多层螺旋CT在小儿复杂先天性心脏病诊断中的应用

Multi-slice computed tomography in infants and children with complex congenital heart disease

目的 探讨多层螺旋CT(MSCT)对小儿复杂先天性心脏病 (简称先心病 )的诊断价值。方法 MSCT对比增强心脏检查 4 8例 ,原始图像在工作站经多平面 (MPR)、最大密度投影 (MIP)、容积再现 (VR)及表面阴影成像 (SSD)法重建。 4 8例作心脏超声 (US)对照 ,2 1例作X线心血管造影 (CAG)对照。所有病例均经手术证实。结果 手术证实畸形共 174处 ,MSCT总的诊断敏感度 97 1%、特异度 99 4 %、准确度 95 9%。其中 ,心脏部分畸形 5 7处 ,MSCT漏诊 4处 ,US误诊 2处 ,CAG漏诊 1处 ,3种检查的诊断准确率差异无显著性意义 (χ2 =0 86 ,P >0 0 5 )。心脏大血管连接部分及大血管部分畸形共计 117处 ,MSCT、US、CAG诊断准确率分别为 97 4 %、76 9%、92 7% ,MSCT(χ2 =2 2 0 2 ,P <0 0 1)及CAG(χ2 =4 90 ,P <0 0 5 )诊断准确率明显高于US ,MSCT与CAG诊断准确率差异无显著性意义 (χ2 =0 80 ,P >0 0 5 )。MSCT与US联合可提高诊断准确率至 99 4 %。结论MSCT对小儿复杂先心病畸形的检出优于US ,MSCT与US联合可提高对小儿先心病诊断的准确率。MSCT可作为CAG的补充 ,有时甚至可取代CAG。

Objective To determine the value of three-dimensional reconstructed multi-slice CT in the assessment of deformities in infants and children with complex congenital heart disease.Methods Forty-eight patients were examined with contrast-enhanced multi-slice CT (MSCT).Three-dimensional reconstructions were performed with multiplanar reformation (MPR),maximum intensity projection (MIP), volume rendering (VR),and shade-surface display (SSD).Correlation was made with 48 echocardiograms (US) and 21 cineangiocardiograms (CAG).Surgical confirmation,which was used as the reference standard,was available in all patients.Results A total of 174 cardiac deformities confirmed by operation were studied.The sensitivity,specificity,and accuracy of MSCT in detecting cardiac deformities were 97.1%,99.4%,and 95.9%,respectively.There were 57 intracardiac deformities,4 missed by MSCT, 2 missed by US,and 1 missed by CAG.MSCT was as accurate as US and CAG in revealing intracardiac deformities (χ 2=0.86,P>0.05).There were 117 extracardiac anomalies.The definite diagnosis rate of MSCT,US,and CAG were 97.4% (114/117),76.9% (90/117),and 92.7% (38/41),respectively.MSCT and CAG were superior to US in the identification of extracardiac deformties (χ 2=22.02,P<0.01 and χ 2=4.90,P<0.05).The diagnosis accuracy of MSCT and CAG showed no difference (χ 2=0.80,P>0.05).MSCT combined with US could increase the definite diagnosis rate to 99.4% (173/174).Conclusion MSCT is superior to US in the detection of pediatric complex congenital heart diseases.The combination of MSCT with US can raise the definite diagnosis rate in pediatric complex congenital heart diseases.MSCT may be used as a complementary technique and occasionally as a substitute for the diagnosis imaging portion of cardiac catheterization with CAG.