Objective To observe the morphological and functional outcome by magnetic resonance imaging after the heterotopic heart transplantation.Method From Apr.2006 to Oct.2007,5 patients with chronic myocardial infarction and severe cardiac dysfunction underwent coronary artery bypass graft plus removal of ventricular aneurysm and heterotopic heart transplantation.1.5 Tesla MRI scanner was used to evaluate the sizes of cardiac chambers,regional or global ventricular function,myocardial perfusion and late enhancement.All the 5 patients received MRI examination 3 times 1 month to 17 months after the operation,and 3 of them underwent MRI examination before the operation.Results All the 5 patients presented significant clinical improvement.Post-operative cavities of the left ventricles(LV)in situ decreased progressively in 3 cases who had received pre-operative MRI scanning.However,only one case showed significant functional improvement and LVEF increased from 18.4% to 47.2%.In the post-operative follow up,the LV function of the hearts in situ showed significant improvement,and LVEF finally increased to 47.2% and 52.1%,respectively in 2 cases.No obvious improvement was found in the other 3 cases,but their heterotopic heart showed enough LVEF.No significant findings were observed either in the first pass perfusion or late enhancement in the postoperative examination.Conclusion "one-stop shop" MRI scanning is a suitable image modality for evaluating the curative effect of the heterotopic heart transplantation.

Objective To evaluate the dynamic changing and prognosis of aortic intramural hematoma(IMH) by electron beam CT(EBCT).Methods A retrospective study was performed during a period of time from January 2002 to September 2004.Twenty-three patients with aortic IMH were scanned by EBCT more than 2 times.The patients were followed-up for 4-405 days(mean 105.8 days).Mean follow-up was 105.84 days.In this group of 23 patients(19 men and 4 women,aged from 30 to 81 years,mean 57.78 years) who had been undergone EBCT were diagnosed with IMH.EBCT scanner was used with a model of Imatron C-150XP.Contrast-enhanced continuous volume scanning(CVS) was performed.The slice thickness was 6 mm or 3 mm with an acquisition time of 100 milliseconds.A total amount of contrast media(Ultravist 300 or 320,or Ominpaque 300 or 320 mg/ml) of 80-100 ml was used with the rate of 3.5-4.5 ml/s.The scan delayed time was 18-30 s.Results Four patients with Standford A IMH were diagnosed.Among them,3 patients were observed complete regression,1 patient was observed without changing.Nineteen patients with Standford B IMH were diagnosed.Among them,9 patients were observed in complete regression,4 patients were observed incomplete regression,4 patients were observed without changing,2 patients were observed in progression on EBCT.From 4 days to 15 days,IMH was observed without change or worse.From 16 days to 30 days IMH was observed regression.Conclusion EBCT was a very useful tool for detecting and following up of IMH.The different features of the involved aortic walls shown on EBCT were used for planning surgery.

OBJECTIVE:To evaluate the evolution of medically treated atherosclerotic aortic ulcers by computed tomography (CT).METHODS:Thirty-five patients (31 men and 4 women, aged from 40 to 79 years, mean 56.2 +/- 10.8 years) with known aortic ulcers were monitored by CT (follow up time 7 - 730 days, mean 135 days), 80 - 100 ml contrast media (Ultravist 300 or 320, or Omnipaque 300 or 320 mg/ml) was injected with a rate of 3.5 - 4.5 ml/s. The scan delayed time was 18 - 30 s. Ulcers dimensions were measured according to maximum depth, maximum length and maximum width.RESULTS:Thirty-one patients with intramural hematomas and 1 patient with atherosclerotic aortic arch aneurysm without intramural hematoma were medically treated and another 3 patients were surgically treated. Intramural hematoma regression was monitored in 31 medically treated patients with intramural hematomas. CT was repeated at 2 weeks, 3 and 6 months. Intramural hematoma resolved gradually during follow up [thickness: (7.69 +/- 4.24) mm at 3 months, (3.06 +/- 1.67) mm at 6 months, P < 0.05 vs. 1st CT: (11.96 +/- 4.16) mm while ulcer maximum depth (11.17 +/- 6.03) mm at 3 months, (11.35 +/- 5.59) mm at 6 months, P < 0.05 vs. 1st CT: (7.36 +/- 6.61) mm, maximum width (14.40 +/- 6.35) mm at 3 months, (18.55 +/- 10.94) mm at 6 months, P < 0.05 vs. 1st CT: (7.15 +/- 6.39) mm, maximum length (17.12 +/- 7.15) mm at 3 months, (18.13 +/- 10.89) mm at 6 months, P < 0.05 vs. 1st CT: (11.64 +/- 10.06) mm increased progressively during follow-up].CONCLUSION:CT was a useful tool for deflecting atherosclerotic aortic ulcers and monitoring therapeutic effects.

