CDE与CTA对小儿部分型和完全型肺静脉异位引流的鉴别诊断价值

The value of CDE and CTA in the differential diagnosis of partial and total anomalous pulmonary venous drainage in children

目的对比彩色多普勒超声心动图(CDE)和CT血管成像(CTA)对小儿部分型和完全型肺静脉异位引流的鉴别诊断价值。方法选取2010年3月-2019年4月徐州市儿童医院收治的经术中所见证实为肺静脉异位引流的92例患儿。患儿术前均实施CDE和CTA。将术中所见作为金标准,统计两种方法的典型特征和诊断结果;对比两种方法对部分型和完全型肺静脉异位引流的鉴别诊断价值;对比两种方法对完全型肺静脉异位引流亚型、肺静脉走行诊断准确率。结果术中有72例患儿部分型肺静脉异位引流,共有20例完全型肺静脉异位引流。CDE、CTA及联合诊断对部分型和完全型肺静脉异位引流鉴别诊断的敏感性、特异性、准确性、阳性预测值和阴性预测值均相近,差异均无统计学意义(P>0.05),CDE和CTA对完全型肺静脉异位引流心上型、心内型、心下型及混合型诊断的敏感性、特异性、准确性、阳性预测值和阴性预测值均相近,差异均无统计学意义(P>0.05)。结论CDE对小儿部分型和完全型肺静脉异位引流鉴别诊断的价值、对完全型肺静脉异位引流的亚型诊断与CTA相当,但是前者安全、操作简便且可重复,建议作为首选。

Objective To compare the value of color Doppler echocardiography(CDE)and computed tomography angiography(CTA)in the differential diagnosis of partial and total anomalous pulmonary venous drainage in children.Methods A total of 92 children with anomalous pulmonary venous drainage confirmed in surgery admitted to our hospital from March 2010 to April 2019 were selected.Both CDE and CTA were carried out before the operation,and the surgery was taken as the gold standard to confirm the presence of anomalous pulmonary venous drainage.The typical features and diagnostic results of the two methods were recorded.The values of the two methods in differential diagnosis of partial and total anomalous pulmonary venous drainage,and the accuracy rates of two methods in diagnosis of total anomalous pulmonary venous drainage subtypes and the distribution of pulmonary vein were compared.Results As observed in surgery,72 cases were partial anomalous pulmonary venous drainage and 20 cases were total anomalous pulmonary venous drainage.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of CDE,CTA,and the combination of CDE and CTA in differential diagnosis of partial and total anomalous pulmonary venous drainage were comparable(P>0.05).The sensitivity,specificity,accuracy,positive predictive value,negative predictive value of CDE and CTA were also similar in the diagnosis of supracardiac,cardiac,infracardiac and mixed types of total anomalous pulmonary venous drainage(P>0.05).Conclusions The values of CDE in differential diagnosis of partial and total anomalous pulmonary venous drainage as well as the diagnosis of total anomalous pulmonary venous drainage subtypes in children are similar to those of CTA.However,CDE is safer,easier to carry out and more repeatable,and is therefore preferred.