儿童先天性心脏病伴气管支气管狭窄的多层螺旋CT诊断  

Multi-slice spiral CT in the diagnosis of congenital heart diseases associated with tracheobronchial stenosis in children

作　　者：王荣品[2] 梁长虹[1] 黄美萍[1] 刘辉[1] 崔燕海[1] 刘其顺[1] 

机构地区：[1]广东省人民医院广东省医学科学院南方医科大学附属华南医院放射科,广州510080 [2]贵州省人民医院放射科,贵阳550002

出　　处：《中华放射学杂志》2010年第8期811-815,共5页Chinese Journal of Radiology

基　　金：广东省科技攻关基金资助项目（2006B36030026,2009B030801257）;广州市科技攻关基金资助项目（200623-E0241）

摘　　要：目的探讨MSCT后处理技术对儿童先天性心脏病（简称先心病）伴气管支气管狭窄的诊断价值。方法对34例先心病伴气管支气管狭窄的患儿行MSCT对比增强扫描及MPR、CPR、MinIP和VR重组以显示气管支气管狭窄情况，并与经手术证实的32例共43个狭窄节段行对比分析。采用非参数检验（Mann-Whitney test）比较各种后处理技术对狭窄程度测量与术中测量的差异性。结果术中测量狭窄累及范围长短不一，其中气管狭窄段4—39mm；主支气管狭窄段4—33mm；叶支气管狭窄段3—12mm。MSCT测量与手术测量相差最大为4mm（3个节段），其余测量相差均〈3mm。术中测量狭窄程度，轻度6个节段，中度16个节段，重度21个节段。MPR或CPR测量狭窄（轻度5个节段、中度17个节段、重度21个节段）；MinIP测量狭窄（轻度2个节段、中度9个节段、重度32个节段）；VR测量狭窄（轻度4个节段、中度11个节段、重度28个节段）。MPR或CPR和VR测量狭窄程度与术中测量差异无统计学意义（Z=-0．105和-1．479，P均〉0．05）；MinIP与术中测量差异有统计学意义，常过估狭窄程度（Z=-2．484，P=0．013）。结论MSCT扫描及其三维重组技术相互结合能准确评估先心病伴气管、支气管狭窄的程度和范围，为临床制定治疗方案提供重要依据。Objective To explore the diagnostic value of post processing techniques of MSCT for diagnosing congenital heart disease associated with tracheobronchial stenosis in children. Methods Thirty four patients with congenital heart disease complicated by tracheobronchial stenosis were evaluated with MSCT. MPR, CPR, MinIP and VR were performed to show the tracheobronchial morphology. Findings in 43 segments of 32 cases were compared with the findings of surgical operation. Mann-Whitney test was employed to assess the significance of measurement between the post processing techniques and the operation. Results The lenghth of stenotic segments were variable seen at operation, with values between 4-39 mm in trachea, 4-33 mm in main bronchi and 3-12 mm in lobe bronchi, respectively. The biggest difference between the measurement of operation and MSCT was 4 mm （ 3 segments）. Other differences of stenotic segments were within 3 mm. Six segments exhibited mild, 16 moderate and 21 severe stenosis at surgery. By contrast, five segments exhibited mild, 17 moderate and 21 severe stenosis by MPR or CPR, 2 mild,9 moderate and 32 severe stenosis by MinIP and 4 mild, 11 moderate and 28 sever stenosis by VR, respectively. There was no significant difference in measuring the degree of tracheobronchial stenosis between MPR or CPR, VR and the surgery （ Z = - 0. 105, - 1. 479 ; P 〉 0. 05 ）, while MinIP frequently overrated the degree of stenosis compared with the measurement at surgery （Z = -2. 484,P = 0. 013 ）. Conclusion The integrated three dimensional reformations of MSCT scan can accurately evaluate the degree and extent of congenital heart disease associated with tracheobronchial stenosis in children and provide valuable information for clinical management.

关 键 词：心脏缺损 先天性 气管狭窄 体层摄影术 X线计算机 成像 三维 

分 类 号：R816.92[医药卫生—放射医学] R725.4[医药卫生—临床医学]