Computed tomography versus transthoracic echocardiography in the detection of complex congenial heart diseases in china:a meta-analysis

Objective:To perform a meta-analysis to evaluate the diagnostic performance of computed tomography(CT) and transthoracic echocardiography(TTE) in complex congenital heart diseases(CHD) in China.Methods:MEDLINE,Cochrane library and China National Knowledge Infrastructure(CNKI) database from January 1966 to October 2010,were searched for initial studies in China.All the studies,published in English or Chinese,used TTE,CT,or both as diagnostic tests for CHD and reported the rate of true-positive,true-negative,false-positive and false-negative diagnoses of CHD from TTE and CT findings with the surgical results as the 'gold-standard'(15 studies,XX patients) were collected.The statistic software package,'Meta-Disc 1.4',was used to conduct data analysis.A covariate analysis was used to evaluate the influence of patient or study-related factors on sensitivity.Results:Pooled sensitivity for diagnosis of CHD were 95% [95% confidence interval(CI):94%~96%] for CT studies and 87%(95% CI:85%~88%) for TTE studies.The difference between the pooled sensitivity of CT and that of TTE was statistically significant(P<0.001).TTE had higher sensitivity [0.96(95% CI:0.94~0.97)] for cardiac malformation but lower sensitivity [0.78(95% CI:0.76~0.81)] for extracardiac malformation than CT.Conclusion:CT can provide added diagnostic information compared with TTE in patients with CHD in China,especially for patients suspected of extracardiac malformation.

Assessment of Intracardiac and Extracardiac Deformities in Patients with Various Types of Pulmonary Atresia by Dual-Source Computed Tomography

Background:Pulmonary atresia(PA)is a group of heterogeneous complex congenital heart disease.Only one study modality might not get a correct diagnosis.This study aims to investigate the diagnostic power of dualsource computed tomography(DSCT)for all intracardiac and extracardiac deformities in patients with PA compared with transthoracic echocardiography(TTE).Materials and Methods:This retrospective study enrolled 79 patients and divided them into three groups according to their main diagnosis.All associated malformations and clinical information,including treatments,were recorded and compared among the three groups.The diagnostic power of DSCT and TTE on all associated malformations were compared.The surgical index(McGoon ratio,pulmonary arterials index(PAI),and total neopulmonary arterial index)and radiation dose were calculated on the basis of DSCT.Results:Of the patients,32,30,and 17 were divided into the groups of PA with ventricular septal defect(VSD),PA with VSD and major aortopulmonary collateral arteries,and PA with other major malformations,respectively.Consequently,182,162,and 13 intracardiac,extracardiac,and other major malformations were diagnosed,respectively.Moreover,DSCT showed a better diagnostic performance in extracardiac deformities(154 vs.117,p<0.001),whereas TTE could diagnose intracardiac deformities better(159 vs.139,p=0.001).The McGoon ratio,PAI,and treatment methods were significantly different among the three groups(p=0.014,p=0.008,and p=0.018,respectively).Conclusion:More than one imaging modality should be used to make a correct diagnosis when clinically suspecting PA.DSCT is superior to TTE in diagnosing extracardiac deformities and could be used to roughly calculate surgical indices to optimize treatment strategy.

Comparison of Intracardiac and Extracardiac Malformations Associated with Single Atrium,Single Ventricle and Single Atrium-Single Ventricle Using Dual-Source Computed Tomography

Background:To evaluate the qualitative and quantitative differences between intracardiac and extracardiac vascular malformations in patients with a single atrium(SA),single ventricle(SV)and single atrium-single ventricle(SA-SV)using dual-source CT(DSCT),and to compare the diagnostic performances of DSCT and transthoracic echocardiography(TTE).Methods:This retrospective study included 24 SA,75 SV and 24 SA-SV patients who underwent both DSCT and TTE before surgery.The diagnostic values of DSCT and TTE for intracardiac and extracardiac malformations were compared according to the surgical results.The diameters of the major artery and vein were measured and calculated based on DSCT and compared among the three groups.Results:The most common malformation was pulmonary artery disease in SA(50.0%)and SA-SV(45.8%)groups and patent ductus arteriosus(33.3%)in SV group.Although there was no statistical difference,arterial development was relatively poor in the SA group.All groups showed the trend of pulmonary artery stenosis(SA vs.SV vs.SA-SV:50.0%vs.30.7%vs.33.3%).There was a significant difference in mean pulmonary vein index among the groups(p=0.017).The diagnostic sensitivity of DSCT was superior to that of TTE for extracardiac malformations.Conclusions:The most common malformation in SA and SA-SV patients is pulmonary artery stenosis.SV patients are most likely to be complicated with patent ductus arteriosus.DSCT is more advantageous than TTE for diagnosing combined extracardiac malformations and can accurately measure the diameter of arteriovenous vessels.

