128层MSCT虚拟仿真内镜技术在婴幼儿先天性心脏病的应用

Application of 128-slice MSCT with virtual endoscopy in infants and children with congenital heart disease

目的:探讨128层MSCT虚拟仿真内镜技术(VE)对婴幼儿先天性心脏病的诊断价值。方法:回顾性分析67例先天性心脏病患儿128层螺旋CT和经胸壁超声心动图(TTE)资料,并与手术结果作对照。采用5分单盲法评价VE图像质量,比较心房心室和大血管的差异,建立VE飞行路径规划。结果:VE诊断主要心脏结构异常的总符合率51.7%~100%,灵敏度51.7%~100%;MPR总符合率53.3%~100%,灵敏度53.3%~100%;TTE总符合率25.0%~100%,灵敏度25.0%~100%。VE和MPR在室间隔缺损、右心室双出口、大动脉转位、肺动脉狭窄、冠状动脉畸形和血管环的诊断中其总符合率和灵敏度都高于TTE,但诊断房间隔缺损及卵圆孔未闭的总符合率和灵敏度不如TTE。VE在显示结构异常的直观性和三维空间感优于MPR。VE图像质量评分对比:RA与LV、RV、LA及大血管图像评分均存在显著性差异(P=0.000<0.01),LA与RV(P=0.006<0.01)、大血管图像评分存在显著性差异(P=0.002<0.01)。大血管VE图像质量最佳,其后为RV及LV,LA、RA图像质量最差。VE飞行路径规划时应将左右心系统分别建立。结论:128层MSCT虚拟仿真内镜技术可准确显示婴幼儿先天性心脏病的心腔和大动脉的异常结构,尤其对室间隔缺损、圆锥动脉干畸形和冠状动脉畸形较TTE更准确。VE有更强的直观性和三维空间感,更接近心脏直视手术视野,有助于手术方案的合理设计,对提高虚拟手术教学和改善医患术前交流有重要意义。

Objective:To explore the value of 128-slice MSCT with virtual endoscopy in the diagnosis of infants and children with congenital heart disease,as well as flight path planning and clinical application.Methods:The 128-slice spiral CT and transthoracic echocardiography(TTE)data of 67 children with congenital heart disease were retrospectively analyzed and compared with the surgical results.The image quality of VE was evaluated by 5-point single blind method,and the differences between left and right atrioventricular and large arteries were compared,to establish the flight path planning.Results:The coincidence rate of VE in the diagnosing of important cardiac structural abnormalities was(51.7%~100%)and the sensitivity was(51.7%~100%),the coincidence rate of MPR was(53.3%~100%)and the sensitivity was(53.3%~100%),and the coincidence rate for TTE was(25.0%~100%)and the sensitivity was(25.0%~100%).The coincidence rate and sensitivity of VE and MPR were higher than TTE in the diagnosis of VSD,DORV,TGA,pulmonary artery stenosis,coronary artery malformation and vascular ring.But the coincidence rate and the sensitivity of VE in the diagnosing of atrial septal defect and patent foramen ovale were lower than TTE.VE was superior to MPR in the visibility of displaying structural abnormalities and the sense of three-dimensional space.From the comparison among different anatomic regions,there was a significant difference between RA and LV,RV,LA and large vessels in the image quality evaluation(P=0.000<0.01),also the score of LA has significant difference compared with RV(P=0.006<0.01)and large vessels(P=0.002<0.01).The VE image quality of large vessels was the best,followed by RV,LV,LA and RA.The left and right heart systems should be established separately in VE flight path planning.Conclusion:The 128-slice MSCT with VE can accurately display the structure abnormalities of cardiac cavity and large vessels in infants and children with congenital heart disease,especially for ventricular septal defect,conic artery trunk malformation and coronary artery origin,which is more accurate than TTE.VE has good visibility and three-dimensional space sense for displaying structural abnormalities,which is closer to the vision field of open-heart surgery and helpful for rational design of surgical plan.This is of great significance to improve the teaching level of virtual surgery and the communication between doctors and patients before surgery.