應(yīng)變超聲心動(dòng)圖

1、2D & 4D StrainMingbo.chenCustomer Education & Training U/S-China超聲心動(dòng)圖的臨床價(jià)值Title or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.2診斷治療監(jiān)測(cè)臨床實(shí)驗(yàn)決定性診斷 結(jié)構(gòu)性心臟病輔助診斷 冠心病介入治療手術(shù)治療臨床治療急救中間指標(biāo)測(cè)量監(jiān)測(cè)隨訪工具See tutorial regarding confidentiality disclosures.心肌層的排列心室肌較厚，分淺、中、深三層：淺層斜行，在心尖捻轉(zhuǎn)形

2、成心渦，然后進(jìn)入深部移行為縱行的深層肌，形成肉柱和乳頭肌，中層呈環(huán)形，為各室所固有，左心室環(huán)形肌特別發(fā)達(dá)。Title or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.4See tutorial regarding confidentiality disclosures.物體運(yùn)動(dòng)方式Title or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.6a：拉伸 b:擠壓 c:剪切 d

3、:彎曲 e:扭轉(zhuǎn)心肌的收縮運(yùn)動(dòng)縱向運(yùn)動(dòng)（長(zhǎng)軸方向Longitudinal）收縮期二尖瓣環(huán)向心尖方向運(yùn)動(dòng)，心肌纖維縮短徑向運(yùn)動(dòng)（短軸方向Radial）收縮期左心室向心運(yùn)動(dòng)，左心室壁增厚環(huán)向運(yùn)動(dòng)（圓周方向Circumferential）收縮期左心室圓周環(huán)形縮短Title or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.7物理學(xué)參數(shù)速度位移應(yīng)變應(yīng)變率扭轉(zhuǎn)參數(shù)Title or Job Number | XX Month 201XSee tutorial regarding confident

4、iality disclosures.8斑點(diǎn)追蹤理論1978年Burckhardt首次描述了超聲圖像中的斑點(diǎn)回聲，并提出其是由低于分辨力的細(xì)微結(jié)構(gòu)的散射信號(hào)互相干擾而形成的，在二維圖像中顯示為亮或暗的點(diǎn)。1982年Robinson首次報(bào)道聲學(xué)斑點(diǎn)的運(yùn)動(dòng)與組織密切相關(guān)，斑點(diǎn)代表了組織內(nèi)各體元的運(yùn)動(dòng)，為分析運(yùn)動(dòng)提供了依據(jù) 。1987年Trahey率先將超聲斑點(diǎn)追蹤技術(shù)引入醫(yī)學(xué)領(lǐng)域，采用二維斑點(diǎn)模型來測(cè)量血流及軟組織運(yùn)動(dòng)。1989年Mailloux將斑點(diǎn)追蹤技術(shù)用于評(píng)價(jià)心肌的形變運(yùn)動(dòng)。Title or Job Number | XX Month 201XSee tutorial regarding

5、confidentiality disclosures.9斑點(diǎn)追蹤原理斑點(diǎn)也稱為散斑，它是人體組織內(nèi)部大量隨機(jī)分布的。直徑遠(yuǎn)小于超聲波長(zhǎng)的散射粒子。該斑點(diǎn)不是心肌細(xì)胞本身，而是經(jīng)過超聲散射和相干反射和折射形成的物理影像。心肌圖像由各個(gè)像素集合組成的，這些亮斑大小20-40個(gè)像素。心肌斑點(diǎn)信號(hào)具有唯一性和穩(wěn)定性。Title or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.10心肌的運(yùn)動(dòng)Title or Job Number | XX Month 201XSee tutorial reg

6、arding confidentiality disclosures.11心肌的運(yùn)動(dòng)IVCTitle or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.12心肌的運(yùn)動(dòng)EjectionTitle or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.13心肌的運(yùn)動(dòng)IVRTitle or Job Number | XX Month 201XSee tutorial regarding

7、confidentiality disclosures.14心肌的運(yùn)動(dòng)ETitle or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.15心肌的運(yùn)動(dòng)DTitle or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.16心肌的運(yùn)動(dòng)ATitle or Job Number | XX Month 201XSee tutorial regarding confidentiality di