Objective To evaluate value of electron beam computed tomography (EBCT) in diagnosis of truncus arteriosus (TA). Methods Ten cases of TA with age ranging from 2-month to 24 years were studied. All cases were examined and diagnosed with Imatron C-150 scanner using contrast media. The results of EBCT were analyzed and compared with the results of echocardiography (in 10 cases), cardiovascular angiography (in 3 cases) and surgery findings (in 1 case). Results EBCT yielded qualitative diagnosis and classification in all 10 cases. Echocardiography revealed qualitative diagnosis in 9 cases, however its classification was accordant to EBCT just!in 5 cases. The concomitant abnormalities of TA were found more with EBCT than that with echocardiography. Cardiovascular angiography was performed in 3 cases, yielding inaccurate classification 2 cases. One case of TA was operated just based on the results of echocardiography, EBCT and catheterization. Conclusion As a noninvasive method, EBCT could yield qualitative diagnosis of TA as well as classification. The results of EBCT examination combining echocardiography and catheterization could guide the operations.

Objective To evaluate the periprothetic leak in aortic valve replacement and/or mitral valve replacement on electron beam CT. Methods A retrospective study was performed in 121 patients who underwent electron beam CT between 2002 and 2004. 102 patients underwent aortic valve replacement, 12 patients underwent mitral valve replacement, and 7 patients underwent double valve replacement. Paravalvar leak was estimated by electron beam CT. Results In 121 patients after the aortic valve replacement and/or mitral valve replacement, 7 patients were diagnosed as trifle aortic paravalvar leak, 3 patients as moderate aortic paravalvar leak, and 4 patients as mass aortic paravalvar leak on electron beam CT. 1 patients were diagnosed as trifle mitral paravalvar leak on electron beam CT. Conclusion Electron beam CT is a very useful method in detecting paravalvar leak after valve replacement and for follow-up.

OBJECTIVE:To evaluate the clinical significance of electron beam computerized tomography (EBCT) in the diagnosis and differential diagnosis of pulmonary thromboembolism (PTE).METHODS:EBCT was performed before March 2004 in 114 consecutive patients with clinically suspected pulmonary vascular diseases, including 76 patients with PTE, 29 with pulmonary arteritis, 5 with primary pulmonary arterial tumor, and 4 with pulmonary arterial invasion by lung or mediastinal carcinoma. EBCT was performed using Imatron C-150 scanner with enhanced continuum volume scan (CVS). The slice thickness was 3 mm with scanning time of 0.1 s. The total amount of contrast media (Omnipaque-300) used was 50-100 ml, with flow rates of 3.0-4.0 ml/s and a delay time of 14-25 s.RESULTS:Deep venous thrombosis (DVT) was confirmed in 58 (76.3%) of the 76 patients with PTE (52 men and 24 women), 8 (10.6%) of them without apparent causes. Of the 2 356 pulmonary arterial branches observed in the 76 cases, 1,668 branches (70.8%) showed signs of PTE, with 545 branches (32.7%) of the central pulmonary arteries and 1 123 branches (67.3%) of the peripheral pulmonary arteries. Central type filling defect, such as the "railway sign" or the "drifting sign", was specific for acute thrombosis. Thrombus calcification was a specific sign of chronic PTE. Indirect signs of PTE included mosaic signs, enlargement of the right ventricle and atrium, pulmonary artery enlargement, pulmonary infarction, pericardial and/or pleural effusion, pulmonary atelectasis and pulmonary consolidation. Pulmonary arteritis (including pulmonary arterial involvement in Takayasu arteritis) was diagnosed by EBCT in 27 (93.1%) of the 29 patients, in which the diagnosis was confirmed by pulmonary angiography in 16, and clinically in 13 Patients. Of the 5 patients with primary pulmonary arterial tumor confirmed by pathology, 1 was misdiagnosed by EBCT. Of the 4 patients with pulmonary arterial involvement by lung or mediastinal carcinoma, 3 were confirmed by surgery and 1 by pulmonary angiography.CONCLUSIONS:DVT and PTE are different manifestations of one disease. The diagnostic strategy aims to detect thrombosis in the pulmonary arteries and in the deep veins of the lower limbs at the same time. EBCT is an effective and non-invasive examination in the diagnosis and differential diagnosis of PTE. By EBCT, acute and chronic thrombi can be initially differentiated, and changes in lung parenchyma, mediastinum, and the pulmonary and systemic arterial walls can be observed, and therefore more valuable radiological information can be collected for clinical decision-making.

