MSCT多维重组技术对肺动脉闭锁的诊断价值  

The Diagnostic Value of MSCT Multi-dimensional Reconstruction for Pulmonary Atresia

作　　者：葛文[1] 宋樟伟[1] 赵雅萍[1] 许崇永[1] 吴爱琴[1] 周忠杰[1] 杨超颖[1] 方必东[1] 

机构地区：[1]温州医学院附属第二医院育英儿童医院,325027

出　　处：《医学研究杂志》2011年第2期55-58,共4页Journal of Medical Research

基　　金：温州市科技局基金资助项目(Y2009189)

摘　　要：目的探讨多层螺旋CT(MSCT)多维重组技术对肺动脉闭锁(PA)的诊断价值。方法回顾性分析9例肺动脉闭锁(PA)患儿的薄层CT增强扫描资料,将数据传至工作站进行多平面重组(MPR)、容积再现技术(VRT)及最大密度投影(MIP),结合手术与超声心动图(UCG)结果分析PA的影像学特点。结果 9例中PA合并室间隔缺损(VSD)者5例;PA不合并VSD者4例,其中3例右心室发育不良及三尖瓣狭窄或闭锁,1例右心室体积基本正常合并三尖瓣重度反流。UCG对PA检出率为77.8%,2例肺动脉瓣闭锁(PVA)均正确诊断,7例肺动脉干闭锁(PTA)正确诊断2例(28.6%),3例误诊为PVA,2例漏诊。MSCT血管成像(MSCTA)对PA诊断准确率为88.8%,其对2例PVA1例正确诊断,另1例疑诊;对7例PTA均正确诊断。6例PA存在侧支血管,MSCTA均能显示侧支来源、数量、走行及直径,UCG均漏诊,其中1例PDA误诊为侧支血管。结论 MSCT多维重组技术对充分显示PA全貌和伴发的心外血管畸形与体肺侧支循环具有重要的诊断价值,UCG对细小心内畸形及心瓣膜的显示可为MSCT提供补充,两者结合应用对包括手术在内的临床治疗具有重要的指导作用。Objective To evaluate the diagnostic value of multi-slice CT（MSCT） and multi-dimensional reconstructions for congenital pulmonary atresia（PA）.Methods The enhanced thin CT images of 9 patients with PA were retrospectively analyzed.The data were transmitted to the workstation for multi-planar reformation（MPR）,volume rendering technique（VRT） and maximum intensity projection（MIP）.The CT imaging features of PA were analyzed combining with operation and Ultrasonic Cardiogram（UCG）.ResultsIn all cases,5 cases were PA with ventricular septal defect（VSD）,4 cases were PA without VSD,including 3 cases with reduced right ventricular volume combined with right ventricular dysplasia and tricuspid stenosis or atresia,1 case with normal right ventricular volume and severe tricuspid regurgitation.The diagnostic rate of UCG on PA was 77.8%.Two cases of PVA were correctly diagnosed.In 7 cases of PTA,UCG correctly diagnosed 2 cases（28.6%）,missed 2 cases,and misdiagnosed 3 cases as PVA.The diagnostic accuracy rate of MSCTA on PA was 88.8%.In 2 cases of PVA,1 case was correctly diagnosed,the other one was suspected of it.All 7 cases of PTA were correctly diagnosed.Six cases of PA had collateral vessels.MSCTA could demonstrate the origin,number,course and diameter of all collateral vessels.UCG missed all 6 patients,and 1 patient was misdiagnosed PDA as collateral vessels.Conclusion MSCT and multi-dimensional reconstruction can well display the whole picture of pulmonary artery,extra-cardiac vascular malformations and collateral circulations between aorta and pulmonary artery in PA.It combined with the ability of UCG in discover the tiny intra-cardiac malformations and valve disease can further improve the diagnostic accuracy of cardiac malformation,give more comprehensive information for surgical and clinical treatment.

关 键 词：肺动脉闭锁 多层螺旋CT 多维重建 超声心动描记术 

分 类 号：R654.2[医药卫生—外科学]