低剂量双源CT与超声心动图对法洛四联症术前评价的临床价值

Clinical value of low-dose dual-source computed tomography and echocardiography in the preoperative assessment of tetralogy of fallot

目的探讨低剂量双源CT血管成像（DSCTA）和经胸超声心动图（TTE）在法洛四联症（TOF）术前评价中的临床价值。方法 30例临床疑为TOF患者行胸痛序列低剂量DSCTA和TTE检查。以手术所见及心导管造影结果为金标准,观察DSCTA及TTE评价TOF心血管结构异常的准确性。结果 30例TOF患者手术及心导管造影证实共205处心血管结构异常。DSCTA误诊2例肺动脉二叶化畸形,漏诊5例卵圆孔未闭和2例房间隔缺损。TTE误诊7例肺动脉二叶化畸形和5例肺动脉狭窄,漏诊12例卵圆孔未闭和3例冠状动脉异常。DSCTA与TTE评价TOF合并心血管畸形的准确性分别为95.6%和86.8%（χ2=12.691,P〈0.05）。DSCTA检查平均有效辐射剂量为（1.09±0.71）mSv（0.312-2.674）。结论胸痛序列低剂量DSCTA可准确评价TOF患者心血管结构异常。在评价肺动脉发育、体-肺侧枝及冠状动脉异常方面,DSCTA优于TTE。

Objective The purpose of this study was to explore the clinical value of low-dose dual-source CT angiography （DSCTA） and transthoracic echocardiography （TTE） in the preoperative assessment of Tetralogy of Fallot （TOF）. Methods Thirty patients clinically suspected with TOF underwent triple-rule-out low-dose DSCTA and TTE. Based on surgical and conventional cardiac angiographic findings, calculation of accuracy of DSCTA and TTE in the evaluation of various cardiovascular anomalies was performed. Results A total of 205 separate cardiovascular anomalies were confirmed by surgery and conventional cardiac angiography. DSCTA incorrectly diagnosed 2 cases of bicuspid pulmonary valve, missed 5 cases of patent foramen ovale and 2 atrial septal defects. TTE incorrectly diagnosed 7 cases of bicuspid pulmonary valve and 5 pulmonary artery stenosis, missed 12 cases of patent foramen ovale and 3 coronary anomalies. The accuracy of DSCTA and TTE were 95.6% and 86.8% in diagnosing various cardiovascular anomalies, respectively （X^2= 12. 691, P〈0.05）. The estimated mean effective radiation dose was 1.09±0. 71 mSv （range, 0. 312-2. 674）. Conclusion Triple-rule-out low-dose DSCTA allows accurate diagnosis of various cardiovascular anomalies, and is superior to TTE in evaluating pulmonary artery stenosis, major aorto-pulmonary collateral arteries and coronary anomalies.