电子束CT在肺静脉异常连接诊断中的临床价值

Clinical Application of EBCT in the Diagnosis of Anomalous Pulmonary Venous Connection

目的 探讨电子束CT(EBCT)在肺静脉异常连接诊断中的临床价值。材料与方法 EBCT诊断肺静脉异常连接患者 2 1例 ,其中男 13例 ,女 8例。年龄 3～ 63岁 ,平均 15 .6岁。 17例行增强单层容积扫描 ,4例行增强连续容积扫描。全部病例均行表面阴影显示法三维重建。 17例有心血管造影或手术结果 ,其中 9例单纯行造影 ,4例单纯行手术 ,4例造影后手术。结果 2 0例术前资料 ,EBCT诊断为完全型肺静脉异常连接 12例 ,部分型肺静脉异常连接 8例。前者包括心上型 3例 ,心脏型 8例和混合型 1例。EBCT均清晰显示异常连接肺静脉的数目、分布和位置。 1例术后复查病例 ,EBCT示吻合口狭窄。 7例完全型肺静脉异常连接者 ,EBCT提示合并内脏心房异位综合征。 8例有手术对照者 ,EBCT对肺静脉异常连接的定性、定位诊断全部正确。结论 EBCT及其三维重建可准确显示异常连接肺静脉的位置、数目和术后狭窄 ,对明确胸腹并发畸形有明显优势 ,是一种重要的无创性诊断肺静脉异常连接的方法。

Objective To investigate the clinical usefulness of electron beam computed tomography (EBCT) in the diagnosis of anomalous pulmonary venous connection.Materials and Methods Anomalous pulmonary venous connection was diagnosed with EBCT in 21 patients, including 13 males and 8 females and aged 3～63 years (mean 15.6 years). Contrast enhanced single slice scanning was performed in 17 patients, and contrast enhanced continuos volume scanning in 4 patients. Shaded surface display was done for 3D reconstruction in all patients. Both angiocardiographic and operative outcomes were obtained in 4 patients, while only angiocardiographic results in 9, only operative results in 4.Results Of the 20 patients received EBCT before operation, partial anomalous pulmonary venous connection was diagnosed in 8, and total anomalous pulmonary venous connection in 12, including supracardiac type (n=3), cardiac type (n=8) and mixed type (n=1). EBCT clearly displayed the number, distribution and location of anomalous pulmonary venous connection in all patients. The diagnosis by EBCT was compatible with the operative results in all the 8 patients receiving surgery. EBCT revealed a stenosis of anastomotic stoma in 1 patient after surgery, as well as the syndrome of visceroatrial heterotaxia in 7 patients with total anomalous pulmonary venous connection. Conclusion EBCT with 3D reconstruction can detect not only the number, distribution, connective location and postoperative stenosis of anomalous pulmonary venous connection, but also the thoracic and abdominal complicated lesions such as the syndrome of visceroatrial heterotaxia. It is a noninvasive method with high accuracy for the diagnosis of anomalous pulmonary venous connection.