Objective:To discuss the clinical value of electron beam tomography( EBCT) in evaluation of thrombolysis and anticoagula-tion efficacy during middle and long-term follow-up of pulmonary embolism (PE). Methods: Sixty-three consecutive patients with diagnosed PE who received thrombolysis and anticoagulation therapy underwent EBVT before and after therapy. EBCT was performed using Imatron C-150 scanner with enhanced continuum volume scan (CVS). The slice thickness was 3 mm with scan time of 0. 1 s. Analysis of EBCT features for PE were accomplished before 3 days, one week,one months and 1 months after treatment. Results: There were about 81. 2% effective rate in 51 patients who received thrombolysis and anticoagulation therapy after treatment, and about 54. 1% in 10 patients who received anticoagulation only. It had significant difference between the two groups (P0. 05). There were 13,24,11 ,and 15 patients re-exmination within 3,4-7,8-30,and more than 30 days after treatment respectively. In our group,43. 57% ,68. 2% ,85.06% ,and 100% of the center type thrombi completely disappeared within 3 ,7 , 8-30,and more than 30 days, respectively. 18. 84% , 12. 99% ,84.41% ,and 28. 93% of the mural type thrombi disappeared within 3,7,8-30,and more than 30 days,respectively. 22.45% ,30.52% ,68.66% ,and 23.28% of the occlusion type thrombi disappear in 3,7,8-30,and more than 30 days, respectively. 40. 12% of the center pulmonary arteries thrombus completely disappeared after therapy. The dissolution rate in left pulmonary arteries was higher than in right pulmonary arteries. The right ventricle cardiac function was significantly improved after therapy. The ejection fraction of the right ventricle was increased from 0. 32± 0. 11 to 0. 45±0. 10(P 0. 01). The diameter of the main pulmonary arteries was decreased from 34. 0±5.3 mm to 32. 2 ±5. 8 mm(P0.01). Conclusions: EBCT is an objective, non-invasive, and accurate method to evaluate the effect of the treatment and follow-up of PE. It had a significant short-term beneficial effect for the center type of thrombi,and a middle or long-term benefit for the mural and occlusion type of thrombi. It can be used to evaluate heart function quantificativelly and changes of complications before and after the treatment of PE.

患者男,35岁.入我院前2 d无明显诱因突发胸背部撕裂样疼痛,当时无大汗淋漓、胸闷气短或恶心呕吐.当地医院诊为冠心病,急诊行冠状动脉造影未发现冠状动脉异常改变,为进一步诊治入我院急诊科.

