CT心包新月征在非钙化的缩窄性心包炎的诊断价值

Diagnosis Value of Pericardium Crescent Sign under CT in Patients with Non-Calcified Constrictive Pericarditis

【目的】探讨CT"心包新月征"在非钙化的缩窄性心包炎诊断中的价值。【方法】回顾性分析经手术及病理证实的非钙化的缩窄性心包炎患者27例,心脏肿瘤46例,全部患者均行CT平扫+增强检查,非钙化的缩窄性心包炎患者分析其心包形态、密度、强化特征、心房、心室、下腔静脉的表现;心脏肿瘤患者分析其心包形态,是否出现"心包新月征"。【结果】27例非钙化缩窄性心包炎患者中,18例患者出现"心包新月征"改变,占66.7%;心室不同程度变形13例,占48%;下腔静脉扩张26例,占93%;心房增大7例,占26%。46例心脏肿瘤患者中,仅有1例患者出现类似"心包新月征"改变。用"心包新月征"诊断缩窄性心包炎时,其灵敏度是66.7%,特异度是97.8%,Youden指数是0.64。ROC曲线下面积是0.82(0.71-0.94),P<0.001。【结论】"心包新月征"是诊断非钙化的缩窄性心包炎重要的CT征象,具有非常高的特异度,是非钙化的缩窄性心包炎与心包肿瘤的重要的影像鉴别诊断依据。

【Objective】To investigate the value of“pericardium crescent sign”in the diagnosis of non-calcified constrictive pericarditis in CT.【Methods】Twenty-seven patients with non-calcified constrictive pericarditis and forty-six cardiac tumors confirmed by surgical pathology were analyzed retrospectively.All patients underwent non-enhanced and enhanced CT scan preoperatively.Pericardial morphology,density,enhancement features,appearance of atrium,ventricle and inferior vena cava of non-calcified constrictive pericarditis were analyzed.Pericardial morphology of cardiac tumors was also analyzed.【Results】Of the27patients with non-calcified constrictive pericarditis,18patients developed“pericardium crescent sign”,accounting for66.7%,ventricular varying degrees of deformation in13cases,accounting for48%;venous dilatation in26cases,accounting for93%;atrial enlargement in7cases,accounting for26%.In46patients with cardiac tumors,only1patient had a similar“pericardial crescent”sign.For the diagnosis of constrictive pericarditis using pericardial crescent sign,the sensitivity was66.7%,the specificity was97.8%,Youden index was0.64.The area under the ROC curve was0.82([0.71-0.94],P<0.001).【Conclusion】“Pericardium crescent sign”is important CT features of non-calcified constrictive pericarditis.It has high specificity for differentiating non-calcified constrictive pericarditis from pericardial tumor imaging.