双源CT在先天性心脏病诊断中的应用价值

Application of dual source CT in congenital heart diseases

目的探讨双源CT在先天性心脏病诊断中的应用价值。方法采用西门子Siemens Somatom Definition DSCT增强扫描检查先天性心脏病50例,其中40例采用心电门控扫描模式,10例因心率过快采用普通胸部增强扫描模式。50例均行心脏超声检查,其中27例经手术证实、9例经X线心血管造影证实。本组以手术或X线心血管造影结果为标准,比较双源CT和心脏超声的诊断准确率。结果经手术或X线心血管造影证实的36例先天性心脏病中,含单纯房间隔缺损、单纯室间隔缺损、主动脉弓离断、单心室、完全型大动脉错位、肺动脉起源异常、冠状窦无顶综合征各1例,单纯动脉导管未闭、校正型大动脉错位、冠状动脉起源异常、肺动脉闭锁并室间隔缺损、左室双出口各2例,右室双出口4例,主动脉缩窄5例,法洛四联症10例。36例共计107处畸形,均以手术或X线心血管造影结果证实,其中心内畸形30处,双源CT和心脏超声诊断准确率分别为93.33%和96.67%(P=1.000)。心外畸形77处,双源CT和心脏超声诊断准确率分别为96.10%和87.01%,双源CT诊断准确率高于心脏超声(χ2=4.117,P=0.042)。双源CT与心脏超声联合诊断准确率为99.21%。结论双源CT对比增强扫描对先天性心脏病心外畸形的诊断准确率高于心脏超声,但二者联合可提高对先天性心脏病的诊断准确率。

Objective To explore the clinical value of dual source CT in diagnosis of congenital heart diseases. Methods 50 patients with suspected congenital heart disease underwent contrast-enhanced dual source CT. Echocardiograph-gated technology was used in 40 patients, and common chest technology was used in 10 patients because of sinus tachycardia. All 50 patients un- derwent echecardiography, 27 of them were confirmed by surgical operations and 9 of them were confirmed by X-ray angiography. Surgical or X-ray angiography was used as a reference standard. Findings were compared with that of echocardiography in 36 pa- tients. Results Of the 36 patients with congenital heart diseases, 1 arterial septal defect, 1 ventricular septal defect, 1 interrup- tion of the aortic arch, 1 single ventricle, 1 complete transposition of the great artery, 1 abnormal origin of the pulmonary artery, 1 abnormal coronary sinus, 2 patent ductus arteriosus, 2 corrected transposition of the great arteries, 2 double outlet left ventri- cle, 2 abnormal origin of the right coronary artery, 2 pulmonary atresia with ventricular septal defect, 4 double outlet left ventri- cle, 5 coarctation of the aorta and 10 Tetralogy of Fallot. 107 deformities were confirmed by surgical or X-ray angiography in 36 patients. The accuracy of dual source CT in detecting cardiac deformities was 95.33%. In 30 intra-cardiac deformities, definite diagnostic rates of dual source CT and echocardiography were 93.33 % and 96.67 %, and dual source CT was as accurate as echecardiography in revealing intracardiac deformities（ P = 1. 000）. In 77 extracardiac anomalies, definite diagnostic rates of du- al source CT and echocardiography were 96.10% and 87.01%, and dual source CY was superior to echocardiography in identify- ing extracardiac anomalies（X^2 = 4.117, P = 0. 042）. Combination of dual source CT and echocardiography increased the deft- nite diagnostic rate to 99.21%. Conclusion Dual source CT is superior to echocardiography in identifying extra-cardiac anomahes. Their combination can improve definite diagnostic rate for congenital heart disease.