320排CT对中央型房间隔缺损和卵圆孔未闭的鉴别诊断价值

The Value of 320-Detector Computed Tomography in Differential Diagnosis of Central Atrial Septal Defect(ASD)and Patent Foramen Ovale(PFO)

目的探讨320排容积CT鉴别诊断中央型房间隔缺损(ASD)和卵圆孔未闭(PFO)的临床应用价值。方法回顾性分析10例行320排容积CT心脏成像的中央型ASD和PFO患者的影像资料(7例ASD,3例PF0)。比较ASD和PFO患者CTA图像上房间隔形态和房间对比剂分流特征。结果PFO患者CTA上房间隔呈"隧道样"改变,斜矢状面重建图像上表现为与心房间夹角为锐角的对比剂分流束从左房射向右房,方向朝下腔静脉。ASD患者CTA上房间隔呈膜孔样缺损,多平面重建图像上表现为垂直于房间隔的对比剂分流束从左房射向右房。另外发现1例ASD患者合并有房间隔瘤。结论320排CT回顾性心电门控冠状动脉成像可以动态观察房间隔异常,根据不同的房间隔形态和房间对比剂分流的特征可以区分中央型ASD和PFO。

Objective To evaluate clinical value of 320-detector computed tomography in differential diagnosis of central atrial septal defect(ASD)and patent foramen ovale(PFO).Methods Imaging data of ten caseswith ASD and PFO(including 7 cases with ASD,3 cases with PFO)who underwent 320-detector CT coronary angiography were analyzed retrospectively.Atrial septal appearance and contrast medium jet characteristics on CTA were compared between patients with ASD and PFO.Results Channel-like appearance of interatrial septum on CTA were showed in patients with PFO,and a contrast medium jet from the left atrium to right atrium flowing towards the inferior vena cave were showed on oblique sagittal images,making an acute angle with atrial septum.In patients with ASD,the atrial septal appeared as a membrane with a hole,and contrast medium jet was perpendicular to the interatrial septum on multiplanner reformation(MPR)images.One patient with ASD was accompanied with atrial septal aneurysm(ASA).Conclusion 320-detector CT coronary angiography with retrospective ECG gate can evaluate atrial septal abnormalitiesdynamically,ASD and PFO can be diagnosis according to different atrial septal appearance and contrast medium jet characteristics on CTA.