Ovbective To evaluate the role of electron beam computed tomography (EBCT) in diagnosis of anomalous pulmonary venous connection. Methods Retrospective analysis on 20 cases diagnosed as anomalous pulmonary venous connection by EBCT. The slice thickness and scan time was 1.5～3mm and 100ms respectively. 3～4ml/s non-ionic contrast medium was injected. Three-dimensional reconstruction of EBCT images was carried out in all cases with special workstation. Meanwhile,ultrasound echocardiography was performed on all patients and conventional cardiovascular angiography was performed on 10 patients as control. 14 cases were operated. Results (1) 4 patients with total anomalous pulmonary venous connection and 16 patients with partial pulmonary venous connection were diagnosed by EBCT preoperatively. (2) Compared with the findings from operations (14 cases),CT results (14 cases) corresponded well in 13 cases and corresponded partially in other 1 case. Meanwhile,ultrasound echocardiography (14 cases) only corresponded partially in 2 case and suggested suspected APVC (without any exact number and connective location of APVC were mentioned) in other 8 cases. Cardiovascular angiography was performed in 6 of 14 cases and APVC was found in 4 of them. (3) In 6 non-operation cases,four underwent conventional cardiovascular angiography. APVC were diagnosed in 2 only of these 4 cases. Meanwhile,the diagnoses of these 6 cases were all confirmed by CT ultrasound,echocardiography didn't yield positive findings of APVC. Conclusion EBCT might be significantly superior to UCG and angiography in the detection of anomalous pulmonary venous connection. According to our experience,EBCT with 3-D reconstruction was a noninvasive,effective method in the diagnosis of APVC.

肺动脉血栓栓塞症(PTE)的临床症状、体征具有相当的不确定性,但如果临床医生对PTE有较强的诊断意识,善于进行识别,结合临床症状、体征,并合理安排进一步的影像学检查可以协助明确诊断.胸部X线平片常常是首选的初筛检查手段,多有异常表现,但缺乏特异性.肺动脉造影目前仍为PTE诊断的"金标准"与参比方法.需注意该检查具有侵入性,费用较高,而且有时其征象亦难于解释.随着无创检查技术如CT检查手段的日臻成熟,多数情况下已可明确诊断,故对肺动脉造影的临床需求已逐渐减少.

目的探讨电子束CT(EBCT)诊断先天性主动脉瓣下隔膜型狭窄的实用价值.方法对EBCT造影诊断为先天性主动脉瓣下隔膜型狭窄的4例患者进行回顾性分析研究,全部病例均经普通X线、超声心动图检查,1例行心血管造影,2例经手术及病理证实.EBCT检查采用心电门控单层连续容积扫描和心脏长、短轴面电影扫描.结果 4例先天性主动脉瓣下隔膜型狭窄患者的EBCT图像均清晰显示出主动脉瓣下隔膜状的负性充盈征象.1例合并镜面右位心、主动脉瓣关闭不全,1例合并动脉导管未闭、房间隔缺损和主动脉瓣、二尖瓣病变,1例合并有室间隔缺损、右位主动脉弓(Ⅱ型),1例合并有主动脉瓣、二尖瓣关闭不全.结论 EBCT对先天性主动脉瓣下隔膜型狭窄及并发的心血管畸形可以获得准确的病理解剖诊断,能满足临床诊断和手术治疗的要求,在左室流出道局部细节的显示上甚至优于常规的心血管造影.在术后随诊观察方面可取代心血管造影.

目的评价电子束CT(EBCT)诊断先天性一侧肺动脉缺如的价值.方法对经平片、超声心动图检查后拟诊为肺血管疾病或原发性肺动脉高压的患者行EBCT检查,EBCT诊断先天性一侧肺动脉缺如的11例患者入选,并与超声心动图、核素通气灌注扫描、心血管造影的检查结果作进一步的比较及评估. 结果单发一侧肺动脉缺如4例,均为女性成年人.合并多发心血管畸形7例,其中合并复杂畸形3例,均为男性儿童和左肺动脉缺如;合并单发心血管畸形4例,其中3例为右肺动脉缺如. 结论 (1)儿童时期明确诊断的一侧肺动脉缺如多合并有心血管畸形,且左肺动脉缺如多见,成年人明确诊断的单发一侧肺动脉缺如多为右肺动脉缺如.(2)EBCT对先天性一侧肺动脉缺如的诊断有较高的实用价值,较之多普勒超声更为准确,与心血管造影各具独特优势,但EBCT为无创检查是其特点.

