目的:探讨永存第五对主动脉弓(PFAA)的解剖学特征,评价几种常用影像学方法的诊断价值.方法:回顾分析2010年10月至2019年9月中国医学科学院阜外医院诊断的8例PFAA患者,收集其临床、影像及手术资料,总结其解剖及影像学特征、类型和伴发畸形情况,对比X线胸片、超声心动图、CT血管造影(CTA)检查结果.结果:本组8例患者中,7例的PFAA与主动脉弓位于同侧、不形成血管环结构,4例的PFAA伴发狭窄及闭锁,8例PFAA均起自升主动脉远端无名动脉开口旁或对侧,6例止于降主动脉近端,2例止于一侧肺动脉干;8例患者均合并心血管畸形,包括室间隔缺损、主动脉弓离断、法乐四联症、动脉导管未闭、共同动脉干、右心室双出口、肺动脉闭锁,以室间隔缺损和主动脉弓离断最常见;CTA对8例PFAA及伴发的其他心血管畸形患者均做出准确诊断,其准确度优于超声心动图及造影结果.结论:PFAA的解剖特征为:起自升主动脉远端无名动脉开口旁或对侧、止于降主动脉近端或一侧肺动脉干,呈弓状血管结构,部分伴发狭窄及闭锁,常合并其他心血管畸形.CTA为PFAA首选的无创检查方法,可部分替代或补充血管造影结果.

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 clinical value of electron beam computed tomography(EBCT)in diagnosis and surgical treatment of chronic thromboembolic pulmonary hypertension.Methods:From December 2003 to May 2006,eight patients with chronic pulmonary thromboembolism accept EBCT examination before and after surgical pulmonary thromboendarterectomy(PTE).Clinical and features of EBCT imaging were analyzed.Results:Before operation,in 8 patients EBCT study showed 7 vessels of pulmonary artery trunk with mural filling defect,28 vessels of lobar and segmental artery with partial filling defect,6 vessels with total occlusion,2 patients with mosaic sign in lung window.After operation(1~2 weeks later),EBCT study showed total occlusion in 6 patients,mural filling defect of 7 vessels and partial filling defect of 22 vessels all disappeared.Conclusion:EBCT is an effective method in diagnosis and treatment of chronic thromboembolic pulmonary hypertension.It can play a significant role in treating and follow-up of PTE.

Objective To evaluate the application value of X-ray,echocardiogram,pulmonary perfusion scintigraphy,EBCT,Magnetic resonance Pulmonary angiography in diagnosis of PTE.Methods Twenty-five consecutive patients clinically diagnosed of having PTE were examined from july 2003 through March 2004. Patients underwent X-ray chest plain film, echoeardiogram, electronic beam computed tomographie (EBCT)angiography,ventilation-perfusion (V-P)seintigraphy,Magnetic resonance Pulmonary angiography (MRPA)and puhnonary angiography according to a strict diagnostic protocol.Two of the independent readers reviewed the pulmonary angiography and record all of the lobe and segmental involved in PTE and compared with other image method.Results Pulmonary angiography:all of the patients success underwent the technique,the pulmonary artery branch with PTE was in 556 of 775 branches (71.7%). Chest radiography had hints of diagnosis in 12 of 25 patients.Nine patients diagnosed with echocardiogram. Right heart enlargement was in 21,and pulmonary hypertension in 18.V-P scintigraphy revealed 247 segmental involved with PTE of 500 (52.0% ),and the sensitivity was 64.66% compare with the pulmonary angiography.There were 523 pulmonary branches involved PTE with EBCT pulmonary angiograpy of 775 branches,and the sensitivity was 94.06%.MRPA: 8 of 10 patients succeed in the technique, 155 branches of 248 were detected with PTE(62.5% ),the sensitivity was 81.29%.Conclusions EBCT is a high sensitivity method in diagnosis of PTE.Chest radiography and echocardiogram are the first-line modality of PTE.V-P scintigrapby is the valid compensation in diagnosis subsegmental pulmonary artery with PTE when EBCT miss diagnosis.Gd-CE-MRPA may be the second-line modality in diagnosis of PTE.