Current characteristics of congenital coronary artery fistulas in adults:A decade of global experience

AIM:To describe the characteristics of coronary artery fistulas(CAFs) in adults,including donor vessels and whether termination was cameral or vascular. METHODS:A PubMed search was performed for articles between 2000 and 2010 to describe the current characteristics of congenital CAFs in adults.A group of 304 adults was collected.Clinical data,presentations,diagnostic modalities,angiographic fistula findings and treatment strategies were gathered and analyzed.With regard to CAF origin,the subjects were tabulated into unilateral,bilateral or multilateral fistulas and compared.The group was stratified into two major subsets according to the mode of termination;coronary-cameral fistulas(CCFs) and coronary-vascular fistulas(CVFs) . A comparison was made between the two subsets. Fistula-related major complications[aneurysm formation,infective endocarditis(IE) ,myocardial infarction(MI) ,rupture,pericardial effusion(PE) and tamponade] were described.Coronary artery-ventricular multiple micro-fistulas and acquired CAFs were excluded as well as anomalous origin of the coronary arteries from the pulmonary artery(PA) . RESULTS:A total of 304 adult subjects(47%male) with congenital CAFs were included.The mean age was51.4 years(range,18-86 years) ,with 20%older than 65 years of age.Dyspnea(31%) ,chest pain(23%) and angina pectoris(21%) were the prevalent clinical presentations.Continuous cardiac murmur was heard in 82%of the subjects.Of the applied diagnostic modalities,chest X-ray showed an abnormal shadow in 4%of the subjects.The cornerstone in establishing the diagnosis was echocardiography(68%) ,and conventional contrast coronary angiography(97%) .However,multislice detector computed tomography was performed in 16%.The unilateral fistula originated from the left in 69%and from the right coronary artery in 31%of the subjects.Most patients(80%) had unilateral fistulas,18%presented with bilateral fistulas and 2%with multilateral fistulas.Termination into the PA was reported in unilateral(44%) ,bilateral(73%) and multilateral(75%) fistulas.Fistulas with multiple origins(bilateral and multilateral) terminated more frequently into the PA(29%) than into other sites(10.6%)(P=0.000) . Aneurysmal formation was found in 14%of all subjects.Spontaneous rupture,PE and tamponade were reported in 2%of all subjects.In CCFs,the mean age was 46.2 years whereas in CVFs mean age was 55.6 years(P=0.003) .IE(4%) was exclusively associated with CCFs,while MI(2%) was only found in subjects with CVFs.Surgical ligation was frequently chosen for unilateral(57%) ,bilateral(51%) and multilateral fistulas(66%) ,but percutaneous therapeutic embolization(PTE) was increasingly reported(23%,17%and 17%,respectively) . CONCLUSION:Congenital CAFs are currently detected in elderly patients.Bilateral fistulas are more frequently reported and PTE is more frequently applied as a therapeutic strategy in adults.

Coronary artery disease in congenital single coronary artery in adults:A Dutch case series

