房间隔缺损大小二维经胸超声心动图、二维及三维CT血管造影测量对比研究

Discrepancies and correlations for measurement of atrial septal defect among two-dimensional transthoracic echocardiography,cardiac CT angiography and three-dimensional cardiac CT axial sequence assisted imaging techniques

目的比较二维经胸超声心动图(2D-TTE)、二维CT血管造影(2D-CTA)及三维CT横断序列辅助(3D-CTAS)技术测量房间隔缺损(ASD)大小的准确性及相关性,探讨二维与三维测量偏倚产生的原因。方法回顾性研究2015年1月至2019年12月成功行介入治疗的不合并房间隔瘤的单发继发孔型ASD患者,患者于封堵前和封堵后第2天均行心电门控CT血管造影(CTA)检查。分别利用2D-TTE、2D-CTA和3D-CTAS技术测量ASD的最大横径(a)和上下径(b),并利用转换公式推算各技术测得的ASD直径[等效圆直径(ED)=短径+2×(长径–短径)/3]。在术后复查CTA图像上测量封堵器腰部直径(DCT-POD),以此作为ASD直径的参考标准,并据此将患者分为A组(DCT-POD<20 mm)及B组(DCT-POD≥20 mm)。将上述相应测量值进行比较。结果共纳入72例(平均年龄46岁,范围18~72岁)患者,其中A组22例,B组50例。对于ASD直径,2D-TTE、2D-CTA和3D-CTAS测得的ED(ED-TTE、ED-CTA和ED-CTAS)与DCT-POD均有良好的相关性(r=0.93、r=0.97及r=0.98),ED-TTE和ED-CTA均明显小于DCT-POD[(–5.09±3.45)mm,P<0.05;(–1.74±2.26)mm,P<0.05],ED-CTAS与DCT-POD相比则差异无统计学意义[(–0.13±1.89)mm,P=0.56]。横径a:2D-TTE与3D-CTAS测量值在A组中[(–1.83±2.37)mm,P<0.001]及B组中[(–2.64±4.69)mm,P<0.001]的差异均有统计学意义,但其差值在两组间差异无统计学意义(P=0.611)。上下径b:2D-TTE与3D-CTAS测量值在A组中[(–2.23±2.30)mm,P<0.001]及B组中[(–7.31±5.22)mm,P<0.001]的差异均有统计学意义,且其差值在两组间差异有统计学意义(P<0.001);A组2D-CTA与3D-CTAS测量值的差异无统计学意义[(–0.28±1.34)mm,P=0.341],B组则差异有统计学意义[(–2.64±4.36)mm,P<0.001],且其差值在两组间差异有统计学意义(P<0.001)。结论3D-CTAS测量ASD大小与金标准没有明显差异,其优于二维测量技术的关键是能准确测量ASD上下径并消除其薄弱边缘。

Objective To validate the accuracy of atrial septal defect(ASD)measurement by three dimensional cardiac CT axial sequence assisted measurement(3D-CTAS)and elucidate the discrepancies of twodimensional transthoracic echocardiography(2D-TTE)and two-dimensional cardiac CT angiography(2D-CTA).Methods We retrospectively investigated the patients successfully performed transcatheter closure of ASDs from January 2015 to December 2019.The included patients were evaluated with gated cardiac CTA twice at pre-and postpercutaneous closures respectively.The maximum dimension in axial planes(a)and maximum dimension in superiorinferior direction(b)were assessment by 2D-TTE,2D-CTA,and 3D-CTAS.The dimension of the ASD by these imaging techniques were arbitrary determined according to the formulation[effi cient diameter=minor axis+2×(major axis–minor axis)/3,ED,ED-TTE,ED-CTA,ED-CTAS].The postoperative occluder-waist dimension (POD)was measured on CT (DCT-POD) and regarded as the reference standard of the ASD size,according to which the patients were divided into two groups:group A (DCT-POD<20 mm) and group B (DCT-POD≥20 mm).The data obtained from 2D-TTE,2D-CTA,and 3D-CTAS were compared to investigate accuracy and correlations with paired and independent sample t tests.Results A total of 72 patients (mean age:46 years old,range from 18–72years old) were included in the study,including 22 patients in Group A,and 50 patients in group B.With respect to ASD diameters,ED-TTE,ED-CTA,and ED-CTAS were well correlated with DCT-POD (r=0.93,0.97,and0.98,respectively);both ED-TTE and ED-CTA were less than DCT-POD significantly[(–5.09±3.45)mm,P<0.05;(–1.74±2.26)mm,P<0.05],and there was no significant difference between ED-CTAS and DCT-POD[(–0.13±1.89)mm,P=0.56].As for a,both groups had signifi cant diff erences comparing 2D-TTEa and3D-CTASa[(–1.83±2.37)mm,P<0.001;(–2.64±4.69)mm,P<0.001],while the difference was no signifi cant between two groups (P=0.611).As for b,both groups had signifi cant diff erence comparing 2D-TTEb and3D-CTASb[(–2.23±2.30)mm,P<0.001;(–7.31±5.22)mm,P<0.001],and the diff erence was signifi cant between two groups(P<0.001).There was no signifi cant diff erence between 2D-CTAb and 3D-CTASb in Group A[(–0.28±1.34)mm,P=0.341],while signifi cant diff erence was found in Group B[(–2.64±4.36)mm,P<0.001],and between two groups(P<0.001).Conclusions There was no significant difference between EDCTAS and the reference standard for ASD sizing,and 3D-CTAS was superior to 2D-TEE and 2D-CTA in measuring b of ASD and eliminating its fl abby rims.