儿童先天性血管环的多层螺旋CT诊断  

Assessment of congenital vascular rings with MDCT on children

作　　者：臧越[1] 周杰[1] 姜涛[1] 杜靖[1] 杜嘉会[1] 吕飙[1] 范占明[1] 

机构地区：[1]首都医科大学附属北京安贞医院影像科,100013

出　　处：《中华医学杂志》2015年第35期2861-2864,共4页National Medical Journal of China

摘　　要：目的 探讨多层螺旋CT（MDCT）对儿童先天性血管环的诊断价值.方法 回顾性分析首都医科大学附属北京安贞医院2008年10月-2014年12月经MDCT诊断为先天性血管环的43例患者的CT资料,其中男21例、女22例,年龄29 d～8岁,中位年龄1.46岁,1岁及1岁以下33例.所有病例心内解剖畸形均与超声心动图结果比较,如有手术即与手术记录对照.进行多平面重建（MPR）、最大密度投影（MIP）、最小密度投影（MinIP）、容积再现（VR）,评价图像质量能否满足诊断要求,探讨MDCT对先天性血管环的诊断方法.结果 43例血管环构成类型：肺动脉吊带6例（13.95％）,右位主动脉弓伴迷走左锁骨下动脉9例（20.93％）,左位主动脉弓伴迷走右锁骨下动脉18例（41.86％）,双主动脉弓10例（23.26％）.40例（93.02％）合并心脏血管或肺部其他畸形,各种畸形均得到清晰显示.心内解剖畸形均得到超声心动图检查证实.3例（6.98％）不合并其他畸形的血管环病例中,2例气管有受压改变.1例为肺动脉吊带,经手术证实;2例为双主动脉弓.43例患者的扫描图像均能够进行三维重建,且图像清晰.MPR、VR重建图像直观显示血管环的起源、形态、走行,MinIP及气管VR重建图像清晰显示气管形态及发育状况,可直观显示血管环与气管、食管的空间关系.对于血管环病例,应注意显示血管环的组成,测量其径线,注重观察气管支气管及食管全程,特别是与血管关系密切的节段,应用MPR测量气管支气管受压狭窄内径,同时依据节段分析法显示及测量可能合并的心内解剖畸形,做出完整诊断.提出血管环标准化诊断方案.结论 MDCT轴位扫描结合多种三维重建后处理技术可直观、清晰显示血管环的组成及与气管、食管间的毗邻关系,是检查血管环的有效手段.Objective To evaluate the value of MDCT on diagnosis of congenital vascular rings on children.Methods Retrospective analysis on 43 cases of congenital vascular rings,which underwent MDCT during Oct 2008 to Dec 2014 in Beijing Anzhen hospital affiliated to capital medical university.21 males,22 females;age from 29 days to 8 years,mean age 1.46 years,33 cases are not beyond 1 year.All the results were compared with that of the echocardiogram or record of the surgery.The CT data were read and reconstructed with multiplanar reconstruction （MPR）,maximum intensity projection （MPR）,minimum intensity projection （MinIP）,volume rendering （VR）.The image quality was evaluated and the diagnostic value and the standard diagnostic program were discussed.Results Of 43 cases of vascular rings：there were 6 cases of pulmonary artery sling （13.95%）,9 cases of right aortic arch /aberrant left subclavian artery （20.93%）,18 cases of left aortic arch/aberrant right subclavian artery （41.86%）,10 cases of double aortic arch （23.26%）.Forty cases （93.02%） were combined with other cardiovascular or pulmonary malformations.Every malformation was revealed clearly and proved by echocardiogram.Of 3 cases （6.98%） without any other malformation,2 cases were combined tracheal stenosis.A pulmonary artery sling was proved by surgery;the other 2 cases were double aortic arch.All the images of 43 cases could be reconstructed well.MPR and VR showed the origin,shape,and whole course of vascular rings directly;MinIP and VR could display the shape,width and development of trachea,revealed the relationship between vascular rings,trachea and esophagus.It was important to show and measure the component vascular of the ring.Attention should be paid to the whole course of trachea and esophagus,especially those segments which were close to the ring vascular.The tracheal stenosis as well as intra-cardio anatomy malformations should be measured on MPR images if existed.According to the segmental analysis method,comes the o

关 键 词：体层摄影术 螺旋计算机 主动脉 肺动脉 心脏病 

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