AIM:To assess the current diagnostic and therapeutic management and the clinical implications of congenital single coronary artery(SCA) in adults.METHODS:We identified 15 patients with a SCA detected from four Dutch angiography centers in the period between 2010 and 2013.Symptomatic patients who underwent routine diagnostic coronary angiography(CAG) for suspected coronary artery disease and who incidentally were found to have isolated SCA were analyzed.RESULTS:Fifteen(7 females) with a mean age of 58.5 ± 13.78 years(range 43-86) had a SCA.ConventionalCAG demonstrated congenital isolated SCA originating as a single ostium from the right sinus of Valsalva in 6 patients and originating from the left in 9 patients.Minimal to moderate coronary atherosclerotic changes were found in 4,and severe stenotic lesions in another 4 patients.Seven patients were free of coronary atherosclerosis.Runs of non-sustained ventricular tachycardia were documented in 2 patients,one of whom demonstrated transmural ischemic changes on presentation.Myocardial perfusion scintigraphic evidence of transmural myocardial ischemia was found in 1 patient due to kinking and squeezing of the SCA with an interarterial course between the aorta and pulmonary artery.Multi-slice computed tomography(MSCT) was helpful to delineate the course of the anomalous artery relative to the aorta and pulmonary artery.Percutaneous coronary intervention was successfully performed in 3 patients.Eight patients were managed medically.Arterial bypass graft was performed in 4 patients with the squeezed SCA.CONCLUSION:SCA may be associated with transient transmural myocardial ischemia and aborted sudden death in the absence of coronary atherosclerosis.The availability and sophistication of MSCT facilitates the delineation of the course of a SCA.We present a Dutch case series and review of the literature.

Prenatal Diagnosis of Proximal Femoral Focal Deficiency Combining Ultrasound and Computer Tomography

Four cases of proximal femoral focal deficiency (PFFD) in an otherwise healthy infant are described. Antenatal diagnosis was made at 27, 23, 23 and 18 weeks of gestation by routine ultrasound (US) examination. Computer Tomography (CT) was performed after 30 weeks of gestation and confirmed the images obtained by US. The diagnosis was confirmed after delivery. These cases illustrate the importance of combining US and CT to improve accuracy of prenatal diagnosis of skeletal disorders.

Comparison of Congenital Coronary Artery Anomalies Between Uyghur and Han： A Multi-slice Computed Tomography Study in Xinjiang, China

Background：The incidence of congenital coronary artery anomalies （CCAAs） is different between ethnic groups,but there is no report about Uyghur CCAAs because of the limitation of inspection methods.This study determined the prevalence of Uyghur CCAAs and analysis the difference of CCAAs between Uyghur and Han ethnic groups by the method of multi-slice computed tomography coronary angiography （MSCTCA）.Methods：Seven thousand four hundred and sixty-nine MSCTCA were analyzed for the CCAAs retroactively,1934 were Uyghur patients while 4746 were Han patients.All the coronary artery images dates obtained by MSCTCA were evaluated for the CCAAs by two doctors.Results：Nineteen kinds of CCAAs were found：（1） The overall incidence of CCAAs was 2.72% （203/7469） among all patients,2.34% （111/4746） among Han patients whereas a significant higher 3.93% （76/1934） among Uyghur patients （χ^2 =12.780,P 〈 0.05）; （2） the incidence of CCAAs among male patients was 2.48% （76/3069） in Han while 4.33% （56/1293） in Uyghur （χ^2 =10.663,P 〈 0.05）; （3） the incidence of CCAAs on the left side was 1.07% （51/4746） among Han patients while 2.17% （42/934） among Uyghur patients （χ^2 =12.047,P 〈 0.05）; （4） among these 19 kinds of CCAAs,there were significant differences of the incidence of the following kinds of CCAAs between Uyghur and Han：Left coronary artery （LCA） high location （χ^2 =8.320,P =0.004）,right coronary artery （RCA） originate from left coronary sinus （χ^2 =5.450,P =0.020）,and RCA originate from left Coronary sinus ＋ LCA high location （P =0.024）.Conclusions：There exists some difference in CCAAs between Uyghur and Han ethnic groups.The CCAAs incidence of Uyghur is higher than that of Han,especially in male patients and on the left side; among all kinds of CCAAs,the incidence of LCA high location,RCA originate from left coronary sinus,RCA originate from left coronary sinus ＋ LCA high locations of Uyghur is higher than Han.

