三维超声近端等速表面积法在二尖瓣狭窄及关闭不全定量中的应用

发布时间：2018-02-28 13:27

本文关键词： 超声心动图三维近端等速表面积法二尖瓣狭窄 Nyquist速度极限三维近端等速表面积法二尖瓣反流定量技术　出处：《华中科技大学》2014年博士论文　论文类型：学位论文

【摘要】：目的探讨三维近端等速表面积(Three-dimensional proximal isovelocity surface area,3D PISA)法测量二尖瓣狭窄患者二尖瓣口面积(Mitral valve Area, MVA)的准确性,并探讨应用3D PISA法测量MVA的最佳Nyquist速度极限。方法对20例二尖瓣狭窄(Mitral stenosis,MS)患者分别采用胸骨旁切面直接勾勒法、二维近端等速表面积(Two-dimensional proximal isovelocity surface area,2D PISA)法及3D PISA法测量MVA,以胸骨旁切面直接勾勒法测量的MVA为参照标准,分析不同的Nyquist速度极限下,上述3种方法测量MVA的异同。结果在不同的Nyquist速度极限(32cm/s、26cm/s、19cm/s)时,3D PISA法测量MVA均不同；随着Nyquist速度极限的增加,胸骨旁切面直接勾勒法与3D PISA法测量的MVA差值逐渐增加,在Nyquist速度极限为19cm/s时：①胸骨旁切面直接勾勒法与3D PISA法、2D PISA法测量的MVA差值均最小；②与2D PISA法测量的MVA相比,3D PISA法测量的MVA与胸骨旁切面直接勾勒法测量的MVA更接近。③2D PISA法、3D PISA法测量的MVA与胸骨旁切面直接勾勒法测量的MVA均有相关性,相关系数分别为(r=0.88,r=0.98)。④与2D PISA法测量MVA相比,3D PISA法与二维胸骨旁切面直接勾勒法测得的MVA有更好的一致性。结论在Nyquist速度极限为19cm/s时,3D PISA法测量的二尖瓣狭窄患者MVA与胸骨旁短轴切面直接勾勒法测量的MVA差值最小；3D PISA法与二维胸骨旁切面直接勾勒法测得的MVA有更好的一致性目的：探讨三维近端等速表面积(Three-dimensional proximal isovelocity surface area,3D PISA)法定量二尖瓣反流的准确性,并探讨应用3D PISA法定量二尖瓣反流(mitral regurgitation, MR)的最佳Nyquist速度极限。方法：选取24例二尖瓣反流患者,其中12例二尖瓣脱垂,8例风湿性心脏病及4例功能性反流的患者作为研究对象,比较经胸二维近端等速表面积(Two-dimensional proximal isovelocity surface area,2D PISA)法及3D PISA法测量二尖瓣有效反流口面积,流量差值法计算的二尖瓣有效反流口面积作为比较的参考。结果：当选择不同Nyquist速度极限(55cm/s,43cm/s,37cm/s,28cm/s,18cm/s),3D PISA法测量的二尖瓣有效反流口面积不同,当Nyquist速度极限从28cm/s逐渐增加时,3DPISA法测量的二尖瓣反流有效反流口面积与参照方法测量的结果差值逐渐增加,在选择的Nyquist速度极限为28cm/s时：流量差值法计算的有效反流口面积与3D PISA法计算的有效反流口面积差值最小为0.06±0.06cm2,其差值百分比为9±8%；3D PISA法及2D PISA法测得的二尖瓣有效反流口的面积与流量差值法计算的二尖瓣有效反流口面积均有相关性,相关系数分别为0.96、0.90,采用三维PISA法测量的二尖瓣有效反流口面积与流量差值法测量的结果具有较高的一致性。结论：选择的Nyquist速度极限为28cm/s,3D PISA法较2D PISA法能够更加准确地定量二尖瓣关闭不全患者的反流,同时三维PISA法操作简便,可能成为临床评价二尖瓣反流量的新方法。
[Abstract]:Objective to investigate the accuracy of three-dimensional proximal isovelocity surface area3 (3D PISA) method in measuring mitral valve area (MVA) in patients with mitral stenosis, and to explore the best Nyquist velocity limit of MVA by using 3D PISA method. Methods Twenty patients with mitral stenosis were examined by direct parsternal cross-sectional method, Two-dimensional proximal isovelocity surface area2D PISA-2D and 3D PISA, respectively. The MVA measured by direct parasternal section was used as the reference standard. The similarities and differences of the three methods mentioned above for MVA measurement under different Nyquist velocity limits are analyzed. Results at different Nyquist speed limits of 32 cm / s ~ 26 cm / s ~ (19 cm / s), 3D PISA was different in measuring MVA, and with the increase of Nyquist velocity limit, the difference of MVA measured by direct delineation method and 3D PISA method increased gradually. When the velocity limit of Nyquist is 19 cm / s, the MVA difference between direct drawing method and 3D PISA method / 2D PISA method is the least than that of MVA with 3D PISA method and MVA with direct delineation method with parasternal section method compared with MVA measured by 2D PISA method. There was a correlation between the MVA measured by the 3D PISA method and the MVA measured by the direct drawing method on the parasternal section of the sternum, which was close to .32D PISA method and 3D PISA method. The correlation