实时三维经胸超声心动图诊断儿童心脏横纹肌瘤的临床价值

Clinical value of real-time three-dimensional transthoracic echocardiography diagnosis of cardiac rhabdomyoma in children

目的探讨实时三维经胸超声心动图(real-time three-dimensional transthoracic echocardiography,RT-3D-TTE)诊断儿童心脏横纹肌瘤的临床价值。方法2016年3月至2022年3月,在解放军总医院第七医学中心首诊发现的心脏横纹肌瘤患儿中,纳入19例为研究对象,其中15例诊断为结节性硬化症(tuberous sclerosis,TSC)。19例患儿均进行二维经胸超声心动图(two-dimensional transthoracic echocardiography,2D-TTE)及RT-3D-TTE检查,记录横纹肌瘤病灶数量、位置、回声描述、形状、大小等结果。从检出病灶数量、病灶大小、病灶与周边组织关系3个方面比较两者的诊断效能。统计学方法采用χ^(2)检验和配对t检验。结果2D-TTE和RT-3D-TTE检查均发现6例单发病例;多发者13例,每例检出病灶数目2~9个。2D-TTE共检查出病灶58个,RT-3D-TTE检出病灶56个。以2D-TTE为标准,TR-3D-TTE检出心脏横纹肌瘤的敏感性为96.5%(56/58)。RT-3D-TTE遗漏2例最大径<3 mm中等回声的横纹肌瘤。2D-TTE与RT-3D-TTE在检测病灶位置、回声描述及形状方面,差异均无统计学意义(P值均>0.05)。RT-3D-TTE对病灶最大径的测值略高于2D-TTE[(11.6±4.6)与(11.2±5.1)mm],但差异无统计学意义(t=0.414,P>0.05)。RT-3D-TTE发现1例轻度左室流出道梗阻病例,2D-TTE漏诊。与2D-TTE比较,RT-3D-TTE在45个病灶中能更好地观察病灶立体结构与周边组织的关系,诊断效能为A级。结论RT-3D-TTE能够诊断儿童心脏横纹肌瘤,并提供丰富的空间结构信息,具有较高的临床应用价值。

Objective To investigate the clinical value of real-time three-dimensional transthoracic echocardiography(RT-3D-TTE)diagnosis of cardiac rhabdomyoma(CR)in children.Method From March 2016 to March 2022,19 cases of CR diagnosed in the Seventh Medical Center of Chinese PLA General Hospital were included in this study.Among them,15 cases were diagnosed as tuberous sclerosis(TSC).Two-dimensional transthoracic echocardiography(2D-TTE)and RT-3D-TTE were performed in all cases.The number,location,echo description,shape and size of CR lesions were recorded.The diagnostic efficiency of 2D-TTE and RT-3D-TTE was compared by the number,size and relationship with peripheral tissu test and paired t test.Result Six cases with solitary lesion and 13 cases with multiple lesions were detected by 2D-TTE and RT-3D-TTE.In cases with multiple lesions,the numbers of lesions were 2 to 9.The total of 58 lesions were detected by 2D-TTE,while 56 lesions were detected by RT-3D-TTE.The sensitivity of RT-3D-TTE for CR is 96.5%(56/58),compared with 2D-TTE.Two moderate echo of CR lesions were not detected by RT-3D-TTE,diameters of which were less than 3 mm.There were no significant differences in locations,echo description and shape of CR lesions between RT-3DTTE and 2D-TTE(all P>0.05).The diameters of lesions detected by RT-3D-TTE were larger than that by 2D-TTE[(11.6±4.6)vs(11.2±5.1)mm],but there was no significant difference(t=0.414,P>0.05).A case with left ventricle outflow obstruction was detected by RT-3D-TTE,which was not diagnosed by 2D-TTE.In 45 lesions,RT-3D-TTE provided better views for the relationship with peripheral tissue of CR lesions,with diagnostic efficiency level A.Conclusion Application of RT-3D-TTE in the assessment of pediatric CR is feasible.RT-3D-TTE can provide more information of the spatial structure of heart,which is valuable in the diagnosis of pediatric CR.