一站式MRI对复杂先天性心脏病的诊断价值

The Value of "one-stop-shop" MRI in the Diagnosis of Complex Congenital Heart Disease

目的评价一站式MRI对复杂先天性心脏病的诊断价值。资料与方法对33例复杂先天性心脏病患儿进行MRI扫描,包括梯度回波序列及自旋回波序列平扫,梯度回波序列电影扫描及三维增强磁共振血管成像(3D-CE MRA)扫描。将患儿MRI影像资料分为平扫+电影(A组)及平扫+电影+3D-CE MRA(B组)两组图像分别进行分析诊断,以手术作为参考标准,评估其诊断价值,并与B超结果进行对照。结果 22例成功完成一站式MRI扫描并经手术证实,共计109处心脏大血管异常,包括心内结构异常46处,心外结构异常63处。A组整体正确诊断率为84.4%,其中心内结构异常及心外结构异常的正确诊断率分别为82.6%、85.7%。B组整体正确诊断率为90.8%,其中心内结构异常及心外结构异常的正确诊断率分别为82.6%、96.8%。B超整体正确诊断率为82.6%,其中心内结构异常及心外结构异常的正确诊断率分别为87.0%、79.4%。结论一站式MRI扫描能明显提高心外大血管异常的正确诊断率,对心内结构异常诊断无明显帮助。与B超比较,MRI平扫+电影及一站式MRI平扫对心内结构异常的诊断均不如B超,对心外结构异常的诊断均比B超更具优势。

Objective To evaluate the value of ＂one-stop shop＂ MRI,included MRI,cine MRI and 3D CEMRA,in the diagnosis of complex congenital heart disease.Materials and Methods Thirty-three patients with complex congenital heart disease,who had undergone ultrasonic examination without clear diagnosis,were enrolled in this research.True FISP sequence,TSE sequence,cine MRI and 3D FLASH sequence were performed.The MRI images of every patient were divided into two groups.In group A,MRI data contained MRI and cine MRI,while in group B,beside that,contained 3D CEMRA.The diagnosis of both groups were compared with ultrasonic examination.Results There were 22 patients performed ＂one-stop shop＂ MRI examination and the diagnosis were confirmed by operation.Of the 109 malformations in all,there were 46 intra-cardiac malformations and 63 extra-cardiac malformations.The diagnostic accuracy of group A,group B and ultrasonic examination for all malformations/intra-cardiac malformations/extra-cardiac malformations were 84.4%/82.6%/85.7%,90.8%/82.6%/96.8% and 82.6%/87.0%/79.4% respectively.Conclusion MRI,cine MRI compounded with 3D CEMRA can absolutely improve the diagnostic accuracy of extra-cardiac malformations,but offer little help in diagnostic accuracy of intra-cardiac malformations.Compared with ultrasonic examination,both of cine MRI and ＂one-stop shop＂ MRI examination are better for the diagnosis of extra-cardiac malformations,but have less value for the diagnosis of intra-cardiac malformations.