宽体探测器CT血管造影与超声心动图对小儿先天性心脏病的诊断效能

目的探讨宽体探测器CT血管造影(computer tomography angiography,CTA)与超声心动图(ultrasound cardiogram,UCG)在小儿先天性心脏病(congenital heart disease,CHD)的诊断效能。方法回顾性分析2019-08/2023-09月作者医院收治的65例疑似CHD患儿的影像学资料,所有患儿均行心脏CTA及UCG检查。对两种检查方式的图像质量进行主观评价并比较其差异;以手术或数字减影血管造影(digital subtraction angiography,DSA)为“金标准”,对比两种检查方式在诊断CHD的灵敏度、特异度、阳性预测值、阴性预测值及准确率的差异,并应用Kappa检验比较与“金标准”结果的一致性;采用受试者工作特征(receiver operating characteristic,ROC)曲线分析两种检查方式对小儿CHD的诊断效能。结果CTA诊断小儿CHD心外畸形图像质量主观评分明显高于UCG,二者比较差异具有统计学意义(P<0.05),心内畸形图像质量主观评分二者比较差异无统计学意义(P>0.05)。两名医师对图像质量主观评分的一致性较好(κ=0.802)。CTA、UCG诊断小儿CHD心内畸形准确率比较差异无统计学意义(P>0.05);CTA诊断小儿CHD心外畸形准确率为96.43%,显著高于UCG 50.00%,组间比较差异具有统计学意义(P<0.05)。CTA诊断小儿CHD的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为90.00%、60.00%、96.43%、33.33%及87.69%,与手术或DSA结果一致性较好(κ=0.766);UCG诊断CHD的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为83.33%、20.00%、92.59%、9.09%及79.81%,与手术或DSA结果一致性一般(κ=0.522)。CTA、UCG两种检查方式诊断小儿CHD的灵敏度、特异度、阴性预测值及准确率差异比较均有统计学意义(P均<0.05)。ROC曲线分析结果显示,CTA与UCG诊断小儿CHD的曲线下面积(area under the cure,AUC)分别为0.853和0.773,二者比较差异有统计学意义(P<0.05)。结论宽体探测器CTA在小儿CHD心外畸形方面的诊断效能优于UCG,而在心内畸形方面稍差,因此建议二者联合检查,诊断价值更高。

先天性心脏病术后右心功能影像学评估研究进展

右心功能恢复是维持心脏病术后患者循环稳定的关键,也是复杂先天性心脏病二期手术时期的重要参考因素。但右心室的复杂几何形态和室壁运动对右心功能的无创评估造成一定困难。心脏磁共振(CMR)是常用影像学方法中的“金标准”,复杂先天性心脏病术后需定期做CMR检查。CMR新技术的应用主要包括4D flow血流动力学测量、定量成像和示踪技术,根据心肌损伤程度评估右心室功能。超声心动图是应用最广的一线影像学检查,适用于所有先天性心脏病术后心功能评估,超声斑点追踪技术的发展已更加成熟。心脏计算机断层扫描评估血管和累及肺部病变具有突出优势,常作为CMR的替代方案。人工智能在图像处理技术的发展大幅度提升了影像学检查的诊断和预测价值。本文对CMR、超声心动图和心脏计算机断层扫描的特点和评估先天性心脏病术后右心功能的研究进展进行综述。

CT Image-based Analysis on the Defect of Polypropylene Fiber Reinforced High-Strength Concrete at High Temperatures

With the application of X-ray computed tomography（CT） technology of C80 high-strength concrete with polypropylene fiber at elevated temperatures, the microscopic damage evolution process observation and image building could be obtained, based on the statistics theory and numerical analysis of the combination of concrete internal defects extension and evolution regularity of microscopic structure. The expermental results show that the defect rate has changed at different temperatures and can determine the concrete degradation threshold temperatures. Also, data analysis can help to establish the evolution equation between the defect rate and the effect of temperature damage, and identify that the addition of polypropylene fibers in the high strength concrete at high temperature can improve cracking resistance.

