64层螺旋CT在先天性心脏病伴气道狭窄手术前后的应用价值

The Clinical Value of 64-slice Spiral CT in Congenital Heart Diseases with Tracheobronchial Stenosis

目的研究64层螺旋CT(64-slices piral CT,MSCT)后处理技术对先天性心脏病(先心病)伴气管、支气管狭窄(气道狭窄)手术前后的临床应用价值。资料与方法对41例术前和29例术后的先心病伴气道狭窄的患者行MSCT对比增强扫描及多平面重组(MPR)、曲面重组(CPR)、最小密度投影(MinIP)和容积再现(VR)以显示气道狭窄情况,并与经手术证实的37例共52个狭窄节段行对比分析。采用非参数检验(Mann-Whitney test)以比较各种后处理技术对狭窄程度的测量与术中测量的差异性。结果MSCT各种重组技术均能较好地显示气道狭窄的部位、形态,MPR/CPR测量狭窄长度与术中测量具有较好的一致性,MPR/CPR和VR测量狭窄程度与术中测量无明显差异性(Z=-0.068,P=0.946和Z=-0.591,P=0.555);MinIP与术中测量有显著差异性,常过估狭窄程度(Z=-2.177,P=0.030)。结论MSCT扫描及其三维重组技术相互结合能准确评估先心病伴气道狭窄的程度和范围,为临床术前制定治疗方案及术后明确气道情况提供重要依据。

Objective To assess the clinical value of post processing techniques of 64 slice spiral CT （MSCT） for congenital heart disease with tracheobronchial stenosis. Materials and Methods Forty-one preoperative patients and 29 postoperative patients with congenital heart disease complicated with tracheobronchial stenosis performed MSCT scan. The post processing reconstructions,including multiplanar reformation （MPR）,curved planar reconstruction （CPR）,minimum intensity projection （MinIP） and volume rendering （VR） were performed to show the tracheobronchial morphology. The CT Findings of 37 cases were compared with the operation results. Mann-Whitney test was applied to assess the difference of tracheobronchial stenosis degree between the CT and the operation results. Results The post processing techniques of MSCT could show the section and morphology of tracheobronchial stenosis correctly and were consistent with the operation. There was no significant difference in measuring the degree of tracheobronchial stenosis between MPR/CPR,VR and the operation,（Z=-0.068,Р=0.94 and Z=-0.591,Р=0.555）,while MinIP frequently overrated the degree of stenosis compared with the operation （Z=-2.177,Р=0.030）. Conclusion The three dimensional reformation of MSCT can accurately evaluate the degree and extent of congenital heart disease with tracheobronchial stenosis and provide essential role in making therapy scheme before operative and identifying the airway condition after operative.