留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码
x

心脏磁共振在房颤患者左心房/左心耳血栓检测中的应用进展

何钗 杨英

何钗, 杨英. 心脏磁共振在房颤患者左心房/左心耳血栓检测中的应用进展[J]. 分子影像学杂志, 2019, 42(1): 27-30. doi: 10.12122/j.issn.1674-4500.2019.01.07
引用本文: 何钗, 杨英. 心脏磁共振在房颤患者左心房/左心耳血栓检测中的应用进展[J]. 分子影像学杂志, 2019, 42(1): 27-30. doi: 10.12122/j.issn.1674-4500.2019.01.07
Chai HE, Ying YANG. Application and progress of cardiac magnetic resonance imaging in the detection of left atrial/left atrial appendage thrombosis in patients with atrial fibrillation[J]. Journal of Molecular Imaging, 2019, 42(1): 27-30. doi: 10.12122/j.issn.1674-4500.2019.01.07
Citation: Chai HE, Ying YANG. Application and progress of cardiac magnetic resonance imaging in the detection of left atrial/left atrial appendage thrombosis in patients with atrial fibrillation[J]. Journal of Molecular Imaging, 2019, 42(1): 27-30. doi: 10.12122/j.issn.1674-4500.2019.01.07

心脏磁共振在房颤患者左心房/左心耳血栓检测中的应用进展

doi: 10.12122/j.issn.1674-4500.2019.01.07
详细信息
    作者简介:

    何钗:何 钗,医师,E-mail: 226879299@qq.com

    通讯作者:

    杨 英,医师,E-mail: 1959382844@qq.com

Application and progress of cardiac magnetic resonance imaging in the detection of left atrial/left atrial appendage thrombosis in patients with atrial fibrillation

  • 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。

     

