超声心动图联合CT造影诊断先天性冠状动脉瘘的诊断价值

The value of echocardiography combined with CT angiography in the diagnosis of congenital coronary artery fistula

目的 通过诊断效能剖析经胸超声心动图(TTE)联合冠状动脉CT血管造影(CTA)诊断先天性冠状动脉瘘(CAF)的准确性,阐述其影像学特征并讨论两种检查方式的诊断价值。方法 经PACS系统选取陕西省人民医院2016~2021年间先行TTE怀疑冠状动脉瘘的患者22例,再行CTA后,均经外科手术或冠状动脉造影后确诊冠状动脉瘘患者16例,其他患者6例。采用多因素logistic回归分析,绘制受试者工作特征(ROC)曲线分析来评估三种诊断方式的性能。结果 16例冠状动脉瘘患者中,Ⅰ型瘘入右心室1例;Ⅱ型瘘入右心房1例;Ⅲ型瘘入左心室3例;Ⅳ型瘘入左心房1例;Ⅴ型瘘入肺动脉10例。其中TTE确诊13例,漏诊3例;CTA确诊14例,漏诊2例;TTE联合CTA确诊15例,漏诊1例。漏诊均为左冠状动脉-肺动脉瘘。其中8例为多发瘘口,瘘口内径1.0~9.6 mm,6例形成冠状动脉瘤,较大者117×51 mm。经诊断效能分析,TTE联合CTA诊断CAF特异度(83.3%)高于TTE(50.0%)和CTA(66.7%),TTE联合CTA诊断CAF敏感度(93.7%)高于TTE(81.3%)和CTA(87.5%),TTE联合CTA诊断CAF阴性预测值(83.3%)高于TTE(50.0%)和CTA(66.7%),ROC曲线下面积TTE(AUC=0.906,95%CI:0.780~1.000,P<0.05),CTA(AUC=0.938,95%CI:0.834~1.000,P<0.05),TTE联合CTA(AUC=0.969,95%CI:0.895~1.000,P<0.05)。结论 TTE联合CTA诊断结果得出,先天性冠状动脉瘘Ⅴ型较为常见。经胸超声心动图联合CT血管造影提高诊断效能,值得临床推广应用。

Objective To analyze the accuracy of transthoracic echocardiography(TTE) combined with coronary computed tomography angiography(CTA) in the diagnosis of congenital coronary artery fistula(CAF),and to describe its imaging features and discuss the diagnostic value of the two examination methods.Methods A total of 22 patients with coronary artery fistula suspected by TTE in Shaanxi Provincial People's Hospital from 2016 to 2021 were selected by PACS system,and then CTA was performed.Sixteen patients with coronary artery fistula were confirmed by surgery or coronary angiography,and 6 other patients.Multivariate logistic regression analysis was used to plot receiver operating characteristic(ROC) curve analysis to evaluate the performance of the three diagnostic modalities.Results Among 16patients with coronary artery fistula,1 patient had type I fistula into the right ventricle.Type II fistula into the right atrium in 1 case;Type III fistula into the left ventricle in 3 cases;Type IV fistula into the left atrium in 1 case;V-type fistula into pulmonary artery in 10 cases.Among them,13 cases were confirmed by TTE and 3 cases were missed.CTA was confirmed in 14 cases and missed in 2 cases.15 cases were diagnosed by TTE combined with CTA,and 1 case was missed.All missed diagnoses were left coronary artery-pulmonary artery fistula.Among them,8 cases had multiple fistulas,the inner diameter of the fistulas was 1.0~9.6 mm,and 6 cases formed coronary aneurysms,the larger of which was 117×51 mm.The specificity of TTE combined with CTA in the diagnosis of CAF(83.3%) was higher than that of TTE(50.0%) and CTA(66.7%).The sensitivity of TTE combined with CTA in the diagnosis of CAF(93.7%) was higher than that of TTE(81.3%) and CTA(87.5%).The negative predictive value of TTE combined with CTA in the diagnosis of CAF(83.3%) was higher than that of TTE(50.0%) and CTA(66.7%).Area under ROC TTE(AUC=0.906,95%CI:0.780~1.000),CTA(AUC=0.938,95%CI:0.834~1.000),TTE combined with CTA(AUC=0.969,95%CI:0.895~1.000).The differences were statistically significant(P<0.05).Conclusion The combined use of TTE and CTA improves the diagnostic efficiency of CAF,with type V fistulas being the most common.The findings suggest that transthoracic echocardiography combined with CT angiography has clinical value and should be considered for broader application.