电子束计算机断层摄影术在小儿心脏病诊断中的应用

Clinical Application of Electron Beam Computed Tomography in Diagnosis of Pediatric Heart Disease

目的 评价电子束计算机断层摄影术 (EBCT)在小儿心脏病诊断中的价值。方法 对 78例患儿经胸常规超声心动图 (TTE)诊断为小儿心脏病 ,其中 74例为先天性心脏病 ,复杂先天性心脏病占 63例 ,非先天性心脏病变 4例 ,同时做EBCT增强单层容积扫描 ,并由计算机工作站进行图像三维重建。其中 2 5例行常规心血管造影 ,4 3例经外科手术 ,进行对照研究。结果 全组 2 0种小儿先天性心脏病共 176处畸形 ,其中复杂先天性心脏病 16种。心内畸形共65处 ,TTE漏诊 1处 (三尖瓣闭锁 ) ,TTE诊断准确率 98 5 %。而心外大血管畸形及心室 -大血管连接异常诊断中两者有明显差别 ,EBCT诊断准确率为 96 4 % ( 10 7/ 111) ,TTE诊断准确率 86 5 % ( 96/ 111)。EBCT与TTE诊断的准确率差异非常显著 ( χ2 =6.964,P <0 .0 1)。手术纠治心脏病变共 10 9处 ,EBCT确诊 10 5处 ,诊断准确率 96 3 % ( 10 5 / 10 9)。TTE确诊 97处 ,诊断准确率 89 0 % ( 97/ 10 9)。EBCT与TTE诊断的准确率有显著差异 ( χ2 =4 .3 18,P <0 .0 5 )。TTE、EBCT对 4例非先天性心脏病均作出正确诊断。TTE与EBCT结合使诊断的总准确率提高到 99 4 % ( 175 / 176)。结论 E BCT对小儿心脏病变的检出优于TTE。EBCT血管造影与TTE及心血管造影相结合 。

Objective The clinical feasibility of electron beam computed tomography in diagnosis of pediatric heart disease was evaluated.Methods A total of 78 children were diagnosed as heart disease by conventional transthoracic echocardiography. Among them 74 patients were suspected congenital heart disease and 63 were complex cases. EBCT single scan mode was performed in the all patients and three-dimensional reconstruction was established. Angiocardiography was also performed in 25 patients. Operation was performed in 43 patients.Results In patients there were 176 deformities in 20 kinds of congenital heart disease, and among them 11 kinds were complex. There were 65 intracardiac deformities, 1 missed by TTE. The definite diagnosis rate of TTE was 98.5%. There was very significant difference between EBCT and TTE in the identification of extracardiac deformities and ventriculo-arterial connections. The definite diagnosis rate of EBCT was 96.4%(107/111). The definite diagnosis rate of TTE was 86.5%(96/111). There was significant difference between EBCT and TTE(χ 2=6.964,P< 0.01 ). There were 109 cardiac deformities performing by operation in which 105 definitely diagnosed by EBCT. The definite diagnosis rate of EBCT was 96.3%(105/109). 97 definitely diagnosed by TTE. The definite diagnosis rate of TTE was 89.0%(97/109). There was also significant difference between EBCT and TTE(χ 2=4.318,P<0.05). Combinated EBCT with TTE could increase the definite diagnosis rate to 99.4%(175/176). Conclusion EBCT is superior to TTE in the detection of pediatric heart disease. The combinated EBCT with TTE and angiocardiography can raise the definite diagnosis rate in pediatric heart diseases and be helpful in surgical or medicinal treatment.