coefficients were 0.984.Compared with 2D PISA method, the MVA measured by 3D PISA method and two-dimensional parasternal section method were in better agreement. Conclusion the MVA of mitral stenosis patients measured by 3D PISA method at Nyquist velocity limit of 19 cm / s is better than that of 2D PISA method. There is a better agreement between the MVA measured by 3D PISA method and that measured by direct drawing method of parasternal short axis section with the method of MVA difference between 3D PISA method and 2D parasternal plane direct drawing method, which is in good agreement with that obtained by the method of direct delineation of parasternal short axis section. Objective: to investigate the accuracy of three-dimensional proximal isovelocity surface 3D Pi SAA in measuring mitral regurgitation, and to explore the optimal Nyquist velocity limit of using 3D PISA to measure mitral regurgitation (MRV). Methods: 24 patients with mitral regurgitation, including 12 patients with mitral valve prolapse and 8 patients with rheumatic heart disease and 4 patients with functional regurgitation, were selected as subjects. The area of effective mitral regurgitation was measured by two-dimensional proximal isovelocity surface surface 2D Pi SAA and 3D PISA method. The effective mitral regurgitation area calculated by flow difference method was used as a reference for comparison. Results: the effective mitral regurgitation area was measured by using different Nyquist velocity limits of 55 cm / s 10 ~ 3 cm / s ~ 3 cm / s ~ (37) cm / s ~ (28) cm / s ~ (28) cm / s ~ (18) cm / s / s ~ (18) cm / s / s / 3D PISA. When the Nyquist velocity limit increased from 28 cm / s to 28 cm / s, the difference between the effective mitral regurgitation area measured by the method and the reference method was gradually increased. When the selected Nyquist velocity limit is 28 cm / s, the minimum difference between the effective backflow area calculated by the flow difference method and the effective backflow area calculated by the 3D PISA method is 0.06 卤0.06cm2, and the percentage of the difference is 9 卤8cm / s between the effective regurgitation area calculated by the flow difference method and the effective regurgitation area calculated by the 3D PISA method and the mitral valvular effectiveness measured by the 2D PISA method and the 3D PISA method. There is a correlation between the area of the regurgitation port and the area of the effective mitral valve regurgitation calculated by the flow difference method. The correlation coefficients were 0.96 and 0.90, respectively. The results of the effective mitral regurgitation area measured by three-dimensional PISA method were in good agreement with the results obtained by the flow difference method. Conclusion: the selected Nyquist velocity limit of 28 cm / s ~ 3 D PISA method is more accurate than 2D PISA method in quantifying mitral regurgitation in patients with mitral regurgitation. Meanwhile, 3D PISA method is easy to operate and may be a new method for evaluating mitral regurgitation flow.
【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R445.1;R654.2

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