MSCT多维重组技术对小儿先天性肺动脉狭窄的诊断价值

The diagnostic value of MSCT multi-dimensional reconstructions for congenital pulmonary stenosis in children

目的探讨多层螺旋CT（MSCT）多维重组技术对小儿先天性肺动脉狭窄（PS）的诊断价值。方法回顾性分析本院33例PS患儿的薄层CT增强扫描资料，将数据传至后处理工作站进行多平面重组（MPR）、容积再现技术（VRT）及最大强度投影（MIP），结合手术与超声心动图（UCG）结果，分析PS影像学特点。结果33例中17例肺动脉瓣狭窄（PVS），10例右心室漏斗部狭窄（RVIS）和6例肺动脉干狭窄（PTS），前两者UCG均正确诊断，MSCTA正确诊断PVS5例，RVIS1例；后者UCG及MSCTA均正确诊断；14例主-肺动脉侧枝（APC）中，MSCTA均正确诊断，UCG漏诊10例（10／14），1例误诊为PDA。对于其它心内畸形（ASD，VSD，RVH，PFO，SV，DORV，TECD及TBD），UCG均能较清晰显示，MSCTA诊断准确率为39．4％；对于心外大血管异常（PDA，RAA，TGA，TAPVD，CoA，PLSV及VLSA），MSCTA能较清晰显示其来源、走行及直径，UCG诊断准确率为69．7％。结论MSCT及多维重组技术是显示PS心外血管畸形及APC的良好方法，结合UCG可以进一步提高心内畸形确诊率，为临床治疗提供诊治依据。

Objective To evaluate the diagnostic value of multi-slice CT （MSCT） and multi-di- mensional reconstructions for congenital pulmonary stenosis （PS） in children. Methods The enhanced thin CT images of 33 patients with PS were retrospectively analyzed, the data was transmitted to the worksta- tion for multi-planar reformation （MPR）, volume rendering technique （VRT） and maximum intensity pro- jection （MIP）. The CT imaging features of PS were analyzed combining with operation results and Ultrason- ic Cardiogram （UCG）. Results In 33 cases of PS, there were 17 cases with pulmonary valve stenosis （PVS）, 10 cases with right ventricular infundibulum stenosis （RVIS）, and 6 cases with pulmonary trunk stenosis （IriS）. The first two were correctly diagnosed by UCG, 5 cases of PVS and leases of RVIS were correctly diagnosed by MSCTA, the later was correctly diagnosed by UCG and MSCTA. In 14 cases with collateral circulations between aorta and pulmonary artery （ APC）, all were correctly diagnosed by MSCTA, only 3 ease was diagnosed by UCG, 1 case was misdiagnosed as PDA. UCG can clearly demonstrate the oth- ers intra-cardiac deformities, such as ASD, VSD, RVH, PFO, SV, DORV, TECD and TBD, the accuracy rate of MSCTA was 39.4%, and MSCTA can clearly demonstrate the origin, course and diameter of extra- cardiac vascular abnormalities, such as PDA, RAA, TGA, TAPVD, CoA, PLSV and VLSA, the accuracy rate of UCG was 69. 7%. Conclusions MSCT and multi-dimensional reconstruction were a kind of non-in- vasive method, it was a good approach for extra-cardiac vascular malformations and APC in PS. Combining with UCG, it can further be used to improve the diagnostic accuracy of intra-cardiac malformation and sup-ply diagnostic evidence for clinical treatment.