患者男,23岁.因出现活动后左胸痛1个月就诊,平时易疲乏、感冒.体检:发育可,心率80次/min,律齐,未闻及杂音,双肺未见异常,双下肢不肿.既往史无特殊.心电图示左室高电压.

Objective To evaluate the role of electron-beam CT (EBCT)in the diagnosis of patients with congenital coronary artery anomalies. Methods Twenty patients with angiocardiography and (or) operation outcomes, and diagnosed as congenital coronary artery anomalies by means of EBCT were analyzed retrospectively. 16 patients had angiocardiographic results. The 13 male and 7 female patients ranged in age from 5 months to 70 years (median age was 15.5 years). Continuous volume scan (CVS) was performed on 1 patient, enhanced single slice mode (SSM) were done on 19 patients (95%) including one adding both plain SSM and cine study, and the other adding cine study. Results EBCT suggested signs of congenital coronary artery anomalies and made correct diagnosis in 19 patients, including 5 patients with anomalous origin and course, 6 patients with single coronary artery and 8 patients with coronary artery fistula. The correct diagnostic rate of EBCT was 19/20, while that of angiocardiography was 15/16. In the Chi square test, χ2=0.32, P>0.05, so that there wasn′t significant difference between them. Conclusion Because of its remarkable advantage in demonstrating origin, course, and drainage sites of coronary artery anomalies, EBCT is an excellent noninvasive method in the diagnosis of coronary artery anomalies.

Objective　To evaluate the clinical value of EBCT in the diagnosis of aorto-arteritis (Takayasu′s disease) involving ascending aorta and aortic valve. Methods　EBCT was carried out by Imatron 150-XP system using contrast enhancement (non-ionic contrast media 300 mg I/ml) in 25 patients with aorto-arteritis during the period from Apr, 1996 to Sept, 1999. Among the series of 25 cases, ascending aorta and aortic valve were involved in 17 patients (14 females, 3 males). The age ranged from 11 to 58 years with mean age of (34±13) years. ECG gated single slice mode (SSM) was performed with slice thickness of 3 mm and scanning time of 0.1 s; continues volume scanning (CVS) was performed with slice thickness of 3 mm and scanning time of 0.1 s. The EBCT features of ascending aorta and aortic valve were analyzed in the 17 cases with aorto-arteritis. Four patients of these cases had severe aortic insufficiency and underwent operation of aortic valve replacement. Two years later, circumvalve leak occurred in two of these four cases and relived with aortic valve replacement again. Results　EBCT image showed the thickening of ascending aortic wall in all 17 cases, and all the lesions extended to the aortic valve. EBCT features of wall-thickening appeared as a concentric wall thickening or double density ring in 10 patients with active disease and low-density ring in 7 patients with inactive disease. 11 of these patients showed ascending aortic dilation with aortic valve regurgitation. Conclusion　Wall-thickening of aorta was the basic feature in EBCT images. According to our study, aorto-arteritis (Takayasu′s disease) involving ascending aorta can also involve aortic valve and resulte in aortic valve regurgitation. Active stage of aorto-arteritis was the contraindication of surgery therapy. EBCT was an important method for the diagnosis of aorto-arteritis (Takayasu′s arteritis) and the stage of aorto-arteritis can be reflected by EBCT.

肺栓塞的早期无创性诊断对尽早进行溶栓治疗、有效降低死亡率具有重要意义［1］。本研究探讨了肺通气/灌注(V/Q)显像与电子束CT(EBCT)肺血管增强造影2种诊断技术在肺栓塞定性和定位诊断中的作用,为正确评价和运用这2种无创性影像技术提供依据。 资料与方法 50例患者,男36例,女14例,平均年龄48岁。均行V/Q显像和EBCT肺血管增强造影。分为3组,A组27例,有典型的临床表现,经溶栓或抗凝治疗均明显有效;B组13例,临床分别诊断为冠心病、肺气肿、先天性心脏病左向右分流和心律失常,均不支持肺栓塞诊断;C组10例,均同时行肺动脉造影,以作对照。

