thorn
15.08.2006, 18:35
Известно, что ЧПэхоКГ позволяет избежать 4 недель антикоагулянтной терапии при фибрилляции предсердий длительностью более 48 часов (ACUTE Pilot Study). ([Ссылки могут видеть только зарегистрированные и активированные пользователи]) Однако, ЧПэхоКГ не самая приятная процедура, при которой необходима седация, что тоже не всегда радует. Существует ли альтернатива ЧПэхоКГ, например МРТ с контрастным услилением? Насколько сравнимы методики, в том числе экономически? У кого есть информация, опыт, мнение – поделитесь, плз! Я нашел тока одно небольшое исследование по этой теме:
Barkhausen J, Hunold P, Eggebrecht H, Schuler WO, Sabin GV, Erbel R, Debatin JF. AJR Am J Roentgenol. Detection and characterization of intracardiac thrombi on MR imaging.
2002 Dec;179(6):1539-44.
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Hufelandstrasse 55, D-45122 Essen, Germany.
OBJECTIVE: The aim of our study was to compare the diagnostic accuracy achieved using different MR techniques with the diagnostic accuracy achieved using transthoracic and transesophageal echocardiography to detect intracardiac thrombi. MATERIALS AND METHODS: Twenty-four patients with known or suspected intracardiac thrombi were examined using MR imaging and echocardiography. All MR examinations were performed on a 1.5-T MR scanner using dark-blood-prepared half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences, fast imaging steady-state free precession (trueFISP) cine sequences, and inversion recovery gradient-echo fast low-angle-shot (inversion recovery turbo FLASH) sequences after injection of 0.2 mmol/kg of gadolinium diethylene triamine pentaacetic acid. RESULTS: MR imaging and echocardiography revealed 12 thrombi-two in the right atrium, one in the right ventricle, three in the left atrium, and six in the left ventricle. Compared with echocardiography, MR imaging revealed three additional thrombi in the left ventricle; these thrombi were confirmed at surgery. All 15 thrombi appeared as filling defects on early contrast-enhanced inversion recovery turbo FLASH MR images. Only seven thrombi were detected on HASTE images, and 10 thrombi were seen on trueFISP images. Four thrombi showed enhancement 10-20 min after contrast material injection and were characterized as organized clots. CONCLUSION: Contrast-enhanced inversion recovery turbo FLASH sequences were superior to dark-blood-prepared HASTE and trueFISP cine MR images in revealing intracardiac thrombi. Compared with transthoracic echocardiography, MR imaging was more sensitive for the detection of left ventricular thrombi. The characterization of thrombi may be used to predict the risk of embolism, which is higher for subacute clots than for organized thrombi.
Barkhausen J, Hunold P, Eggebrecht H, Schuler WO, Sabin GV, Erbel R, Debatin JF. AJR Am J Roentgenol. Detection and characterization of intracardiac thrombi on MR imaging.
2002 Dec;179(6):1539-44.
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Hufelandstrasse 55, D-45122 Essen, Germany.
OBJECTIVE: The aim of our study was to compare the diagnostic accuracy achieved using different MR techniques with the diagnostic accuracy achieved using transthoracic and transesophageal echocardiography to detect intracardiac thrombi. MATERIALS AND METHODS: Twenty-four patients with known or suspected intracardiac thrombi were examined using MR imaging and echocardiography. All MR examinations were performed on a 1.5-T MR scanner using dark-blood-prepared half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences, fast imaging steady-state free precession (trueFISP) cine sequences, and inversion recovery gradient-echo fast low-angle-shot (inversion recovery turbo FLASH) sequences after injection of 0.2 mmol/kg of gadolinium diethylene triamine pentaacetic acid. RESULTS: MR imaging and echocardiography revealed 12 thrombi-two in the right atrium, one in the right ventricle, three in the left atrium, and six in the left ventricle. Compared with echocardiography, MR imaging revealed three additional thrombi in the left ventricle; these thrombi were confirmed at surgery. All 15 thrombi appeared as filling defects on early contrast-enhanced inversion recovery turbo FLASH MR images. Only seven thrombi were detected on HASTE images, and 10 thrombi were seen on trueFISP images. Four thrombi showed enhancement 10-20 min after contrast material injection and were characterized as organized clots. CONCLUSION: Contrast-enhanced inversion recovery turbo FLASH sequences were superior to dark-blood-prepared HASTE and trueFISP cine MR images in revealing intracardiac thrombi. Compared with transthoracic echocardiography, MR imaging was more sensitive for the detection of left ventricular thrombi. The characterization of thrombi may be used to predict the risk of embolism, which is higher for subacute clots than for organized thrombi.