64层MSCT血管成像对婴幼儿主动脉缩窄及离断的评价

64-slice MSCT Angiography Evaluation of Coarctation and Interruption of Aorta in Pediatric Patients

目的:评价64层螺旋CT血管成像在婴幼儿主动脉缩窄及离断诊断中的应用价值及其准确性。方法:对临床和超声怀疑主动脉缩窄的21例患儿行胸片、心脏大血管彩超及CT主动脉成像,其中5例行DSA检查,16例进行了手术治疗。CT血管重建技术包括VR、MIP、MPR及CPR等,对主动脉缩窄程度、长度、侧枝血管显示情况进行评价,并比较原始数据、VR、MPR、MIP及CPR几种后处理方式对主动脉缩窄诊断的准确性和敏感性。结果:21例患者中,19例为主动脉缩窄,2例为主动脉离断。病变部位于左锁骨下动脉远端、动脉导管开口附近20例(95.2%),正对左锁骨下动脉1例(4.8%)。病变部位位于动脉导管近段2例,动脉导管附着处3例,动脉导管远段16例。多层螺旋CTA对主动脉狭窄诊断的总体准确率和敏感性均为100%,对主动脉缩窄的显示以靶血管VR最好,其次是CPR和MPR;对侧枝血管的显示以整体VR和CPR最好,其次是MIP和MPR;而整体VR和原始轴位图像对主动脉缩窄显示较差。结论:64层MSCT血管成像各种后处理技术相结合能为主动脉缩窄及离断患者提供了更多有价值的诊断信息,有助于临床术前评估和制定恰当的治疗方案。

Objective： To evaluate the applicative value and accuracy of 64-slice multi-slice spiral computed tomography （MSCT） angiography in coarctation of aorta （COA） and interruption of aorta arch （IAA）. Methods： 21 cases suspected COA were performed with Chest, heart and great vessels CDFI and CT angiography （CTA）, in which 5 cases performed with DSA and 16 cases confirmed by surgery. CTA reconstruction techniques included VR, MIP, MPR and CPR, etc. We evaluated the extent of the coarctation of the aorta, length, collateral vascular, and compared accuracy and sensitivity of several methods, including the original data, VR, MPR, MIP and CPR, in diagnosing coarctation of aorta. Results： In 21 cases of patients, 19 cases were coarctation of aorta, two cases were interruption of of aorta arch. Lesions located in distal left subclavian artery, near patent ductus arteriosus openings in 20 cases （95.2 %）. Opposited the left subclavian artery in 1 case （4.8 %）. On the other side, lesions located near arterial catheter in 2 cases, attached to it in 3 cases, distal patent ductus arteriosus in 16 cases. The global accuracy and sensitivity ofMSCT angiography for diagnosising of aortic stenosis was 100 %. VR images of the target vessel showed the coarctation of the aorta best, followed by the CPR and MPR. VR images of the whole chest and CPR showed collateral vessels best, followed by the MIP and MPR. The VR images of whole chest and original axial images showed poor accuracy and sensitivity of coarctation of the aorta. Conclusion： The combilations of various post-processing techniques of 64-slice MSCT angiography play an important role in providing valuable diagnostic informations for coarctation of aorta and interruption of aorta arch, and contribute to the preoperative clinical assessment and develop appropriate treatment programs.