超声心动图结合Flash CT对部分性肺静脉畸形引流的诊断价值

Echocardiography Combined with Flash CT in Diagnosis of Partial Anomalous Pulmonary Venous Connection

目的采用超声心动图结合Flash CT对部分性肺静脉畸形引流(PAPVC)患者行术前检查,并与手术结果对照,评价超声心动图结合Flash CT对PAPVC的诊断价值。资料与方法收集28例PAPVC患者,术前均行超声心动图及Flash CT大螺距扫描检查,观察PAPVC的类型、房间隔缺损的大小及合并其他畸形,并与手术结果进行对照。结果 28例患者中,超声确诊16例,提示可疑5例(其中4例证实为PAPVC,超声诊断正确;1例为肺静脉栓塞,超声误诊),漏诊6例,误诊1例;CT误诊1例;超声诊断准确率(71.4%,20/28)低于CT(96.4%,27/28)(P<0.05);28例患者合并畸形共44处,超声确诊43处,漏诊1处;CT确诊34处,误诊2处,漏诊8处。超声诊断准确率(97.7%,43/44)高于CT(77.3%,34/44)(P<0.05)。28例平均剂量长度乘积为(15.5±3.2)m Gy·cm,平均有效剂量为(0.354±0.058)m Sv。结论 Flash CT对PAPVC的诊断准确率较超声心动图高,但对合并心内畸形的诊断准确率低于超声心动图,而且超声可以对瓣膜病变、肺动脉压力及心功能做出全面评价,两者联合应用可以提高术前诊断准确率。

Purpose To investigate clinical significance of echocardiography combined with Flash CT in diagnosis of partial anomalous pulmonary venous connection（PAPVC）. Materials and Methods Twenty-eight cases of PAPVC were recruited in the study. All the subjects underwent both preoperative echocardiography and coarse pitch Flash CT scanning. Imaging findings were compared with the results of surgery, including the type of PAPVC, size of atrial septal defect（ASD）, and other combined malformations. Results Among 28 patients, 16 cases and 5 suspicious cases（4 cases of PAPVC and 1 case of pulmonary vein embolism） were diagnosed by echocardiography. Six cases were missed, and 1 case was misdiagnosed. CT misdiagnosed 1 case. The accurate diagnosis rate of echocardiography（71.4%, 20/28） was lower than that of Flash CT（96.4%, 27/28）（P〈0.05）. There were 44 combined malformations in 28 cases, 43 lesions were diagnosed by echocardiography, and 34 lesions were diagnosed by Flash CT. The accurate diagnosis rate of echocardiography（97.7%, 43/44） was higher than that of Flash CT（77.3%, 34/44）（P〈0.05）. The average DLP was（15.5±3.2） m Gy · cm and average effective dose（ED） was（0.354±0.058） m Sv. Conclusion Flash CT has a higher diagnosis accuracy of PAPVC but a lower diagnostic accuracy of combined malformations when compared with echocardiography. Moreover, echocardiography can make comprehensive evaluation in valve disease, pulmonary artery pressure and cardiac function. Flash CT combined with echocardiography may improve preoperative diagnosis.