多排螺旋计算机断层扫描血管造影在儿童主动脉弓发育异常中的诊断价值

Diagnostic Value of Multi-Row Helical Computed Tomography Angiography in Children with Aortic Arch Dysplasia

目的评估多排螺旋计算机断层扫描(multi-detector computed tomography,MDCT)血管造影在患儿主动脉弓发育异常中的诊断价值,以及进一步了解患儿先天性主动脉弓发育异常的影像学表现。方法收集泰康同济(武汉)医院2010年至2022年经MDCT血管造影和经胸超声心动图(transthoracic echocardiography,TTE)检查诊断为先天性心脏病的362例患儿(年龄范围为5 d~12岁,平均年龄为3.3岁)。所有诊断结果均经手术和(或)心血管造影所证实。结果362例被诊断为先天性心脏病的患儿中,198例为先天性主动脉发育异常,包括主动脉缩窄、主动脉弓离断、右位主动脉弓和迷走右锁骨下动脉以及主动脉双弓,例数分别为134、32、20、10及2例。6例罕见先天性主动脉弓异常:2例双主动脉弓,2例孤立右锁骨下动脉伴动脉导管未闭(patent ductus arteriosus,PDA),1例孤立颈总动脉伴PDA,1例双侧PDA合并单心室和肺动脉闭锁。32例主动脉弓离断患儿中,27例为A型、5例为B型。MDCT血管造影诊断先天性心脏病的敏感度、特异度、准确率分别为100%(198/198)、98%(161/164)和99%(359/362)。TTE的诊断敏感度、特异度、准确率分别92%(182/198)、81%(133/164)和87%(315/362)。结论MDCT血管造影诊断患儿先天性主动脉弓发育异常是一个可靠的、无损伤的活体检查方法,可获得比传统的血管造影术更多的解剖信息及影像学表现。

Objectives To evaluate the diagnostic value of multi-detector computed tomography(MDCT)angiography in children patients with aortic arch dysplasia,and to further understand the imaging manifestations of congenital aortic arch dysplasia in children.Methods A total of 362 children patients(age ranged from 5 days to 12 years,mean age was 3.3 years)diagnosed with congenital heart disease by MDCT angiography and transthoracic echocardiography(TTE)from 2010 to 2022 in Taikang Tongji(Wuhan)Hospital were collected.All the diagnosis were confirmed by surgery and(or)cardiovascular angiography.Results Among the 362 pediatric patients diagnosed with congenital heart disease,198 cases had congenital aortic abnormalities,including coarctation of the aorta,disconnection of the aortic arch,right aortic arch and vagus right subclavian artery and aortic double arch,with 134,32,20,10 and 2 cases,respectively.Six rare congenital aortic arch abnormalities:2 had double aortic arch,2 isolated right subclavian artery with patent ductus arteriosus(PDA),1 isolated common carotid artery with PDA,and 1 bilateral patent ductus arteriosus with single ventricular and pulmonary atresia.Among the 32 cases of aortic arch dissection,27 were type A and 5 were type B.The sensitivity,specificity and accuracy of MDCT angiography in the diagnosis of congenital heart disease were 100%(198/198),98%(161/164)and 99%(359/362),respectively.The diagnostic sensitivity,specificity and accuracy of TTE were 92%(182/198),81%(133/164)and 87%(315/362),respectively.Conclusions MDCT angiography is a reliable and non-invasive biopsy method for the diagnosis of congenital aortic arch dysplasia in children patients,which can obtain more anatomical information and imaging manifestations than traditional angiography.