MSCT术前评价复杂性先天性心脏病伴随的肺静脉异位引流的价值  

Diagnostic Value of MSCT in Patients with APVC Associated with Complex Congenital Heart Disease

作　　者：刘晶哲 许玉峰[2] 祁丹妮 白燕 刘志博 陆萍 吴清玉 

机构地区：[1]清华大学第一附属医院放射科,100016 [2]大学第一医院医学影像科,北京100034 [3]清华大学第一附属医院心脏中心,100016

出　　处：《临床放射学杂志》2011年第5期644-648,共5页Journal of Clinical Radiology

基　　金：清华大学伍舜德基金资助项目(编号:202400008009)

摘　　要：目的评价MSCT对肺静脉异位引流的诊断价值。资料与方法回顾性分析35例经外科手术证实的肺静脉异位引流患者的临床和影像检查资料。以术中所见作为参考标准,评价MSCT、经胸超声心动(TTE)和心导管造影检查对肺静脉异位引流患者的诊断准确性。同时评估异位引流肺静脉的形态。结果 35例肺静脉异位引流患者中有25例为复杂性肺静脉异位引流,10例为单纯性肺静脉异位引流。MSCT正确诊断了所有肺静脉异位引流的患者,单纯性和复杂性肺静脉异位引流患者中MSCT与外科结果的一致性均为100%。心导管造影检查未能诊断5例复杂性肺静脉异位引流,单纯性和复杂性肺静脉异位引流患者中心导管造影与外科结果的一致性分别为100%和75%。TTE检查中有9例与外科结果不符,其中8例为复杂性肺静脉异位引流,单纯性和复杂性肺静脉异位引流患者中TTE与外科结果的一致性分别为90%和68%。在单纯性肺静脉异位引流中,MSCT和TTE(χ2=0.48,P=0.52)、MSCT和心导管(χ2=1.07,P=0.30)诊断一致性的差异均无统计学意义。在复杂性肺静脉异位引流中,MSCT和TTE(χ2=7.29,P=0.007)、MSCT和心导管(χ2=4.73,P=0.030)诊断一致性的差异均有统计学意义。MSCT清楚显示了11例异位引流肺静脉发育不良。结论 MSCT评价复杂性肺静脉异位引流的价值优于TTE和心导管造影检查。Objective To evaluate the diagnostic accuracy of MSCT in patients with APVC associated with complex cardiac abnormality.Materials and Methods The clinical and imaging data of 35 patients with APVC confirmed by surgery were retrospectively reviewed.Using surgical findings as the reference standard,diagnostic agreement of MSCT,TTE and cardiac catheterization for detection of APVC were calculated.Configurations of abnormal pulmonary veins were also evaluated.Results Of all 35 patients,25 patients were grouped as complex APVC and 10 patients were isolated APVC.MSCT correctly diagnosed APVC in all patients and the diagnostic agreements between MSCT and surgery were both 100% in isolated and complex group.All 5 APVCs which could not be detected at cardiac catheterization were in complex group,and the diagnostic agreements were 100% and 75% in isolated and complex groups respectively.At TTE,eight of nine disagreed patients were complex cases.The diagnostic agreements of TTE were 90% and 68% in isolated and complex groups respectively.In isolated APVC,no significant difference in diagnostic accuracy were showed between MSCT and TTE（χ2=0.48,P=0.52）,and between MSCT and cardiac catheterization（χ2=1.07,P=0.30）.There was significant difference in diagnostic accuracy between MSCT and TTE（χ2=7.29,P=0.007）,and between MSCT and cardiac catheterization（χ2=4.73,P=0.030）.The dysplastic pulmonary veins were identified in 11 patients by MSCT.Conclusion MSCT is superior to catheterization and TTE in evaluation of APVC associated with complex cardiac defects.

关 键 词：体层摄影术 X线 心导管造影 超声 诊断 先天性心脏病 

分 类 号：R541.1[医药卫生—心血管疾病]