64排CT在先天性主动脉缩窄合并心血管发育畸形诊断中的价值

Value of 64-slice Spiral CT in Diagnosis of Congenital Aortic Coarctation Accompanied with Cardiovascular Malformation

目的：探讨64排螺旋CT血管成像（CTA）对先天性主动脉缩窄合并心血管发育畸形的诊断价值及后者的影像学特点。方法：对32例主动脉缩窄患者（男24例，女8例，年龄26天～26岁）进行64排螺旋CT血管成像扫描，数据在工作站利用容积再现（VR）、最大密度投影（MIP）、多平面重组（MRP）等三维重建方法进行图像后处理。结果：64排螺旋CT血管成像清晰显示32例主动脉缩窄（单纯主动脉缩窄6例，26例合并心血管复杂畸形），6NJ单纯主动脉缩窄中，3N伴狭窄后扩张，3N伴广泛侧支循环，2例伴升主动脉瘤样扩张；26例主动脉缩窄伴复杂畸形中，合并动脉导管未闭20例，合并肺动脉高压14例，合并室间隔缺损15例，合并房间隔缺损3例，合并双上腔静脉4例，合并大动脉转位3例，合并主动脉弓发育不良3例，合并双奇静脉弓2例，合并右室双出1212例，合并迷走右锁骨下动脉2例。结论：64排螺旋CT血管成像可以清晰显示主动脉缩窄的类型、程度、范围、侧支循环及合并的心血管发育畸形，可以作为先天性主动脉缩窄合并心血管发育畸形的首选影像学检查，为临床诊断及治疗方案的选择提供最有价值的指导。

Puepose： To assess the value of 64-slice spiral CT Angiography （CTA） in diagnosis of congenital aortic coarctation （COA） accompanied with cardiovascular malformation. Methods： Thirty- two patients with COA （male： female = 24：8; age： 26 days to 26 years） were enrolled for 64-slice spiral CT angiography scanning. Image data were post-processed with 3D reconstruction technique such as volume rendering （VR）, maximum intensity projection （MIP） and multiple planar reconstruction （MRP） on the workstation. Results： Of all the 32 patients, 6 were simple COA and 26 were complex COA. Of these 6 simple COA patients, 3 were accompanied with expansion after stenosis, 3 with extensive collateral circulation, 2 with ascending aortic aneurysm; Of these 26 complex COA, 20 were accompanied with patent ductus arteriosus （PDA）, 14 with pulmonary hypertension, 15 with ventricular septal defect （VSD）, 3 with atrial septal defect （ASD）, 4 with double superior vena cava（DSVC）, 3 with transposition of the great arteries（TGA）, 3 with hypoplastic aortic arch, 2 with double arch of azygos vein, 2 with double outlet right ventricle（DORV）, and 2 with aberrant right subclavicular artery. Conclusion： 64-slice spiral CTA can clearly display the type, degree, scope, collateral circulation and accompanied cardiovascular malformations of the COA, and provide valuable guidance for the clinical diagnosis and treatment.