电子束CT血管造影及三维重建在肺静脉畸形引流临床诊断中的应用

Comprehensive evaluation of anomalous pulmonary venous connection by electron beam CT

目的 评价电子束CT血管造影及三维重建在肺静脉畸形引流临床诊断中的作用。方法 对 2 0例电子束CT诊断的肺静脉畸形引流病例进行回顾性分析。电子束CT检查采用增强单层容积扫描 ,层厚 1 5～ 3 0mm ,扫描时间 10 0ms。所有病例均行三维重建。 2 0例均行超声心动图检查 ,有 10例尚行心血管造影检查。 14例有手术资料对照。结果 在 14例有手术对照的病例中 ,电子束CT对肺静脉畸形引流的定性及定位诊断符合 13例 ,部分符合 1例 ;超声心动图仅诊断 2例 ,手术对照 ,仅部分符合 ;怀疑 8例 ,心血管造影 6例中诊断 4例 ,与手术对照完全符合 ,怀疑 2例。未行手术治疗的 6例中 ,电子束CT均可见肺静脉畸形引流 ,血管造影 4例中仅有 2例发现 ,超声心动图则均未诊断。结论 电子束CT血管造影及三维重建在肺静脉畸形引流的临床诊断中具有明显优势 ,是肺静脉畸形引流的有效、无创检查方法。

Ovbective To evaluate the role of electron beam computed tomography (EBCT) in diagnosis of anomalous pulmonary venous connection. Methods Retrospective analysis on 20 cases diagnosed as anomalous pulmonary venous connection by EBCT. The slice thickness and scan time was 1.5～3mm and 100ms respectively. 3～4ml/s non-ionic contrast medium was injected. Three-dimensional reconstruction of EBCT images was carried out in all cases with special workstation. Meanwhile,ultrasound echocardiography was performed on all patients and conventional cardiovascular angiography was performed on 10 patients as control. 14 cases were operated. Results (1) 4 patients with total anomalous pulmonary venous connection and 16 patients with partial pulmonary venous connection were diagnosed by EBCT preoperatively. (2) Compared with the findings from operations (14 cases),CT results (14 cases) corresponded well in 13 cases and corresponded partially in other 1 case. Meanwhile,ultrasound echocardiography (14 cases) only corresponded partially in 2 case and suggested suspected APVC (without any exact number and connective location of APVC were mentioned) in other 8 cases. Cardiovascular angiography was performed in 6 of 14 cases and APVC was found in 4 of them. (3) In 6 non-operation cases,four underwent conventional cardiovascular angiography. APVC were diagnosed in 2 only of these 4 cases. Meanwhile,the diagnoses of these 6 cases were all confirmed by CT ultrasound,echocardiography didn't yield positive findings of APVC. Conclusion EBCT might be significantly superior to UCG and angiography in the detection of anomalous pulmonary venous connection. According to our experience,EBCT with 3-D reconstruction was a noninvasive,effective method in the diagnosis of APVC.