8、sclosures.17斑點(diǎn)信號(hào)的追蹤Title or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.18Old locationdXNew locationXdYY0逐幀追蹤高亮度斑點(diǎn)1)比較斑點(diǎn)的新位置和其上一幀的位置2)記錄下一幀新位置 Time Line以自然聲學(xué)“標(biāo)記”來描記心肌運(yùn)動(dòng)Old location應(yīng)變的原理Title or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosu

9、res.19L0LStrain () = (L-L0)/ L0 心肌的收縮運(yùn)動(dòng)Title or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.20縱向運(yùn)動(dòng)徑向運(yùn)動(dòng)環(huán)向運(yùn)動(dòng)心肌收縮運(yùn)動(dòng)Title or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.21縱向應(yīng)變徑向應(yīng)變環(huán)向應(yīng)變縱向應(yīng)變Title or Job Number | XX Month 201XSee tutorial reg

10、arding confidentiality disclosures.22射血前期心內(nèi)膜下心肌的縮短同時(shí)伴心外膜下心肌纖維的伸展。心室射血期心內(nèi)膜下心肌和心外膜下心肌層同時(shí)縮短。射血后期心外膜下心肌纖維伸展伴心內(nèi)膜下心肌纖維的縮短環(huán)向應(yīng)變Title or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.23射血前期心內(nèi)膜下心肌的縮短同時(shí)伴心外膜下心肌纖維的伸展。心室射血期心內(nèi)膜下心肌和心外膜下心肌層同時(shí)縮短。環(huán)向應(yīng)變大于縱向應(yīng)變。射血后期心外膜下心肌纖維伸展伴心內(nèi)膜下心肌纖維的縮短徑向應(yīng)變

11、Title or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.24連續(xù)的機(jī)械力學(xué)提示縱向和環(huán)向的縮短會(huì)導(dǎo)致心肌在徑向上增厚。由于剪切力朝心內(nèi)膜下心肌的方向是逐漸增加的，因此心內(nèi)膜下心肌的增厚應(yīng)變高于心外膜下心肌。扭轉(zhuǎn)參數(shù)旋轉(zhuǎn)（Rotation）心肌沿左室長(zhǎng)軸的旋轉(zhuǎn)運(yùn)動(dòng)。代表旋轉(zhuǎn)的位移大小，以度為單位。正常情況下，心室基底和心尖旋轉(zhuǎn)方向相反。擰轉(zhuǎn)（Twist）心尖-心底旋轉(zhuǎn)角度的絕對(duì)差值用于表示LV凈擰轉(zhuǎn)（net twist）的角度（單位也是度）。扭轉(zhuǎn)（Torsion）以左室長(zhǎng)軸為中心，

12、從心底-至心尖旋轉(zhuǎn)角度的梯度，單位為度/厘米。Title or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.25心室的旋轉(zhuǎn)Title or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.26心尖短軸切面旋轉(zhuǎn) 二尖瓣短軸切面旋轉(zhuǎn) 心室的擰轉(zhuǎn)Title or Job Number | XX Month 201XSee tutorial regarding confidentialit

13、y disclosures.27Apical rotationBasal rotationTwist擰轉(zhuǎn) (Twist) = 心尖 - 心底 (旋轉(zhuǎn)角度) 心室的扭轉(zhuǎn)扭轉(zhuǎn)=(心尖-心底) /扭轉(zhuǎn)距離Title or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.28扭轉(zhuǎn)（torsion）是指以左室長(zhǎng)軸為中心，從心底-至心尖旋轉(zhuǎn)角度的梯度，單位為度/厘米。收縮期心肌的扭轉(zhuǎn)和剪切力改變了基質(zhì)的形狀并完成了能量的儲(chǔ)存。舒張期扭轉(zhuǎn)反彈或解旋會(huì)釋放能量，有助于對(duì)心房?jī)?nèi)血流的抽吸作用，使LV的早期充

14、盈加快。四維斑點(diǎn)追蹤感興趣區(qū)于左室舒張末期系統(tǒng)自動(dòng)生成，由心內(nèi)膜及心外膜間的網(wǎng)格組建而成。心內(nèi)膜的網(wǎng)格采用的是測(cè)量舒張末期容積時(shí)生成的網(wǎng)格。心外膜的網(wǎng)格由測(cè)量左室重量時(shí)得出，由舒張末期跟蹤至收縮末期。Title or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.29四維斑點(diǎn)追蹤Title or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.30縱向應(yīng)變（ Longitudinal

