总结心肌声学造影（MCE）图像序列中存在的问题。

回顾性分析武汉大学人民医院2021年6月至12月MCE图像序列，总计133例患者，心尖切面图像序列553个，心尖四腔心切面（A4C）181个，两腔心切面（A2C）181个，三腔心切面（A3C）191个。统计3个心尖切面图像序列中各种图像问题的发生率，采用χ²检验比较3切面图像质量问题发生率的差异。图像质量问题包括心腔内增强剂浓度过高、心腔内增强剂浓度过低、肋骨/肺遮挡、过度爆破、增益过高、增益过低。

心腔内增强剂浓度过高、浓度过低、肋骨/肺遮挡、过度爆破、增益过高、增益过低的发生率分别为12.12%（67/553）、9.76%（54/553）、13.92%（77/553）、19.53%（108/553）、6.33%（35/553）、2.17%（12/553）。其中检查流程中最先采集的A4C中发生心腔内增强剂浓度过高的比例较其他切面高（A4C vs A2C vs A3C：18.23% vs 8.29% vs 9.95%，χ²=9.694，P=0.008），A2C发生心腔内增强剂浓度过低的比例最高，与其他切面比较差异无统计学意义（A4C vs A2C vs A3C：8.84% vs 12.71% vs 7.85%，χ²=2.746，P=0.253），A2C和A3C发生肋骨/肺遮挡声影的比例较A4C高（A4C vs A2C vs A3C：3.87% vs 19.89% vs 17.80%，χ²=23.043，P＜0.001）。

在MCE检查过程中，增强剂团注阶段采集的A4C图像易发生心腔内增强剂浓度过高。A2C和A3C易发生肋骨/肺遮挡。过度爆破占比较高，需加以重视。

To review and summarize the problems of myocardial contrast echocardiography (MCE) image sequences.

We retrospectively analyzed MCE image sequences of a total of 133 patients with 553 apical view images at Renmin Hospital of Wuhan University from June 2021 to December 2021, including 181 apical four-chamber view (A4C), 181 apical two-chamber view (A2C), and 191 apical three-chamber view (A3C) images. The incidence of various image problems in the three apical view image sequences was counted. The chi-square test was used for comparison of the incidence of image quality problems in the three apical view image sequences. The image problems were classified as: excessive and too low intracardiac contrast medium concentration, rib/lung occlusion, substandard flash, and too high and low gain.

The incidences of excessive and too low intracardiac contrast medium concentration, rib/lung occlusion, substandard flash, and too high and low gain were 12.12% (67/553), 9.76% (54/553), 13.92% (77/553), 19.53% (108/553), 6.33% (35/553), and 2.17% (12/553), respectively. The incidence of excessive intracardiac contrast medium concentration was highest in the A4C sequence, which was first acquired during the examination (A4C vs A2C vs A3C: 18.23% vs 8.29% vs 9.95%, χ²=9.694, P=0.008); the incidence of too low intracardiac contrast medium concentration was lower in the A2C sequence compared to the A4C sequence, but the difference did not reach statistical significance (A4C vs A2C vs A3C: 8.84% vs 12.71% vs 7.85%, χ²=2.746, P=0.253); a higher proportion of rib/lung obscuring acoustic images occurred in the A2C and A3C sequences compared to the A4C sequence (A4C vs A2C vs A3C: 3.87% vs 19.89% vs 17.80%, χ²=23.043, P＜0.001).

In MCE examination, A4C images captured during the bolus injection process are prone to excessive intracardiac contrast medium concentration, while A2C and A3C images are prone to rib/lung occlusion. Unqualified flash is in high percentage and should be avoided during examination.