256层CT诊断肺动脉闭锁合并室间隔缺损的影像学分析

Application of 256-slice CT in the analysis of congenital heart disease with pulmonary atresia and ventricular septal defect

目的:探讨256层螺旋CT对肺动脉闭锁合并室间隔缺损(PA/VSD)的诊断及预后分析。方法:回顾16例PA/VSD患者的影像及临床资料,归纳总结该病及其伴随的多种畸形的影像学特点,测量患者的McGoon指数及肺动脉指数(Nakata指数)作为临床治疗的参考。结果:CT对本组病例均做出了正确诊断,且发现了多种伴随的畸形,本组病例中15例合并主动脉骑跨,12例发现较为明显的体肺循环侧支血管(Major aorto-pulmonary collateral arteries,MAPCAs)形成,5例伴发右位主动脉弓右位降主动脉,4例合并动脉导管未闭,3例头臂动脉发育异常,1例可见房间隔缺损。本组病例McGoon指数>1.2者5例,而Nakata指数>150 mm2/m2者共计4例。结论:多层螺旋CT对于PA/VSD具有极高的诊断正确率,特别是对于体肺循环间的侧支及合并的畸形的显示和患者的临床治疗、预后评估具有重要意义。

Objective：To explore diagnostic value of the spiral CT in the diagnosis of congenital heart disease with pulmonary atresia.Methods：Sixteen patients with pulmonary atresia associated with ventricular septal defect were enrolled in this study.All of them had X-ray plain film,256-slice spiral CT and echocardiography.And all the imaging data were analyzed retrospectively.Results：All patients obtained correct diagnosis by spiral CT,and many associated malformations were also found.All patients in this study group complicated with ventricular septal defect,15 of them with overriding aorta,twelve cases were found to have obvious major aorto-pulmonary collateral arteries and five patients associated with right aortic arch and descendding aorta,4 patients had patent ductus arteriosus.Three patients were found to have developmental abnormalities of brachiocephalic artery,7 cases had varying developmental abnormalities of main pulmonary artery.Only one case appeared to have atrial septal defect.In 5 cases Mcgoon index was 〉1.2,4 patients＇ Nakata index 〉150 mm2/m2.Conclusion：Application of multislice CT has a high diagnostic accuracy rate for congenital heart disease with pulmonary atresia and ventricular septal defect,particularly in the diagnosis of aorto-pulmonary collateral arteries.