a new non-invasive technique. It can dynamically observe the motor function and hemodynamics of left atrial and left atrial appendage, and has a high detection rate of LA/LAA thrombosis. CMR is expected to replace TEE in the clinical application of diagnosing LA/LAA thrombosis.
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表 1 CMR与其它检查技术的比较
比较项目 TEE 多层螺旋CT CMR 适应症 急诊手术麻醉需要排除心脏和大血管的并发症；心律失常；肺动脉高压；肺栓塞；心脏瓣膜性疾病；感染性心内膜炎；心肌病；血流动力学指标；围术期监测等 血管性疾病及血管造影；心肌灌注成像；心脏瓣膜性疾病；先天性心脏病；肺栓塞；心肌病；心脏占位；心脏容积测量；心功能评价等 先天性心脏病；心肌病；心力衰竭及心功能评价；血管性疾病；心脏瓣膜性疾病；心脏占位；心包病变；心脏电影；心肌灌注成像；心肌活性成像等 禁忌症 先天性或获得性上消化道疾病；凝血功能障碍；咽部占位；纵隔放疗史；颈椎疾病严重心血管疾病；麻醉剂过敏等 造影剂过敏；严重肝、肾功能不全；重症甲状腺疾患（甲亢）等 抗磁性金属植入者；对比剂过敏；早期妊娠（3月内）等 操作前准备 相关查血准备；禁食4~6 h，口咽部麻醉等 相关查血准备；心率准备（建议低于70次/min）；注射造影剂（必要时）等 去除身体上金属、磁性以及电子物件，注射对比剂（必要时）等 是否需要术中监测 是 否 否 并发症 咽部黏膜出血；食管损伤；心律失常；一过性血压异常；感染；麻醉剂过敏；下颌关节脱位等 造影剂过敏，肾功能损伤等 射频场（RF）的致热效应；对比剂过敏或致肾源性系统性纤维化（罕见） 优点 更接近左心房，能清楚观察左房结构；快速等 无创；时间、空间分辨率高；可重复性强；方便快捷等 无创；无放射性；时间、空间分辨率更高；成像速度快；可重复性；组织对比度高；3D成像等 不足 半有创侵入式检查，时间短，不能充分观察，有一定误诊率，对检查医师依赖性强等 运动伪影、射线硬化伪影；辐射剂量大；造影剂过敏；对于较多钙化斑块和支架内管腔的观察受限；评估管腔内血流动力学状况受限等 价格高；检测时间长；噪声大；MR扫描室内金属物体飞射；体内金属植入患者禁行此项检查等 
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