右心声学造影左心声学造影心肌声学造影

L/O/G/O心脏超声造影右心声学造影1234左心声学造影心肌声学造影其他201420152017右心声学造影诊断或排除肺内或心内右向左分流相关疾病，如卵圆孔未闭（patentforamen，PFO）、肺动静脉瘘、肝肺综合征、永存左上腔静脉、术后残余分流或侧支等右心声学造影剂造影剂的注射分流量分级右心声学造影适应症1.隐源性脑卒中，TIA晕厥患者2.偏头痛特别是有先兆偏头痛患者3.减压病患者，潜水员或航天员上岗前检查4.经皮卵圆孔未闭封堵术后的检测5.怀疑肺内动静脉瘘患者6.准确评价右心大小、结构和功能卵圆孔未闭预防性封堵术中国专家共识(2017)适应证：（1）CS/TIA合并PFO，有1个或多个PFO的解剖学高危因素（2）CS/TIA合并PFO，有中～大量RLS，合并1个或多个临床高危因素（3）PFO相关脑梗死/TIA，有明确DVT或肺栓塞，不适宜抗凝治疗者（4）PFO相关脑梗死/TIA，使用抗血小板或抗凝治疗仍有复发（5）CS或外周栓塞合并PFO，有右心或植入器械表面血栓（6）年龄16岁（有明确反常栓塞证据者，年龄可适当放宽）相对适应证：（1）CS/TIA合并PFO，有下肢静脉曲张/瓣膜功能不全（2）PFO伴颅外动脉栓塞（3）正在使用华法林治疗的育龄期妇女伴PFO，中～大量RLS，有怀孕计划，既往发生过CS者左心声学造影(LVO)&心肌声学造影(MCE)1、全身血管均显影2、其他科室使用同样造影剂开展包括甲状腺、乳腺、前列腺、大血管、肝脏、肾脏、子宫等多脏器的声学造影检查声学造影剂声诺维（SonoVue）SonoVue是意大利Bracco公司生产的超声造影剂。其内充填六氟化硫气体，外包裹膦脂成分，为白色冻干粉末。使用前用5ml生理盐水稀释，摇荡20s后，成为乳白色六氟化硫微泡混悬液，其微泡平均直径2.5μm，密度为（2~5）×108个/mlSonoVue已进入我国，并且是目前唯一进口超声造影剂左心声学造影适应症1、心尖部解剖结构和功能异常的诊断2、负荷超声心动图的造影增强3、左心室心尖肥厚4、心肌梗死并发症：左心室假性室壁瘤、游离壁破裂和心肌梗死后室间隔缺损，使用造影剂可以区分假性室壁瘤和真性室壁瘤5、心肌致密化不全6、心尖血栓、心尖室壁瘤7、增强多普勒信号LVO—指南推荐Contrastechocardiographyshouldbeconsideredwhenapicalhypertrophyanddiverticula,pseudoaneurysm,myocardialrupture,non-compactionandLVthrombiaresuspectedbutnotclearlydocumentedorexcludedonnon-contrastimagesI,BContrastinjectionmaybeconsideredwhennativeimagesareinconclusiveforthediagnosisofLAAthrombusIIa，CInpatientswithacuteaorticsyndromesandinpatientsundergoingthoracicendovascularaorticrepairprocedures,contrastagentsmaybeusedtoassesstheaorticpathologyifnon-contrast2DechocardiographicandDopplerimagesaresuboptimalorambiguousIIa，CStressEchocardiographyfortheassessmentofRWMAforthedetectionofmyocardialischaemiashouldbeperformedwithcontrastagentswhentwoormorecontiguoussegmentsarenotadequatelyvisualizedatrestI,ALVO—指南推荐ContrastechocardiographyshouldbeusedwhentwoormorecontiguousLVsegmentsarenotclearlyvisualizedI,BContrast2DechocardiographyshouldbeconsideredirrespectiveofimagequalitywhenclinicalmanagementdependsonaccuratemeasurementsofLVEFsuchasmonitoringofpatientstreatedwithCardiotoxicDrugsandwhenimplantationofICDorCRTdevicesareconsideredIIa，BThenormalvaluesforEFandgradingofreducedEF(mild,moderateorsevere)butnotLVvolumespublishedintherecentASE/EACVIrecommendationscanbeusedforcontrastechocardiographyIIa，CBecauseoflimitednumberofstudies,3DcontrastechocardiographyisnotyetrecommendedIII,BLVO增强内膜显影LVO心尖肥厚LVO心尖血栓LVO排除血栓和心内膜增厚LVO—肥心LVO—鉴别诊断心尖肥厚LVO—假性室壁瘤LVO心耳血栓LVO伪心耳血栓LVO伪心耳血栓LVO主动脉夹层LVO-MCE对比MCE显影流程心肌声学造影适应症1、冠状动脉阻塞后心肌危险面积和梗塞面积2、测定冠状动脉血流储备3、评价慢性冠状动脉疾病4、评价心肌存活性5、评价冠心病疗效6、估测侧枝循环血流状态7、应激性心肌病等MCE—指南推荐InSElaboratorieswiththeavailabilityoflowMIimagingandexpertiseofthestaff,MCEshouldbeconsideredinallpatientsundergoingdobutamine,vasodilatorSEandhigh-riskpatientsundergoingphysiologicalstressforimproveddiagnosisandriskstratificationofCADbeyondwallmotionassessmentI,AMCEmayalsobeperformedtoimprovedetectionofmyocardialviabilityparticularlyindobutaminenon-responsivesegments,wherewallthicknessispreservedIIa，BTheflash-replenishmenttechniqueshouldbeusedfortheassessmentofmyocardialperfusionI,AContrastechocardiographyforperfusionmaybeusedinpatientswithcardiacmassessuspiciousofatumourtodistinguishitfromathrombuswhenCMRisnotavailableorinconclusiveIIa，CMCE—定性心肌血流MCE—定性心肌血流MCE急性心梗MCE右冠心梗PCI前与术后一周对比MCE—负荷超声心动图MCE—肺癌转移MCE—结肠癌转移MCE—嗜酸粒细胞增多症还能做啥？急性心梗声学溶栓超声造影全容积L/O/G/O