基于计算机断层扫描阈值分割评估儿童法洛四联症心功能的临床应用价值

Clinical value of computed tomography based on volume rendering in assessment of cardiac function in children with tetralogy of Fallot

目的:研究计算机断层扫描(computed tomography,CT)阈值分割评估儿童法洛四联症(tetralogy of Fallot,TOF)心功能的可行性及其临床应用价值。方法:回顾性纳入2018年11月至2019年12月诊断为TOF并行手术治疗的患儿38例,术前、术后6个月随访时行计算机断层扫描血管造影术(computed tomography angiography,CTA)扫描,获取图像,通过阈值分割法评估左、右心功能参数,包括左、右心室舒张末期容积、收缩末期容积、每搏输出量及射血分数。对比分析TOF患儿术前与术后6个月左、右心室容积和心功能参数变化,并进行统计分析。结果:CT基于阈值分割可同时评估TOF患儿左、右心功能参数。术后6个月与术前相比,左心功能参数无明显变化,差异无统计学意义,术后右心室收缩末期容积略高于术前[(23.88±7.44)mL/m^(2)v s(19.67±6.52)mL/m^(2)],但差异无统计学意义(P=0.066),术后右心室舒张末期容积略高于术前[(49.86±14.82)mL/m^(2)vs(46.30±14.46)mL/m^(2)],但差异无统计学意义(P=0.079);术后右心射血分数低于术前(51.47%±4.68%vs 57.84%±5.09%),差异有统计学意义(P=0.001)。结论:基于CT阈值分割可准确评估TOF患儿左、右心功能,可以早期发现术后右心功能下降,从而及时采取干预措施,对TOF患儿预后评估有重要意义。

Objective:To investigate the clinical value of computed tomography(CT)based on volume rendering in evaluating cardiac function in children with tetralogy of Fallot.Methods:Thirty-eight children with tetralogy of Fallot in our hospital from November 2018 to December 2019 were retrospectively enrolled in this study.CT scanning were performed before and 6 months after surgery.CT images were acquired and segmented by volume rendering to evaluate left and right ventricular function parameters including left and right ventricular end-diastolic volume,end-systolic volume,stroke volume,and ejection fraction.The left and right ventricular volume and cardiac function parameter changes of children with tetralogy of Fallot preoperatively and 6 months after operation were statistically compared.Results:CT based on volume rendering can both simultaneously evaluate left and right cardiac function parameters in children with tetralogy of Fallot.There were no significant changes in left ventricular function parameters between the 6 months after surgery and the preoperative period,the difference was not statistically significant.Right ventricular end-systolic volume 6 months after surgery was higher than that in the preoperative period[(23.88±7.44)mL/m^(2)vs(19.67±6.52)mL/m^(2)],but the difference was not statistically significant(P=0.066).Right ventricular end-diastolic volume six months after surgery was higher than preoperative volume[(49.86±14.82)mL/m^(2)vs(46.30±14.46)mL/m^(2)],but the difference was not statistically significant(P=0.079);and the right ventricular ejection fraction was significantly lower than that before surgery(51.47%±4.68%vs 57.84%±5.09%),the difference was statistically significant(P=0.001).Conclusion:CT based on volume rendering can accurately evaluate the preoperative and postoperative left and right cardiac function in children with tetralogy of Fallot,and can detect the early decline of right cardiac function after surgery,which is important for the assessment of prognosis in children with repaired tetralogy of Fallot.