Dual-source Computed Tomography for the Diagnosis of Patients with Congenital Heart Disease
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摘要:
目的 探讨双源计算机断层摄影(dual-source computed tomography, DSCT)诊断先天性心脏病(先心病)的临床应用价值。 方法 DSCT增强扫描检查先心病患者20例, 年龄4个月~53岁, 平均19岁; 所有病例均以心脏超声(echocardiography, ECHO)为对照, 并经手术证实。 结果 20例患者经手术证实的心内外结构畸形共63处, DSCT检出59处, 诊断敏感性为93.7%;ECHO检出55处, 诊断敏感性87.3%, 两种方法诊断敏感性比较差异无统计学意义(χ2=1.474, P=0.225)。63处结构畸形中, 心脏部分畸形41处, DSCT检出37处(90.2%), ECHO检出37处(90.2%), 两者敏感性相当(P=1.000);心脏-大血管连接处畸形9处, DSCT检出9处(100%), ECHO检出8处(88.9%), 差异无统计学意义(P > 0.05);大血管部分畸形13处, DSCT检出13处(100%), ECHO检出10处(76.9%), 差异无统计学意义(P > 0.05)。 结论 DSCT能够显示心内外结构畸形, 具有较高的诊断敏感性, 对先天性心脏病, 特别是合并心外大血管畸形的诊断有重要价值。 -
关键词:
- 心脏缺损,先天性 /
- 断层摄影术,X线计算机 /
- 超声心动描记术
Abstract:Objective To evaluate the value of dual-source computed tomography (DSCT) in the diagnosis of congenital heart disease. Methods Twenty patients aged 4 months to 53 years (mean age 19 years) with congenital heart disease underwent contrast-enhanced DSCT. The results were compared with those of echocardiography (ECHO) and confirmed by surgery. Results Among the 20 patients, DSCT detected 59 of 63 (93.7%) anomalies that confirmed by surgery, and ECHO detected 55 of 63 (87.3%) (χ2=1.474, P=0.225). In the 41 intracardiac anomalies, DSCT was as sensitive as ECHO (both 90.2%, P=1.000). In the 9 heart-vessel conjunction deformities, no significant difference was found between the sensitivities of two modalities (100% vs. 88.9%, P > 0.05). In the 13 great vessel deformities, no significant difference was found between the sensitivities of two modalities (100% vs. 76.9%, P > 0.05). Conclusion DSCT detects intra- and extra-cardiac anomalies with high sensitivity and has an important value in the diagnosis of congenital heart disease especially those with extra-cardiac anomoalies. -
Key words:
- heart defects, congenital /
- tomography, X-ray computed /
- echocardiography
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表 1 先心病患者双源CT与心脏超声诊断比较
畸形类型 手术证实数 DSCT ECHO 诊断数 误诊数 漏诊数 诊断数 误诊数 漏诊数 心脏内部结构异常 41 37 4 37 4 室间隔缺损 11 11 11 房间隔缺损 8 8 7 1 二尖瓣脱垂 1 1 1 三尖瓣脱垂 1 1 1 三尖瓣下移畸形 1 1 1 三尖瓣闭锁 1 1 1 肺动脉瓣二叶瓣 3 1 2 3 肺动脉瓣狭窄 7 6 1 7 右室流出道狭窄 8 8 8 心脏-大血管连接异常 9 9 8 1 1 主动脉骑跨 6 6 6 大动脉转位 1 1 1 右室双出口 1 1 1 肺静脉畸形引流 1 1 1 1 大血管异常 13 13 10 2 3 动脉导管未闭 5 5 5 肺动脉狭窄 4 4 4 1 永存左上腔静脉 1 1 1 1 冠状动脉变异 2 2 2 冠状动脉瘘 1 1 1 总计 63 59 55 3 8 DSCT:双源计算机断层摄影; ECHO:心脏超声 表 2 先心病患者双源CT与心脏超声诊断敏感性比较[n (%) ]
检查方法 心脏内部结构异常 心脏-大血管连接异常 大血管异常 总计 ECHO 37/41 (90. 2) 8/9 (88. 9) 10/13 (76. 9) 55/63 (87. 3) DSCT 37/41 (90. 2) 9/9 (100. 0) 13/13 (100. 0) 59/63 (93. 7) χ2 - - - 1.474 P 1. 000 1. 000 0. 220 0. 225 DSCT、ECHO:同表 1 -
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