目的:探讨电子束CT(EBCT)在心脏良性非粘液瘤性肿瘤诊断中的价值.方法:对1995-07～1999-02,经EBCT检查并手术、病理证实的7例心脏良性非粘液瘤性肿瘤的EBCT、超声心动图结果与手术、病理所见进行回顾性分析.7个病例,男性4例(57.1%),女性3例(42.9%),年龄从5个月至42岁,平均21.6岁.所有病例同时行单层增强和电影序列.结果:7例心脏非粘液性良性肿瘤,包括2例浸润性脂肪瘤,2例纤维瘤,1例横纹肌瘤,1例淋巴管瘤,1例间皮瘤,EBCT不但能够明确肿瘤的位置、附着、大小、范围、运动,而且以优良的密度分辨率,在6个病例显示肿瘤病理学特征,提示正确的病理学定性诊断,准确性为85.7%;2个病例术后提示肺不张与胸腔积液.同组病例中,超声心动图无1例做出正确组织病理学定性.结论:EBCT具有优良的时间、空间和密度分辨率,在对超声心动图难以准确定性的良性非粘液瘤性肿瘤的诊断中具一定优势,同时可展示邻近病变情况.

目的探讨心房粘液瘤的电子束CT(EBCT)征象和诊断价值.材料与方法对9例手术、病理证实的心房粘液瘤病例的EBCT所见进行回顾性分析.9例患者,男5例,女4例.年龄31～66岁,平均54岁.7例同时行单层增强序列(contrast SSM)和横断电影序列(movie study),1例行单层平扫(plain SSM),1例行单层增强.结果 EBCT提示7例(77.8%)瘤体位于左心房,2例(22.2%)位于右心房.行增强检查的8例,肿瘤最大径1.5～9.5cm,平均5.3cm,6例(75%)呈分叶状.肿瘤密度不均,5例(55.6%)可见钙化;瘤体均附着于房间隔,随心动周期规律性运动.EBCT征象与手术、病理结果吻合.结论中老年患者以胸闷气促来诊,心前区闻及舒张期、收缩期或双期杂音,EBCT显示心房内附着于房间隔的分叶状密度不均肿块,含或不含钙化,随心动周期规律运动,应首先考虑心房粘液瘤.

目的评价电子束ＣＴ（ＥＢＣＴ）在诊断肺动脉栓塞（ｐｕｌｍｏｎａｒｙｅｍｂｏｌｉｓｍ，ＰＥ）中的作用。方法对２０例肺动脉栓塞患者进行回顾性分析，年龄２８～７８岁。应用ＩｍａｔｒｏｎＣ１５０ＥＢＣＴ机，连续容积扫描（ＣＶＳ）或单层序列扫描（ＳＳＭ），层厚３ｍｍ或６ｍｍ（以３ｍｍ为主），扫描时间０．１秒，造影剂流速约２．８～３．３ｍｌ／ｓ，造影剂总量约４５～９０ｍｌ，扫描延迟时间１０～２０秒。结果对２０例４４２支血管进行分析，２５５支发生肺动脉栓塞（５７．７％）。４７．５％肺叶以上动脉（主肺动脉、左右肺动脉主干及双侧中间段动脉）、６３．３％肺叶动脉及５９．７％肺段动脉受累。肺动脉栓塞的ＣＴ形态：（１）直接征象：①腔内充盈缺损，包括部分充盈缺损（７６．９％）、附壁充盈缺损（９．２％）、完全堵塞（９．６％）及轨道征（４．３％）。其中前三者为慢性肺动脉栓塞的征象，而轨道征则提示急性肺动脉栓塞，对临床治疗有重要意义，动态显示还可见栓子在腔内活动。②肺动脉纤细，腔内灌注减低、不均匀（纵隔窗）。（２）间接征象：部分病例可见“马赛克”征（肺窗）及肺梗死灶。其他还包括肺纹理稀疏、右心室增大及右心功能下降等。结论ＥＢＣＴ是一种无