计算机断层扫描在二尖瓣区心内占位性病变鉴别诊断中的作用：临床病例系列

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通过超声心动图识别的二尖瓣环区心内占位性病变的鉴别诊断可能具有挑战性。其解决方案通常需要采用多模式方法。通常这种形成的性质与二尖瓣的瓣膜下钙化有关。诊断的最大困难是其相当罕见的变体 — 干酪样形式。在其他诊断方法，特别是超声心动图结果不明确的情况下，本系列病例突出了计算机断层扫描在二尖瓣环瓣下钙化的检测和定性方面的重要性和临床意义。本文旨在提高专家对二尖瓣瓣下环干酪样钙化在不同成像模式下的典型体征的认识。同时，还特别关注鉴别诊断系列的构建，确定能够区分二尖瓣瓣下环干酪样钙化与该定位中的其他病理状况的特征。医生有必要了解二尖瓣区域存在的这种变化，以便预测可能出现的相关并发症，并制定治疗策略，这在某些情况下有助于避免不必要的手术干预。

作者简介

Maria V. Onoyko

Lomonosov Moscow State University

编辑信件的主要联系方式.
Email: onoykomary@gmail.com
ORCID iD: 0000-0002-7727-3360
SPIN 代码: 6380-7495

MD

俄罗斯联邦, Moscow

Elena A. Mershina

Lomonosov Moscow State University

Email: elena_mershina@mail.ru
ORCID iD: 0000-0002-1266-4926
SPIN 代码: 6897-9641

MD, Cand. Sci. (Medicine), Assistant Professor

俄罗斯联邦, Moscow

Amalia A. Arakelyants

Lomonosov Moscow State University; Sechenov First Moscow State Medical University

Email: nxrrimma@mail.ru
ORCID iD: 0000-0002-1243-2471
SPIN 代码: 4990-6008

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Moscow

Valentin E. Sinitsyn

Lomonosov Moscow State University

Email: vsini@mail.ru
ORCID iD: 0000-0002-5649-2193
SPIN 代码: 8449-6590

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Moscow

参考

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2. 1. Transthoracic echocardiography, B-mode — clinical case 1: a–c — volumetric formation in the posterior flap of the mitral valve; d — signs of mitral regurgitation during Dopplerography; a — parasternal access, long axis of the left ventricle; b — apical four-chamber position; c — parasternal access, short axis on mitral valve level; d — apical two-chamber position.

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3. Fig. 2. Computed tomography of the heart with ECG synchronization - clinical case 1: a—c – with contrast enhancement in the "bone window"; d — without contrast in the "soft tissue window"; subcarvular caseous calcification of the posterior mitral valve: a — three—chamber view; b —four-chamber view; c — image along the short axis at the level of the mitral valve; d is the axial projection.

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4. 3. Computed tomography of the heart with ECG synchronization - clinical case 2: a—c – with contrast enhancement in the "bone window"; d — without contrast in the "soft tissue window"; subcarvular caseous calcification of the posterior mitral valve leaflet: a — four—chamber view; b — two-chamber view along the long axis of the left ventricle; c is the image along the short axis at the level of the mitral valve; d is the axial projection.

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5. 4. Clinical case 3: a–c — magnetic resonance imaging of the heart; d — computed tomography of the heart with ECG synchronization; green arrows - formation in the posterior flap of the mitral valve in a patient with transmural postinfarction scar in the lower wall of the left ventricle at the level of the basal and middle sections (red arrows); a–b — SSFP (Steady-State Free Precession) sequences, two-chamber view along the long axis of the left ventricle, without contrast; c — T1-weighted image with suppression of the signal from the myocardium and delayed contrast enhancement, two-chamber view along the long axis of the left ventricle; d — axial projection, "bone window".

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