Double-chambered left ventricle with a thrombus in an asymptomatic patient:A case report

BACKGROUND Double-chambered left ventricle(DCLV)is an extremely rare congenital disease in which the left ventricle(LV)is divided by abnormal muscle tissue.Due to its rarity,there is a lack of data on the disease,including its diagnosis,treatment,and prognosis.Accordingly,we report a case in which DCLV was diagnosed and followed up.CASE SUMMARY A 45-year-old man presented to our hospital due to abnormal findings on an electrocardiogram recorded during a health check.He had no specific cardiac symptoms,comorbidities or relevant past medical history.Echocardiography revealed that the LV was divided into two by muscle fibers.There were no findings of ischemia on coronary angiography and coronary computed tomography angiography performed to exclude differential diagnoses.After comprehensive analysis of the images,DCLV was diagnosed.As it seemed to be asymptomatic DCLV,we decided the patient was to be observed without administering any medication.However,follow-up echocardiography revealed a thrombus in the accessory chamber(AC).Anticoagulant medication was initiated,the thrombus resolved,and the patient is currently undergoing follow-up without any specific symptoms.CONCLUSION Asymptomatic,uncomplicated DCLV was diagnosed through multimodal imaging;however,a thrombus in the AC occurred during the follow-up.The findings highlight that multimodal imaging is essential in diagnosing DCLV,and that anticoagulation is important in its management.

儿童复杂性先天性心脏病超声心动图与多层螺旋CT检查及应用的临床效果观察

目的:观察儿童复杂性先天性心脏病超声心动图与多层螺旋CT检查及应用的临床效果。方法:回顾性分析开封市中心医院2011年1月-2022年1月收治的50例患有复杂性先天性心脏病儿童的临床资料。所有患儿入院时均进行超声心动图与多层螺旋CT检查,以手术病理为金标准,分析两种检查方式对复杂性先天性心脏病的诊断效果。结果:50名患儿中,共发现178种心脏畸形,包括71种心内畸形及107种心外畸形。多层螺旋CT对心外畸形的检出率为98.13%,高于超声心动图的84.11%,差异有统计学意义(χ^(2)=11.321,P<0.05)。多层螺旋CT检查对心内畸形的检出率为95.77%,超声心动图检出率为92.96%,差异无统计学意义(χ^(2)=0.133,P>0.05)。结论:多层螺旋CT和超声心动图对复杂性先天性心脏病的阳性检出率较高,但多层螺旋CT在诊断心外畸形方面优于超声心动图。

320排CT心脏四维容积动态成像评价先天性心脏病患者左心室功能研究

目的:探讨320排CT心脏四维容积动态成像(4D-CCTA)评价先天性心脏病(CHD)患者左心室功能的价值。方法:选取医院收治的12例CHD患者,所有患者均行4D-CCTA检查及二维超声心动图检查,记录并对比患者左心室舒张末期容积(EDV)、收缩末期容积(ESV)、每搏输出量(SV)以及射血分数(EF)等指标;分析两种检查方法所测定结果的相关性以及4D-CCTA检查在先天性心脏病左心室功能检查中的价值。结果:4D-CCTA检查测定的EDV、SV及EF高于二维超声心动图测量值,ESV低于二维超声心动图测量值,但差异均无统计学意义。Pearson线性相关分析显示,4D-CCTA与二维超声心动图两种检查方式测定的EDV、ESV、SV及EF均具有较好的相关性(r=0.962,r=0.928,r=0.925,r=0.909;P<0.05)。4D-CCTA与二维超声心动图检查的受试者工作特征(ROC)曲线下面积(AUC)分别为0.892及0.875。结论:4D-CCTA与二维超声心动图在评价CHD患者左心室功能方面具有较高的相关性,能够准确评估CHD患者的左心室功能。

