经皮介入术后封堵器腰部直径作为房间隔缺损大小参考标准的有效性:胸部平片与CT测量对比研究

Validation of Postoperative Occluder Waist Diameter in Chest Radiograph as the Reference Standard of Atrial Setptal Defect Size:Compared with Computed Tomography Measurement

目的探讨将介入治疗术后封堵器腰部直径的胸部平片测量作为房间隔缺损大小参考标准的价值。方法研究37例房间隔缺损(ASD)后下缘短缺(<3 mm)并成功实施介入封堵手术的中老年房间隔缺损患者,均于术后第二日复查胸部平片及CT。胸部X线检查拍摄后前位(PA)、左侧位(LL)及左前斜位(LAO)胸片,在LL及LAO胸片上测量封堵器的腰部直径(CR-PODll,CR-PODlao),并评断出显示封堵器双盘平行的较佳投照体位。CT检查采用冠状动脉扫描模式,将患者冠状动脉CTA资料进行三维容积重建,在收缩期时相及舒张期时相分别测量横断面直径a(CT-PODsa,CT-PODda)与矢状面直径b(CT-PODsb,CT-PODdb)。将上述测量数据进行配对t检验及相关性分析,并拟合回归方程。结果胸部平片CR-PODll与CR-PODlao测量值之差为1.61 mm,有显著性差异(t=7.88,P<0.05);对二者胸片呈现双盘平行的占比行Fisher精确检验,无显著性差别(t=0.642,P=0.321)。CT-PODsa分别与CT-PODsb及CT-PODda测量结果相比,差值分别为-0.02mm及-0.10mm,均无显著性差异(t=-0.11,P=0.91;t=-0.73,P=0.47)。CR-PODll及CR-PODlao分别与CT-PODda相比,平均差值分别为3.23 mm及1.62 mm,均有显著性差异(t=12.57,P<0.001;t=6.62,P<0.001);且二者与CT-PODda均有极强且接近的相关性(R=0.95,P<0.001),其回归方程分别为YCR-PODll=1.04X+1.7及YCR-PODlao=0.97X+2.5。结论房间隔缺损介入治疗术后封堵器腰部直径的X测量与CTA测量有极好的相关性,差别微小,可以在临床研究中作为估测缺损大小的参考标准。

Objective To assess the validation of postoperative occluder waist diameter in chest radiography as the reference standard of atrial septal defect(ASD)size compared with CT measurement.Methods A total of 37 consecutive ASD patients with deficient posterior-inferior rim(≤3mm)were referred for attempted transcatheter closure and successfully underwent the procedure.Chest radiography and MSCT were performed 24 h after the implantation of occluders respectively.Posteroanterior(PA),left lateral(LL)and left-anterior oblique(LAO)projections were performed in plain X-ray.The chest radiography examination included measurement of the postoperative occluder-waist diameter(POD)in left lateral(CR-PODLL)and left-anterior oblique projection(CR-PODLAO),in addition,the better projection to show the paralleled double discs of ASO were appraised.MSCT were underwent with CCTA mode,and 3D reconstruction were performed in systolic and diastolic phases to measure the POD in axis view a(CTPODsa,CT-PODda)and sagittal view b(CT-PODsb,CT-PODdb)respectively.comparisons between measurements were done by paired t-test and linear regression analysis.Fisher's Exact Test was used to assess the proportion of paralleled double discs of ASO in LAO and LL view.Results In chest radiography,there was no significant differences in showing the paralleled double discs between LAO and LL view(t=0.642,P=0.321),but the POD size measured in LL view was significantly greater than that in the LAO view(35.38±5.13 vs 33.38±4.77,P<0.001)in CT-POD size,there were no significant difference between axis and sagittal view,even at ventricular end-systole or end-diastole phase.Either CR-PODLAO or CR-PODLL was significantly larger than CT-POD,while the difference is tiny.The correlations and agreements between measurements were significantly better between CR-POD and CT-POD,the linear regression formulas between CR-POD and CT-POD were established:YCR-PODll=1.04XCT-PODda+1.7,YCRPODlao=0.97X+2.5.Conclusion Compared between CR-POD and CT-POD,the difference is tiny,and the correlations was significantly better.Thus,it is rational and reliable to use CR-POD as reference standard of ASD size.