先天性心脏病复杂畸形的影像学诊断

Imaging diagnosis of complex anomalies of congenital heart disease:optimization of the modalities

目的:探讨多层螺旋CT、超声心动图以及心血管造影三种影像学方法在先天性心脏病复杂畸形诊断中的优选应用。方法:对50例患有先天性心脏病复杂畸形的患者术前均行多层螺旋CT、超声心动图以及心血管造影检查,检查后行心脏外科手术治疗,以手术后所得到的诊断结果为对照,并计算其诊断的准确率。将三种检查方法所得到的诊断准确率分别进行统计学分析。结果:手术证实畸形共149处,其中心内畸形66处,心外畸形83处。多层螺旋CT(MSCT)、超声心动图(UCG)和心血管造影(CAG)对心内畸形诊断的准确率分别为97.0%、100%和98.5%,三者诊断准确率差异无显著性意义(χ2=0.098,P>0.05);MSCT、UCG和CAG对心外畸形诊断准确率分别为92.8%、78.3%和97.6%,MSCT和CAG诊断准确率明显高于UCG(χ2=71.58,P<0.01和χ2=4.08,P<0.05),MSCT与CAG之间诊断率差异无显著性意义(χ2=1.37,P>0.05)。MSCT与UCG联合可提高诊断准确率至98.7%。结论:MSCT在心外血管结构的显示上较UCG有优势,而UCG对心内结构的评价更准确;MSCT与UCG的联合应用可提高小儿先天性心脏病诊断准确率;但对显示体-肺侧支,肺血管特别是外围血管的发育,测量心脏及大动脉内压力等,目前仍需依靠有创性的心血管造影。

Objective：To choose the best applicable method in the diagnosis of complex anomalies of congenital heart disease among the three imaging modalities.Methods：50 patients underwent multislice spiral computed tomography （MSCT）,ultrasonic cardiogram （UCG） and cadioangiography （CAG） before the operation.The accuracy rate of diagnosis was calculated with correlation to the results of operation.The statistical analysis was carried out respectively.Results：A total of 149 car-diac anomalies confirmed by operation were studied,including 66 intracardiac anomalies and 83 extracardiac anomalies.The diagnostic accuracy of MSCT,UCG and CAG for the intracardiac anomalies was 97.0%,100%,98.5% respectively,the diagnostic accuracy showed no statistical difference.The diagnostic accuracy of MSCT,UCG and CAG for the extracardiac anomalies was 92.8%,78.3% and 97.6% respectively,MSCT and CAG were superior to UCG （χ^271.58,P〈0.01 and χ^24.08,P〈0.05）.The diagnosis accuracy of MSCT and CAG showed no difference （χ^21.37,P〉0.05）.MSCT combined with UCG could increase the rate of definite diagnosis to 98.7%.Conclusion：MSCT is superior to UCG in detection of extracardiac anomalies,while UCG is superior to MSCT in detection of intracardiac anomalies.The combination of MSCT with UCG can raise the diagnosis accuracy rate in pediatric complex congenital heart diseases.The angiocardiography is superior to the other two modalities in the demonstration of collateral circulation and the development of peripheral vessel,and the measurement of pressure of heart and great vessels.