  • 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
    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
    下载: 导出CSV
  • [1] Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a global burden of disease 2010 study[J]. Circulation, 2014, 129(8): 837-47 doi: 10.1161/CIRCULATIONAHA.113.005119
    [2] 王玉兵, 殷跃辉. 心房颤动治疗进展[J]. 中国当代医药, 2018, 25(16): 28-35 doi: 10.3969/j.issn.1674-4721.2018.16.008
    [3] Jaber WA, White RD, Kuzmiak SA, et al. Comparison of ability to identify left atrial thrombus by three-dimensional tomography versus transesophageal echocardiography in patients with atrial fibrillation[J]. Am J Cardiol, 2004, 93(4): 486-9 doi: 10.1016/j.amjcard.2003.10.052
    [4] 卢小军, 李 康, 杨庆军. 磁共振成像左室功能检查技术进展[J]. 检验医学与临床, 2014, 11(14): 2002-4 doi: 10.3969/j.issn.1672-9455.2014.14.052
    [5] Larson AC, White RD, Laub G, et al. Self-gated cardiac cine MRI[J]. Magn Reson Med, 2004, 51(1): 93-102 doi: 10.1002/(ISSN)1522-2594
    [6] 尹 刚, 贺光军, 赵世华. 心血管MRI第二部分-心血管MRI的基本序列和常用技术[J]. 磁共振成像, 2013, 24(5): 382-8 doi: 10.3969/j.issn.1674-8034.2013.05.012
    [7] Griswold MA, Jakob PM, Heidemann RM, et al. Generalized autocalibrating partially parallel acquisitions (GRAPPA)[J]. Magn Reson Med, 2002, 47(6): 1202-10
    [8] Pruessmann KP, Weiger M, Scheidegger MB, et al. SENSE: sensitivity encoding for fast MRI[J]. Magn Reson Med, 2010, 42(5): 952-62
    [9] Sodickson DK, Mckenzie CA. A generalized approach to parallel magnetic resonance imaging[J]. Medical Physics, 2001, 28(8): 1629-43 doi: 10.1118/1.1386778
    [10] 翁 卓, 谢国喜, 刘 新, 等. 基于k空间加速采集的磁共振成像技术[J]. 中国生物医学工程学报, 2010, 29(5): 785-92 doi: 10.3969/j.issn.0258-8021.2010.05.023
    [11] Kim YJ, Seo JS, Choi BW, et al. Feasibility and diagnostic accuracy of whole heart coronary MR angiography using free-breathing 3D balanced turbo-field-echo with SENSE and the half-fourier acquisition technique[J]. Korean J Radiol, 2006, 7(4): 235-9 doi: 10.3348/kjr.2006.7.4.235
    [12] Homma K, Nitta N, Numano T, et al. World congress on medical physics and biomedical engineering 2006[M]. Berlin: Springer Berlin Heidelberg, 2007: 1583-6.
    [13] Willinek WA, Hadizadeh DR, Urbach H, et al. 4D time-resolved MR angiography with keyhole (4D-TRAK): more than 60 times accelerated MRA using a combination of CENTRA, keyhole, and SENSE at 3.0T[J]. J Magn Reson Imaging, 2008, 27(6): 1455-60 doi: 10.1002/jmri.21354
    [14] 林明宽, 刘 浩, 何喜民, 等. 左心房内径与心房颤动的关系[J]. 中国循证心血管医学杂志, 2015, 34(3): 414-5 doi: 10.3969/j.1674-4055.2015.03.44
    [15] Tamura H, Watanabe T, Nishiyama S, et al. Prognostic value of low left atrial appendage wall velocity in patients with ischemic stroke and atrial fibrillation[J]. J Am Soc Echocardiogr, 2012, 25(5): 576-83 doi: 10.1016/j.echo.2012.01.012
    [16] Iwama M, Kawasaki M, Tanaka R, et al. Left atrial appendage emptying fraction assessed by a feature-tracking echocardiographic method is a determinant of thrombus in patients with nonvalvular atrial fibrillation[J]. J Cardiol, 2012, 59(3): 329-36 doi: 10.1016/j.jjcc.2012.01.002
    [17] Ono K, Iwama M, Kawasaki M, et al. Motion of left atrial appendage as a determinant of thrombus formation in patients with a low CHADS2 score receiving warfarin for persistent nonvalvular atrial fibrillation[J]. Cardiovasc Ultrasound, 2012, 10(1): 1-8 doi: 10.1186/1476-7120-10-1
    [18] Wu N, Tong S, Xiang Y, et al. Association of hemostatic markers with atrial fibrillation: a meta analysis and meta-regression[J]. PLoS One, 2015, 10(4): e0124716-24 doi: 10.1371/journal.pone.0124716
    [19] Ohyama H, Hosomi N, Takahashi T, et al. Comparison of magnetic resonance imaging and transesophageal echocardiography in detection of thrombus in the left atrial appendage[J]. Stroke, 2003, 34(10): 2436-9 doi: 10.1161/01.STR.0000090350.73614.0F
    [20] Chen J, Zhang H, Zhu D, et al. Cardiac MRI for detecting left atrial/left atrial appendage thrombus in patients with atrial fibrillation: Meta-analysis and systematic review[J]. Herz, 2018, 13(1): 1-8
    [21] Kitkungvan D, Nabi F, Ghosn MG, et al. Detection of LA and LAA thrombus by CMR in patients referred for pulmonary vein isolation[J]. JACC Cardiovasc Imag, 2016, 9(7): 809-18 doi: 10.1016/j.jcmg.2015.11.029
    [22] Pazos-López P, Pozo E, Siqueira ME, et al. Value of CMR for the differential diagnosis of cardiac masses[J]. JACC Cardiovasc Imag, 2014, 7(9): 896-905 doi: 10.1016/j.jcmg.2014.05.009
    [23] Braggion MF, Koenigkam-Santos M, Teixeira SR, et al. Magnetic resonance imaging evaluation of cardiac masses[J]. Arq Bras Cardiol, 2013, 101(3): 263-72
    [24] Daccarett M, Mcgann CJ, Akoum NW, et al. MRI of the left atrium: predicting clinical outcomes in patients with atrial fibrillation[J]. Expert Rev Cardiovasc Ther, 2011, 9(1): 105-11 doi: 10.1586/erc.10.177
    [25] Manning WJ, Spahillari A. Combined pulmonary vein and LA/LAA thrombus assessment: Can CMR kill two birds with one stone[J]. JACC Cardiovasc Imag, 2016, 9(7): 819-21 doi: 10.1016/j.jcmg.2015.12.017
    [26] 孙卫红, 胡春艾, 陈 刚, 等. 3.0 T磁共振检查左心耳的方法和扫描序列[J]. 中国介入影像与治疗学, 2015, 29(11): 700-4
    [27] 卓利勇, 李彩英. 左心耳多模态磁共振成像研究进展[J]. 磁共振成像, 2018, 23(4): 294-8
    [28] Sun L, Li Y, Zhang YT, et al. A computer-aided diagnostic algorithm improves the accuracy of transesophageal echocardiography for left atrial thrombi: a single-center prospective study[J]. J Ultrasound Med, 2014, 33(1): 83-91 doi: 10.7863/ultra.33.1.83
    [29] 金彦彦, 马长生, 何 华, 等. 非瓣膜性心房颤动血栓形成的相关因素分析[J]. 中国介入心脏病学杂志, 2008, 16(3): 133-6 doi: 10.3969/j.issn.1004-8812.2008.03.004
    [30] Zou H, Zhang Y, Tong J, et al. Multidetector computed tomography for detecting left atrial/left atrial appendage thrombus: a meta-analysis[J]. Intern Med J, 2015, 45(10): 1044-53 doi: 10.1111/imj.12862
    [31] Rathi VK, Reddy ST, Anreddy S, et al. Contrast-enhanced CMR is equally effective as TEE in the evaluation of left atrial appendage thrombus in patients with atrial fibrillation undergoing pulmonary vein isolation procedure[J]. Heart Rhythm, 2013, 10(7): 1021-7 doi: 10.1016/j.hrthm.2013.02.029
  • 加载中
表(1)
计量
  • 文章访问数:  2693
  • HTML全文浏览量:  1087
  • PDF下载量:  20
  • 被引次数: 0
出版历程
  • 收稿日期:  2018-10-11
  • 刊出日期:  2019-01-01

目录

    /

    返回文章
    返回

    关于《分子影像学杂志》变更刊期通知

    各位专家、作者、读者:

    为了缩短出版时滞,促进科研成果的快速传播,我刊自2024年1月起,刊期由双月刊变更为月刊。本刊主要栏目有:基础研究、临床研究、技术方法、综述等。

    感谢各位专家、作者、读者长期以来对我刊的支持与厚爱!

    南方医科大学学报编辑部

    《分子影像学杂志》

    2023年12月27日