低辐射剂量宽探测器CT智能心电门控技术对儿童先天性心脏病冠状动脉的可视性评估

目的结合智能心电门控技术探讨低辐射剂量冠状动脉血管成像(CCTA)对先天性心脏病患儿冠状动脉成像的检出率、图像质量及辐射剂量。资料与方法前瞻性招募2017年11月—2020年9月青岛市妇女儿童医院确诊或拟确诊为先天性心脏病患儿79例,应用80 kVp低管电压、智能心电门控前瞻性心电门控轴扫序列行CCTA扫描。按年龄分为≤3个月18例、≥4个月~<1岁29例及≥1岁32例,研究低电压智能心电门控扫描技术对不同年龄患儿行CCTA的可行性,并分析3组图像质量、冠状动脉检出率、显示效果、主动脉根部CT值、显示效果及有效辐射剂量(ED)。结果3组11个节段总检出率为90.1%(783/869),左冠状动脉总体检出率为90.4%(500/553),右冠状动脉总体检出率为89.6%(283/316)。≤3个月、≥4个月~<1岁及≥1岁组冠状动脉检出率分别为84.8%(168/198)、90.3%(288/319)及92.9%(327/352),差异有统计学意义(χ^(2)=9.225,P=0.010)。右冠状动脉起源部位显示效果最佳检出率达100%(79/79),左前降支远段、左回旋支远段及右冠状动脉远段最差,检出率低于80%。3组的噪声指数分别为(10.4±2.0)Hu、(9.7±1.8)Hu和(10.9±2.2)Hu,主动脉根部CT值分别为(609±122)Hu、(547±110)Hu和(568±93)Hu。3组的ED分别为(1.33±0.32)mSv、(0.99±0.16)mSv和(0.78±0.14)mSv,差异有统计学意义(F=39.750,P<0.05),年龄越小,ED越大。结论对于>1岁的先天性心脏病患儿,低电压宽探测器CT前瞻性心电门控CTA扫描ED较小,对冠状动脉检出率高。对于<1岁,尤其是≤3个月的患儿,冠状动脉检出率较高,但ED略大,应结合临床需求综合考虑。

先天性心脏病小儿MSCT心脏成像后血管空气栓塞分析

目的:分析接受MSCT心脏成像检查的先天性心脏病(CHD)小儿发生血管空气栓塞(VAE)的原因、风险及预防方法。方法:连续纳入490例CHD小儿MSCT心脏成像资料,记录空气栓子出现部位、大小、形状及数量,评估CHD小儿VAE发生率和相关风险因素。结果:VAE发生率为9.2%(45/490),45例VAE中发生于右心房66.7%(30/45)、主肺动脉22.2%(10/45)、右心室11.1%(5/45)、主动脉根部6.6%(3/45)、左锁骨下静脉2.2%(1/45)、左心室2.2%(1/45);静脉系统VAE 91.1%(41/45),动脉系统VAE 8.9%(4/45);单处88.9%(40/45),多处11.1%(5/45);小量VAE 75.6%(34/45),中等量VAE 24.4%(11/45),无大量VAE。共发现90个气泡,圆形或类圆形57.8%(52/90),不规则形42.2%(38/90)。发生VAE组与未发生VAE组患儿的年龄、身高、体重、性别、有无心内或肺内分流、静脉留置针型号及对比剂注射流率、剂量、类型、回流路径差异均无统计学意义(P>0.05)。结论:CHD小儿MSCT心脏成像检查中VAE发生率低且多数空气栓子较小、多无症状,但仍存在较高潜在医疗风险需引起重视,在检查过程中应仔细排气并运用一些操作技巧及措施以避免其发生。

Patient-specific three-dimensional printed heart models benefit preoperative planning for complex congenital heart disease

Background Preoperative planning for children with congenital heart diseases remains crucial and challenging.This study aimed to investigate the roles of three-dimensional printed patient-specific heart models in the presurgical planning for complex congenital heart disease.Methods From May 2017 to January 2018,15 children diagnosed with complex congenital heart disease were included in this study.Heart models were printed based on computed tomography (CT) imaging reconstruction by a 3D printer with photosensitive resin using the stereolithography apparatus technology.Surgery options were first evaluated by a sophisticated cardiac surgery group using CT images only,and then surgical plans were also set up based on heart models.Results Fifteen 3D printed heart models were successfully generated.According to the decisions based on CT,13 cases were consistent with real options,while the other 2 were not.According to 3D printed heart models,all the 15 cases were consistent with real options.Unfortunately,one child diagnosed with complete transposition of great arteries combined with interruption of aortic arch (type A) died 5 days after operation due to postoperative low cardiac output syndrome.The cardiologists,especially the younger ones,considered that these 3D printed heart models with tangible,physical and comprehensive illustrations were beneficial for preoperative planning of complex congenital heart diseases.Conclusion 3D printed heart models are beneficial and promising in preoperative planning for complex congenital heart diseases,and are able to help conform or even improve the surgery options.

