摘要
目的:研究64层螺旋CT对复杂先天性心脏病的扫描方法、图像的后处理方法及诊断程序,并与Echo及金标准(手术结果或DSA结果)相比较,探讨64层螺旋CT血管造影在复杂先天性心脏病诊断及手术治疗中的临床应用价值。方法:回顾性分析26例(其中男12例,女14例,平均年龄17.13±16.24岁,中位年龄14岁,最大55岁,最小54d)34种畸形的复杂先天性心脏病患者MSCTA资料,并与金标准(手术结果或DSA结果)及Echo结果比较研究。所有原始图像采用AW4.3工作站进行后处理。结果采用SPSS 13统计软件分析。对心内结构和心外结构异常的诊断,均分别统计Echo组和MSCTA组的灵敏度和假阴性率,并就两组间的灵敏度进行卡方检验,两组间诊断符合性进行一致性检验。对心内外全部结构异常的诊断,分别统计Echo、MSCTA、MSCTA+Echo组的灵敏度和假阴性率,并就三组间的灵敏度进行卡方检验,以及三组间两两诊断符合性的一致性检验。P<0.05差异有统计学意义。结果:26例患者,共有心内外结构异常34种,其中心内结构异常8种,心外结构异常26种。结合手术结果或DSA结果,共发现心内、外血管结构异常131处,其中心内结构异常34处,心外大血管异常97处。MSCTA、Echo诊断心内畸形灵敏度分别为67.65%(23/34)、97.06%(33/34)(χ2=10.12,P=0.001<0.05),假阴性率分别为32.35%(11/34)、2.94%(1/34);MSCTA、Echo诊断心外畸形灵敏度分别为93.81%(91/97)、67.01%(65/97)(χ2=22.12,P<0.000<0.05),假阴性率分别为6.19%(6/97)、32.99%(32/97);MSCTA组、Echo组、MSCTA+Echo组诊断CCHD的灵敏度分别为87.02%(114/131)、74.81%(98/131)、94.66%(124/131)(χ2=21.18,P<0.0001<0.05),假阴性率分别为12.98%(17/131)、25.19%(33/131)、5.34%(7/131)。结论:MSCTA能够用于评价复杂先天性心脏病的形态学改变,特别表现在能够准确评价心外大血管解剖形态、排列关系、冠状动脉的解剖变异及心外侧支循环空间位置关系。MSCTA与Echo联合,有助于提高复杂先天性心脏病的诊断灵敏度。三维重建图像能在术前准确提供心脏大血管的起源与解剖形态、异常侧支循环的分布情况和一些常见并发症,有助于术前手术方案的制定和完善,以及对术后患者进行追踪及疗效评价。
Purpose：The aim of our study was to approach the scan type,imaging post processing mode and diagnostic program of 64-slice spiral computer tomography in the detection of complex congenital heart disease（CCHD）,to evaluate the value of multi-slice spiral computer tomography angiography（MSCTA） in the detection of deformities in patients with complex congenital heart disease（CCHD）, and to compare the consequence with gold standard（operation treat or digital subtraction angiography（DSA） consequence）,MSCTA and echocardiography（Echo）.Methods： MSCTA and echocardiography were performed in 26 patients（male 12,female 14,mean age 17.125 years old,oldest 55 years old,youngest 54 days） with known complex congenital heart disease,the consequence was compared with gold standard（operation or DSA） and echocardiography.All MSCTA raw images were reconstructed with multiple planar reconstruction（MPR）,maximum intensity projection（MIP）,surface shaded display（SSD） and volume rendering（VR）.Statistics of the consequence were done by SPSS13.All patients were divided into two groups（the group of Echo and the group of MSCTA） to evaluate the diagnosis of intracardiac or extracardiac malformation.An evaluation of diagnostic test（sensitivity and miss-diagnosis rate）,and sensitivity＇s chi square test,consistency test were done between the two group,P0.05 was used as statistical significance.All patients were divided into three groups（the group of Echo,the group of MSCTA and the group of MSCTA＋Echo） to evaluate the diagnosis of CCHD,an evaluation of diagnostic test（sensitivity and miss-diagnosis rate）,and sensitivity＇s chi square test,consistency test were done within the three group,P0.05 was used as statistical significance.Results： There were 34 kinds of cardiovascular malformations,8 kinds of intracardiac malformation,and 26 kinds of extracardiac malformation.The total of 131 anomalies were diagnosed,including 34 intracardiac and 97 extracardiac malformations.The diagnosis sensitivity on intracardiac malformation of MSCTA,Echo were 67.65%（23/34）,97.06%（33/34）（χ2=10.12,P=0.0010.05）,with their miss-diagnosis rate were 32.35%（11/34）,2.94%（1/34）.The diagnosis sensitivity on extracardiac malformation of MSCTA,Echo were 93.81%（91/97）,67.01%（65/97）（χ2=22.12,P0.0000.05）,with their miss-diagnosis rate were 6.19%（6/97）,32.99%（32/97）.The diagnosis sensitivity on CCHD of MSCTA,Echo,MSCTA＋Echo were 87.02%（114/131）,74.81%（98/131）,94.66%（124/131）（χ2=21.18,P0.00010.05）,with their miss-diagnosis rate were 12.98%（17/131）,25.19%（33/131）,5.34%（7/131）.Conclusion：Morphological alteration of complex congenital heart disease could be estimated by MSCTA.It could exactly appraise of great vessels＇ anatomic form,disposed relation,dissection anomalism of coronary artery,dimensional position relation of collateral circulation exceptionally.MSCTA and Echo may become an alternative method in the detection of complex congenital heart disease.The combination of both is helpful to provide a final diagnosis and also to improve the management of that.Some common complication and preoperative information,such as origin and anatomic form of great vessels,distribution of abnormal collateral circulation,could be exactly displayed with three-dimensional reconstruction image.
出处
《中国医学计算机成像杂志》
CSCD
北大核心
2010年第6期475-486,共12页
Chinese Computed Medical Imaging