15、 Strain ）四維斑點(diǎn)追蹤Title or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.31環(huán)向應(yīng)變（ Circumferential Strain）四維斑點(diǎn)追蹤Title or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.32面積應(yīng)變（ Area Strain ）四維斑點(diǎn)追蹤Title or Job Number | XX Month 201XSee tutorial r

16、egarding confidentiality disclosures.33徑向應(yīng)變（ Radial Strain (VolC)）四維斑點(diǎn)追蹤Title or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.34擰轉(zhuǎn)（Twist）/扭轉(zhuǎn)（Torsion）斑點(diǎn)追蹤技術(shù)的臨床應(yīng)用Title or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.3517/18節(jié)段可選擇斑點(diǎn)追蹤在冠心病的運(yùn)

17、用Title or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.36斑點(diǎn)追蹤在心肌分層的應(yīng)用心肌缺血面積達(dá)到左室總面積5%時(shí)及心肌缺血厚度達(dá)到心室厚度25%就可檢測(cè)到室壁運(yùn)動(dòng)異常Title or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.37Title or Job Number | XX Month 201XSee tutorial regarding confidenti

18、ality disclosures.38左房功能的評(píng)估（A）用QRS起點(diǎn)作為參考點(diǎn)，測(cè)量左心房（LA）長(zhǎng)軸應(yīng)變的正向峰值和（B）用P波作為參考點(diǎn)，測(cè)量LA長(zhǎng)軸應(yīng)變的第一個(gè)負(fù)向峰值（LA收縮期）、第二個(gè)正向LA應(yīng)變峰值（LA管道功能）及它們的總和。 Title or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.39右心功能的評(píng)估右心室游離壁各節(jié)段應(yīng)變及應(yīng)變率心尖段最小，基底段最大。右心室游離壁各節(jié)段收縮期形變不隨年齡改變。右心室縱向應(yīng)變及應(yīng)變率與右心室的等容加速度呈正相關(guān)，與右心室心肌做

19、功指數(shù)呈負(fù)相關(guān)?？v向應(yīng)變率與右心室射血分?jǐn)?shù)呈正相關(guān)Title or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.40斑點(diǎn)追蹤參數(shù)Segmental:Strain / SR (Long., circ., rad., shear, principal, principal direction)Velocity / displacement (Long., circ., rad.)Rotation / rotation rateLocal torsion (= shear strain)De

20、rived parameters (timing, PSI, etc)Area strainAutomatic classification (normal/abnormal)Global:Global strainLV Torsion / torsion rateSub-segmental:Strain in myocardial layersTitle or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.41斑點(diǎn)追蹤的臨床應(yīng)用評(píng)價(jià)心房、心室整體收縮與舒張功能評(píng)價(jià)不同節(jié)段心肌的主動(dòng)性運(yùn)

21、動(dòng)與存活性評(píng)價(jià)心室節(jié)段同步性可以得到縱向、橫向、圓周、面積應(yīng)變、扭轉(zhuǎn)等復(fù)雜運(yùn)動(dòng)信息應(yīng)用于各種心臟疾病功能的評(píng)價(jià) 冠心病、心肌病、心衰，全身疾病對(duì)心臟的影響Title or Job Number | XX Month 201XSee tutorial regarding confidentiality disclosures.42斑點(diǎn)追蹤尚待解決的問題1、節(jié)段運(yùn)動(dòng)異常本身尚不能反應(yīng)真實(shí)的冠狀動(dòng)脈灌流，從理論上說，冠狀動(dòng)脈缺血致心肌節(jié)段運(yùn)動(dòng)異常源于相關(guān)血管的狹窄，但實(shí)際上并非所有狹窄的動(dòng)脈都引起室壁運(yùn)動(dòng)異常。2、力學(xué)角度看，斑點(diǎn)追蹤計(jì)算應(yīng)變尚未考慮殘余應(yīng)力的因素。研究證實(shí)，殘余應(yīng)力是跨壁分布的，當(dāng)展