64层螺旋CT诊断复杂先天性心脏病及与超声心动图和手术对照

目的探讨64层螺旋CT对复杂先天性心脏病(简称复杂先心病)的诊断价值。资料与方法对25例复杂先心病患者的心脏CT和超声心动图(TTE)进行回顾性分析,并与手术结果对照。全部病例均经手术证实。结果25例患者中手术证实畸形79处,64层螺旋CT与TTE诊断的准确率分别为96%和73%。其中,心脏部分畸形29处,64层螺旋CT漏误诊2处,TTE漏误诊4处,两种检查的诊断准确率差异无统计学意义。心脏-大血管连接部及大血管部分畸形50处,64层螺旋CT漏误诊1处,TTE漏误诊17处,两种检查的诊断准确率差异有统计学意义。结论64层螺旋CT在复杂先心病诊断中畸形的检出率优于TTE,诊断准确率达96%,特别是对主动脉、肺动脉及肺静脉畸形的显示具有明显优势。

多层螺旋CT对复杂型先天性心脏病的诊断价值

目的探讨多层螺旋CT(MSCT)对比增强及后处理技术对复杂型先天性心脏病(CCHD)的诊断价值。资料与方法分析35例经手术证实的CCHD的MSCT资料,术前均行经胸心脏二维超声(TTE)检查,其中17例有X线心血管造影(CAG)对照。结果手术证实畸形共136处,MSCT、TTE及CAG总的诊断准确性分别为94.9%、72.1%,95.3%;其中心脏畸形47处,MSCT漏诊4处,TTE漏诊2处,CAG漏诊1处,3种检查的诊断准确性差异无统计学意义(χ2=0.89,P>0.05);心脏大血管连接部及大血管畸形共计89处,MSCT、TTE、CAG诊断准确性分别为96.6%,59.6%,95.1%,MSCT(χ2=35.76,P<0.01)及CAG(χ2=17.17,P<0.01)诊断准确性明显高于TTE,MSCT与CAG诊断准确性差异无统计学意义(χ2=0.17,P>0.05);MSCT与TTE联合应用可提高诊断准确性达97.8%。结论MSCT能客观清晰地显示CCHD的病理解剖形态,对心脏大血管连接部及大血管畸形的诊断明显优于TTE,在CCHD的无创性检查中具有较高的诊断价值。

电子束CT和超声心动图在诊断先天性心脏病中的对照研究

目的探讨电子束CT(electron beam computed tomography,EBCT)和超声心动图在先天性心脏病(简称先心病)诊断中的价值。方法32例经临床及经胸超声心动图(transthoracic echocardiography,TTE)诊断为先心病的患者进行EBCT心血管造影检查,与导管法心血管造影检查和手术结果进行对照。结果32例患者中,EBCT总体诊断符合率87·5%(28/32),TTE诊断符合率78.1%(25/32)。EBCT对心外及大血管与房室连接诊断准确率为96.6%(57/59),明显优于TTE的66.1%(39/59)。而TTE对心内畸形的诊断准确率为97.7%(43/44),高于EBCT的81.8%(36/44)。EBCT与TTE两者结合,可将诊断准确率提高为96.9%(31/32)。结论EBCT对先天性心脏病有重要的诊断价值,尤其对心外及大血管与房室连接关系诊断准确率较高。将EBCT与TTE检查相结合,可大大提高对各种先心病的诊断准确率。

256层多排探测器螺旋CT在儿童复杂先心病中的临床应用研究

目的:探讨256层多排探测器螺旋CT(256层CT)在儿童复杂先天性心脏病(CCDH)中的临床应用研究。方法:回顾性分析2009年8月—2011年5月在我院行256层CT心脏血管成像(CTA)和经胸部超声心动图(TTE)检查的69例14岁以下CCDH患儿的临床资料,所有患儿均经手术证实。CTA、TTE结果与手术结果对照,比较256层CT与TTE的诊断优势。结果:256层CT与TTE诊断心脏部分畸形的检出率分别为91.3%和98.8%,差异无显著统计学意义(P=0.07);256层CT与TTE诊断心脏大血管连接部畸形的检出率分别为95.7%和97.8%,差异无显著统计学意义(P=1.0);256层CT与TTE诊断心外大血管畸形的检出率分别为97.3%和84.0%,差异有显著统计学意义(P=0.012)。结论:256层CT在CCDH的诊断中检出率很高,尤其是在心外大血管畸形的诊断中,其检出率优于TTE。