低剂量心电门控CTA在复杂先天性心脏病诊断中的应用

Application of low-dose ECG-gated CTA in patients with complex congenital heart disease

目的观察低剂量大范围回顾性心电门控心脏大血管CT造影(CTA)在复杂性先天性心脏病(CCHD)诊断中应用情况,并比较其与经胸超声心动图(TTE)对CCHD诊断效能的差异。方法随机选择我院2018.07~2020.06间手术治疗的CCHD患者36例作为观察对象。所有患者术前均分别行TTE和CTA检查。以手术结果为金标准,比较两种方法对CCHD诊断准确率地差异。同时观察CTA检查的辐射剂量。结果36例CCHD患者总计121处畸形,包括心内畸形48处,73处心外畸形。CTA法和TTE法诊断CCHD的灵敏度分别为95.9%和88.4%(P=0.389)。CTA对CCHD诊断准确率为为90.9%(110/121),明显优于TTE的81.8%(99/121),差异有统计学意义(P<0.001)。CTA和TTE对心内畸形诊断准确率分别为81.5%(39/48)和95.8%(46/48);而对心外畸形诊断准确率则分别为97.3%(71/73)和72.6%(53/73),差异均具有统计学意义(P<0.001)。CTA检查中容积CT剂量指数(CTDIvol)为11.60mGy,有效剂量为5.15±0.25 mSv。结论低剂量大范围回顾性心电门控扫描CTA法和TTE法诊断CCHD时灵敏度基本相同,但CTA法对心外畸形和总体畸形数目诊断准确率显著优于TTE法,并且有着图像清晰、辐射剂量较低的优势,值得在临床进一步应用。

Objective The purpose of this study is to observe the application of low-dose and large-scale retrospective electrocardiographic-gated CT angiography(CTA)in the diagnosis of complex congenital heart disease(CCHD),and to compare its difference with transthoracic echocardiography(TTE)in the diagnostic efficiency of CCHD.Methods A total of 36 patients with CCHD undergoing surgical treatment in our hospital from Jul.2018 to Sep.2019 were randomly selected as the objects of observation.All patients underwent TTE and CTA examinations before surgery.Taking the surgical results as the gold standard,the differences in the accuracy of the two methods in the diagnosis of CCHD were compared.Meanwhile,the radiation dose of CTA was collected.Results A total of 121 malformations were discovered in 36 patients with CCHD,including 48 intracardiac malformations and 73 extracardiac malformations.The sensitivity of CTA and TTE were 95.9% and 88.4%,respectively(P=0.389).The diagnostic accuracy of CTA for CCHD was 90.9%(110/121),which was significantly better than 81.8%(99/121)of TTE,and the difference was statistically significant(P<0.001).The diagnostic accuracy rates of CTA and TTE for intracardiac malformations were 81.5%(39/48)and 95.8%(46/48)respectively,while the diagnostic accuracy rates for extracardiac deformities were 97.3%(71/73)and 72.6%(53/73)respectively.The results indicated that the two methods have statistically significant differences in the diagnostic accuracy for these two types of malformations(P<0.001).Besides,the volume CT dose index(CTDIvol)in CTA examination was 11.60mGy,and the effective dose was 5.15±0.25 mSv.Conclusion The sensitivity of low-dose and large-scale retrospective electrocardiographic-gated CTA and TTE have basically the same sensitivity in the diagnosis of CCHD,but the diagnostic accuracy of CTA for both extracardiac malformations and the number of total malformations is significantly better than that of TTE.In addition,with the advantages of clearer images and lower radiation dose,CTA is worthy of further clinical application.