多排螺旋CT血管成像在肺静脉异位引流诊断中的应用

Clinical application of multi-slice CT angiography in the diagnosis of anomalous pulmonary venous connecton

目的:通过与血管造影(DSA)及术中诊断结果相比较,探讨多排螺旋CT血管成像(CTA)在肺静脉异位引流(APVC)及其伴随畸形诊断中的准确性。方法:回顾性分析2011年至2019年北京安贞医院及北京大学首钢医院收治的134例临床可疑APVC患者CTA图像,通过多种重建方式,显示心内外及内脏合并其他畸形,并与外科手术及造影诊断结果相比较,评价CTA诊断准确性。结果:134例APVC患者中TAPVC 66例,PAPVC 68例,DSA及术后诊断与CT诊断结果完全一致。PAPVC患者中单支肺静脉引流异常患者最常见,共44例(64.7%),同时单纯右侧肺静脉受累患者最多,共47例(69.1%)。APVC患者最常见的合并畸形为房间隔缺损,共95例(70.9%)。TAPVC患者合并某些心内外及内脏畸形病例明显高于PAPVC患者。共8例患者存在肺静脉或引流静脉狭窄。结论:CTA能够准确诊断APVC畸形肺静脉走行及连接,并同时评价伴随的心内外及内脏合并其他畸形。

Objective:By comparing with the results of DSA and intraoperative diagnosis,the accuracy of multislice computed tomography angiography(CTA)in the diagnosis of anomalous pulmonary venous connection(APVC)associated deformities was discussed.Methods:CTA images of 134 patients with clinically suspicious APVC from 2011 to 2019 were retrospectively analyzed in Beijing Anzhen Hospital and Peking University Shougang Hospital.Through various reconstruction methods,CTA images showed internal and external cardiac malformations.The diagnostic accuracy of CTA was evaluated by comparing with the results of operation and angiography.Results:Of the 134 APVC patients,total anomalous pulmonary venous connection(TAPVC)was diagnosed in 66,and partial anomalous pulmonary venous connection(PAPVC)in 68.DSA and postoperative diagnosis were completely consistent with CTA diagnosis.Single anomalous pulmonary venous connection was the most common(44 cases,64.7%)in patients with PAPVC,while the involvement of the right pulmonary vein was the most common(47 cases,69.1%).Atrial septal defect was the most common coexistent malformation in 95 patients(70.9%).The patients with TAPVC combined with other cardiovascular coexistent malformations were significantly higher than those with PAPVC.A total of 8 patients was diagnosed pulmonary vein or drainage vein stenosis.Conclusions:CTA can accurately diagnose the distribution and connection of anomalous pulmonary veins in patients with APVC,and simultaneously evaluate the accompanying cardiovascular coexistent malformations.