双源计算机断层摄影对先天性心脏病的诊断

Dual-source Computed Tomography for the Diagnosis of Patients with Congenital Heart Disease

目的探讨双源计算机断层摄影（dual-source computed tomography,DSCT）诊断先天性心脏病（先心病）的临床应用价值。方法 DSCT增强扫描检查先心病患者20例,年龄4个月~53岁,平均19岁;所有病例均以心脏超声（echocardiography,ECHO）为对照,并经手术证实。结果 20例患者经手术证实的心内外结构畸形共63处,DSCT检出59处,诊断敏感性为93·7%;ECHO检出55处,诊断敏感性87·3%,两种方法诊断敏感性比较差异无统计学意义（χ2=1·474,P=0·225）。63处结构畸形中,心脏部分畸形41处,DSCT检出37处（90·2%）,ECHO检出37处（90·2%）,两者敏感性相当（P=1·000）;心脏-大血管连接处畸形9处,DSCT检出9处（100%）,ECHO检出8处（88·9%）,差异无统计学意义（P〉0·05）;大血管部分畸形13处,DSCT检出13处（100%）,ECHO检出10处（76·9%）,差异无统计学意义（P〉0·05）。结论 DSCT能够显示心内外结构畸形,具有较高的诊断敏感性,对先天性心脏病,特别是合并心外大血管畸形的诊断有重要价值。

Objective To evaluate the value of dual-source computed tomography （DSCT） in the diagnosis of congenital heart disease. Methods Twenty patients aged 4 months to 53 years （mean age 19 years） with congenital heart disease underwent contrast-enhanced DSCT. The results were compared with those of echocardiography （ECHO） and confirmed by surgery. Results Among the 20 patients, DSCT detected 59 of 63 （93.7%） anomalies that confirmed by surgery, and ECHO detected 55 of 63 （87.3%） （χ2=1.474, P=0.225）. In the 41 intracardiac anomalies, DSCT was as sensitive as ECHO （both 90.2%, P=1.000）. In the 9 heart-vessel conjunction deformities, no significant difference was found between the sensitivities of two modalities （100% vs. 88.9%, P〉0.05）. In the 13 great vessel deformities, no significant difference was found between the sensitivities of two modalities （100% vs. 76.9%, P〉0.05）. Conclusion DSCT detects intraand extra-cardiac anomalies with high sensitivity and has an important value in the diagnosis of congenital heart disease especially those with extra-cardiac anomoalies.