OBJECTIVE:To observe the clinical and magnetic resonance imaging (MRI) characterizations in patients with isolated left ventricular noncompaction (LVNC).METHODS:All patients were examined by MRI. The LV was divided into 9 segments for localizing non compacted segments. A new value, C/VS, was introduced to assess the degree of non compacted segments.RESULTS:A total of 31 patients was diagnosed as LVNC (23 males; 39.9 +/- 15.7 years). Palpitations presented in 74% of patients, abnormal EKG found in 93.5% of patients, 33.3% segments were affected and most commonly in the mid-ventricular and apical segments, 84% of patients had > or = 2 affected segments. Right ventricle was affected in 2 patients. Left ventricular thrombi were detected in 3 patients. LVEF was 37.2% +/- 16.5% (14% - 70%), N/C was 3.6 +/- 1.4 (2.2 - 9.2) and C/VS was 0.43 +/- 0.11 (0.27 - 0.69).CONCLUSIONS:Cardiac MRI allows accurate LVNC assessment.

电子束CT结合前置心电图触发提高了时间分辨力,使心脏成像取得进展.多年来作为主要无创性技术应用心脏钙化积分及无创性冠状动脉造影.多层螺旋CT(MSCT)在大容积覆盖,高空间分辨力以及后置心电图门控技术等方面具有优越性.两种技术在冠状动脉钙化积分、冠状动脉造影以及心室和瓣膜功能分析等方面的比较,表明MSCT图像质量更具优越性,已成为无创性心脏成像的首选检验方法,尤其对冠状动脉的评价.

Objective To evaluate the valve of EBCT in diagnosis of aortic-pulmonary septal defect (APSD). Methods There were 7 cases of APSD with age from 1-13 ages. In the all of 7 patients, the imaging studies included; x-ray plain film, ultrasound echocardiography and EBCT. ECG gating EBCT angiography were performed with 270 mg I/ml non-ionic contrast media and the slice thickness was 1.5-3.0 mm. Among them, 3 cases had cardiovascular angiography and 2 cases underwent surgical operation. Results The diagnosis of APSD were obtained in all cases by EBCT, out of which, 2 patients were proved ty surgical operation, 3 cases were proved by angiocardiography. Only 2 cases with APSD were correctly diagnosed by echocardiography. Four cases with anomalous origin of right pulmonary artery and interruption of aortic arch were clearly detected by EBCT. Two cases with anomalous origin of right pulmonary artery and 2 cases with interruption of aortic arch were missed by echocardiography. One patient with patent ductus arteriosus was missed by angiocardiography. Conclusion APSD is an uncommon congenital heart disease. Its clinical diagnosis relies on imaging examinations, including X-ray plain film, ultrasound echocardiography, cardiovascular angiography and EBCT. According to this study, as a noninvasive method, EBCT has significant value in diagnosis of APSD and associated anomalies.

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.

目的:分析总结主动脉壁内血肿的临床特点、诊断及治疗,以便早期正确处理,降低病死率.方法：回顾性分析连续21例经电子束计算机断层摄影术(EBT)确诊的主动脉壁内血肿住院患者的临床资料,并进行随访.结果：21例患者均有突发持续胸背痛,高血压18例,一半以上患者有血白细胞、中性粒细胞、血沉、C-反应蛋白升高,部分患者X线胸片、经胸超声心动图可见非特异性征象,而EBT均可见特异性征象.其中Stanford A型4例,Stanford B型17例.除1例Stanford A型行外科手术外,均给予降压及负性肌力药物治疗,病情好转出院.共随访到17例,1例Stanford A型死亡,1例Stanford A型进展为典型主动脉夹层,4例Stanford B型血肿吸好转,其余11例无症状存活,但未复查EBT.结论：综合分析临床资料,可提高对主动脉壁内血肿的早期识别,有助于选择合适的治疗方法并改善预后.

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.