高清CT容积螺旋穿梭技术在儿童法洛四联症临床路径中的价值  

The value of volume helical shuttle of high-definition CT in clinical path of tetralogy of Fallot in children

作　　者：徐冬生[1] 孙凤伟[1] 范丽娟[1] 张立仁[1] 李旭[1] 杨丕丕[1] 

机构地区：[1]泰达国际心血管病医院放射科,天津300457

出　　处：《中华胸心血管外科杂志》2013年第11期644-648,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的研究高清CT（HDCT）容积螺旋穿梭技术（VHS）对儿童法洛四联症（TOF）的诊断能力及其在临床路径中的价值。方法88例术前行HDCTVHS扫描及超声心动图（ECHO）检查诊断为TOF的学龄前儿童，男51例，女37例，年龄1个月-10岁，中位年龄1岁。60例经手术证实，对比分析HDCTVHS与ECHO对TOF基本畸形，血流动力学及其他心内、外病变的显示能力，计算HDCT辐射剂量（mSv）。结果室间隔缺损（VSD）位置，HDCT诊断符合率95．O％（57／60），ECHO诊断符合率90．O％（54／60）；测量VSD大小，HDCT数值小于ECHO，P〈0．05，差异有统计学意义。判断TOF畸形VSD血流方向时，HDCT均显示VSD右向左分流，符合率100％（60／60），15例同时显示左向右分流，而ECHO均显示双向低速分流。右心室心肌肥厚性狭窄、流出道狭窄、肺动脉瓣狭窄畸形共99处，HDCT、ECHO与手术三者基本一致。McGoon比值，HDCT测量值大于ECHO，P〈0．01，差异有统计学意义。主动脉骑跨畸形，HDCT与ECHO骑跨程度符合率均为98．3％（59／60），各误诊1例。其他心内畸形，如房间隔缺损、卵圆孔未闭等共37处，VHS漏诊25处，ECHO漏诊8处。其他心外畸形如一侧肺动脉的狭窄或闭锁、体-肺侧支血管、冠状动脉异常及动脉导管未闭等共88处，HDCT诊断符合率98．8％（87／88），ECHO诊断符合率59．1％（52／88）。HDCT平均有效剂量为（1．58±0．43）mSv。结论HDCTVHS诊断TOF有明显的优势，多组扫描数据能准确、直观地反映心内、外解剖畸形，辐射剂量在可接受的范围内。HDCTVHS与ECHO结合可作为儿童TOF术前确诊与鉴别诊断以及制定手术方案的临床路径。Objective To discuss the value of volume helical shuttle （VHS） of high-definition CT （HDCT） in diagnosis and clinical path of tetralogy of Fallot（TOF）. Methods 88 preschool children with TOF were examined with VHS of HDCT and eehocardiography（ECHO）. 60 children were received surgery. Based on surgical data, the results of VHS of HDCT were compared with that of ECHO, assessing the display ability of basic deformity of TOF, the intra-cardiac lesion, extra-cardiac le- sion and hemodynamics. The radiation dose（mSv） were calculated. Results The diagnostic accuracy of HDCT was 95.0% and the ECHO was 90.0% on the positional display. The results of HDCT were slightly smaller than ECHO on the measure of size of VSD, P 〈 0.05, the difference was significant between the two methods. The display on right-to-left shunt of VSD using HDCT were all coincided with ECHO. One quarter of the cases showed the left-to-right shunt simultaneously. Whereas all the cases were showed slow hi-directional shunt by ECHO. There are 99 deformity in pulmonary artery stenosis, including right ventricular hypertrophy, outflow tract stenosis, pulmonary stenosis. The results of HDCT, ECHO and the operation showed no difference. All the MeGoon ratio of HDCT were obviously higher than ECHO, P 〈 0.01. Statistical difference was significant. The coincidence rates in aortic straddles by HDCT and ECHO both were 98.3%. Each has one case misdiagnosed. 37 other in- tra-cardiac lesions, for example, foramen ovale and atrial septal defect. VAS has 25 misdiagnosed places and ECHO has 8.88 other extra-cardiac lesions, such as one side of pulmonary artery stenosis or atresia, collateral circulation between systemic andpulmonary circulation,coronary artery abnormal, patent ductus arteriosus（PDA） and so on. The diagnostic accuracy of HDCT was 98.8% and the ECHO was 59.1%. Average effective dose with HDCT was （ 1.58 ± O. 43 ） rosy. Conclusion VHS of HDCT scan has obvious advantages in the diagnosis of TOF. Multiple data can reflect i

关 键 词：法洛四联症 体层摄影术 x线计算机 

分 类 号：R816.2[医药卫生—放射医学] R725.4[医药卫生—临床医学]