多层螺旋CT在先天性主动脉缩窄和主动脉弓离断诊断中的应用

Diagnostic Value of Multi Slice Spiral Computed Tomography in the Evaluation of Coarctation of Aorta and Interruption Aortic Arch

目的探讨多层螺旋CT(MSCT)在先天性主动脉缩窄(COA)和主动脉弓离断(IAA)诊断中的应用。资料与方法搜集23例经手术或心导管证实的COA(17例)和IAA(7例)患者资料(年龄28天～26岁),总结和分析其MSCT增强扫描及使用多平面重组(MPR)、曲面重组(CPR)、最大密度投影(MIP)、容积再现(VR)图像后处理结果。结果23例患者术前MSCT均诊断正确,其中COA 17例,4例经DSA证实,13例手术证实,诊断准确率100%。对于合并其他畸形,如肺动脉高压(PH)、室间隔缺损(VSD)、单心室、动脉导管未闭(PDA)、主动脉弓发育不良、肺动脉骑跨、大动脉转位、左室流出道狭窄、体肺侧支循环MSCT均能正确诊断,诊断符合率100%。但2例二尖瓣狭窄和2例主动脉瓣狭窄未能诊断。3例有房间隔缺损(ASD)者漏诊1例,诊断准确率为66.67%。彩色超声心动图有4例导管前型轻至中度狭窄未诊断(未手术),1例导管旁型未诊断,1例导管旁型误诊为IAA,诊断准确率为64.7%,1例肺动脉骑跨超声心动图未诊断,其余均与MSCT诊断相符。MSCT诊断IAA 6例,其中B型4例,A型2例,所有病例均合并有VSD、PDA及PH,其中合并永存动脉干者1例,房间隔缺损2例,合并右锁骨下动脉迷走1例,左室流出道狭窄1例,除1例ASD漏诊外其他畸形与手术完全符合,IAA的诊断准确率为100%,均手术证实。彩超有1例IAA合并右锁骨下动脉迷走未诊断,符合率为83%。结论MSCT作为一种无创性诊断方法,对于COA和IAA及其合并的其他畸形,具有重要的诊断价值,值得广泛推广。

Objective To assess the value of muhi slice spiral computed tomography （MSCT） in the diagnosis of coarctation of aorta（COA） and interruption of aortic arch（IAA）. Materials and Methods 17 cases of COA and 7 cases of IAA （range from 28 days to 26 years old） were collected in this study. All cases were confirmed by surgery or cardiac catheterization. CT angiography and imaging recontruction included MPR, MIP, CPR, VR were performed by GE 16 MSCT scan. Results Twenty-two cases were diagnosed correctly by MSCT. 17 cases of COA were confirmed by DSA in 4 cases and surgery in 11 case. Other abnormalities complicated with COA such as PH, VSD, SV, PDA. DAA （ dysplasia of aortic arch）, PAO （pulmonary artery overriding）, TCA（ transposition of conducting arteries） Stegnosis of LV outflow tract Systemic-Pulmonary Collateral Circulation were diagnosed correctly. The accuracy and accordance rate of diagnosis were 100% respectively. Among the 15 cases of COA,2 cases of MS and 2 AS were failed to diagnose. 1 case （1/3） of ASD missed diagnosis with the diagnose accordance rate of 66.67%. In Color Ultrasound, 4 cases of anteduct type light-midrange stegnosis, 1 case of latero-duct type were misdiagnosed or missed diagnosed with the accordance rate of 60%. 6 cases of IAA （4 cases of B-type, 2 cases of A-type） were correctly diagnosed by MSCT. All the cases of IAA were combined with VSD, PDA and PH. Other abnormalities complicated with IAA, such as PTA, ASD, RSA, Stegnosis of LV outflow tract, were accord with operation except 1 ASD, the diagnose accordance rate was 100%. In Color Ultrasound, 1 case of RSA aberration was misdiagnosed with the diagnose accordance rate of 83 %. Conclusion MSCT is a generally excellent non-invasive diagnosis modality in diagnosing CoA, IAA and other combined malformations.