MSCTA对先天性血管环的诊断价值

Evaluation of MSCTA diagnosis of congenital vascular rings

目的:探讨儿童先天性血管环的MSCTA表现,提高临床对本病的认识水平。方法:搜集2011年1月-2012年2月经手术确诊30例先天性血管环患者的病例资料,年龄1个月～9岁。主要临床表现为反复呼吸道感染者19例,反复呕吐、进食困难等消化道症状4例,6例合并心内畸形,1例为偶然发现。MSCTA原始图像以0.6mm层厚重建,使用多平面重组(MPR)、最大密度投影(MIP)、容积再现(VR)等技术对图像进行后处理。结果:30例中双主动脉弓4例,右位主动脉弓伴迷走左锁骨下动脉9例,左位主动脉弓伴迷走右锁骨下动脉7例,肺动脉吊带9例,右位主动脉弓伴迷走左头臂动脉1例。合并气管病变26例,主要为先天性气道发育畸形(4例)和气管狭窄(22例)。结论:MSCTA能清楚显示心外大血管情况,对先天性血管环明确诊断的同时,可了解气管受压程度及狭窄范围,有助于临床明确诊断及选择治疗方法。

Objective：To explore the MSCTA findings of children＇s congenital vascular ring,and to increase clinical understanding of the disease. Methods：Collected from January 2011 to February 2012, MSCTA images of 30 patients with the diagnosis of congenital vascular ring were analyzed retrospectively. The patient＇s age were from 1 month to 9 years old. The main clinical manifestations were recurrent respiratory tract infection in 19 cases and recurrent vomiting with eating dif- ficulty in 4 cases. Source images with thickness of 0. 625mm were used for image reformation. Multi-planar reformation （MPR）, maximum intensity projection （MIP） and volume rendering （VR） technology were used for reformation. Results： Of the 30 cases of vascular ring,double aortic arch were proved in 4 cases,right aortic arch and aberrant left subclavian artery in 9 cases,left aortic arch and aberrant right subclavian artery in 7 cases, pulmonary artery sling in 9 cases, right aortic arch and aberrant left brachiocephalic artery in 1 case. There were 26 cases associated with tracheal abnormality,including con- genital tracheal malformation （n= 4） and tracheal stenosis （n： 22）. Conclusion： MSCT could clearly show the great vessels, the degree of compression and narrow range of trachea, and confirm the diagnosis of congenital vascular ring, which is help- ful in clinical diagnosis and treatment guidance.