新生儿及婴儿复杂先天性心脏病的双源CT诊断

Dual-source CT Diagnosis of Complex Congenital Heart Disease in Neonates and Infants

目的:探讨双源CT(DSCT)对新生儿及婴儿复杂先天性心脏病的诊断价值。材料和方法:18例新生儿及婴儿复杂先天性心脏病,年龄7d～20个月,采用DSCT心电门控下对比增强完成心脏检查,舒张末期重建原始图像,并在图形图像工作站完成多平面、最大密度投影和三维容积漫游处理。同期所有病例均完成超声心动图检查,1例进行心导管检查,8例进行手术治疗、结果:18例复杂先天性心脏病中DSCT共检出90处心内外结构异常,超声心动图检出65处。9例经手术、血管造影证实的心内外结构异常共50处,DSCT检出其中的心内畸形14/16处、心室大血管连接异常3/3处、心外血管异常30/31处,超声心动图分别检出16/16处,3/3处和17/31处,DSCT与超声心动图联合应用的诊断准确率为98%、结论:DSCT是新生儿及婴儿复杂先天性心脏病检查的一种良好无创影像技术,对血管病变诊断优于超声心动图,对心脏本身以及心脏大血管连接的诊断与超声心动图相当,两者联合应用可在绝大多数病例中避免创伤性的心血管造影。

Purpose： To explore the clinical values of dual - source CT（DSCT） in diagnosis of complex congenital heart disease（CCHD） in neonates and infants. Materials and Methods： Eighteen patients（age range, 7days - 20 months） with CCHD were underwent cardiac imaging with a dual - source CT scanner. Two - and three - dimensional images were reformated by means of MPR （coronal, sagital and oblique）, MIP and VR. Echocardiography was performed in all cases at same time, cardioangiography in 1 case, and 8 patients finally were treated with surgery. Results： DSCT revealed 90 anomalies and echocardiography revealed 65 in all 18 cases. Among the 50 anomalies proved by operation and cardioangiography in 9 patients, DSCT detected 14/ 16, 3/ 3, 30/ 31 of intracardic anomalies, abnomal connection of atrium or ventricle to great vessels and vessel anomalies, meanwhile echocardiography detected 16/16, 3/3, 17/31 respectively. The combination of DSCT and echocardiography could raise the diagnostic accuracy to 98%. Conclusion： As non- invasive imaging technique, DSCT is equal or superior to echocardiography in detecting anomalies of CCHD in neonates and infants, especially in revealing vessel anomalies. The com- bination of two techniques can avoid invasive cardioangiography in most cases of CCHD.