双主动脉弓及合并畸形的MSCT和超声心动图诊断对比分析  

Comparison of CT and echocardiographic diagnosis of double aortic arch and associated cardiac anomalies

作　　者：陈鑫[1] 彭志远[1] 陈险峰[1] 张雪莲[1] 陈艳[1] 李炜[1] 熊青峰[1] 马小静[1] 

机构地区：[1]武汉亚洲心脏病医院影像中心,湖北武汉430022

出　　处：《影像诊断与介入放射学》2016年第4期276-281,共6页Diagnostic Imaging & Interventional Radiology

基　　金：湖南省武汉市卫计委临床医学科研项目(编号:WX12A07)

摘　　要：目的评价及对比分析MSCT及UCG对诊断双主动脉弓(DAA)及合并畸形的价值。方法回顾性15例确诊为双主动脉弓病例的临床、超声心动图及多层螺旋CT资料,并将其影像诊断结果与手术结果进行对照。结果所有患者均行手术治疗。15例DAA患者MSCT均完全符合诊断,其中TypeⅠ型(双弓开放)13例,右弓粗大者9例、左弓粗大2例,两弓均衡2例;TypeⅡ型(一弓闭锁)2例,均为左弓闭锁。超声心动图确诊9例,误诊6例。6例误诊患者中,5例超声诊断为右位主动脉弓,其中实为双侧主动脉弓均开放者3例(右弓粗大、左弓细小),双主动脉弓左弓闭锁者2例;1例超声诊断为左位主动脉弓,实为双侧主动脉弓均开放者(左弓粗大、右弓细小)。15例DAA中,仅2例为单发畸形,其余13例均合并一种或多种心、外内畸形,合并畸形主要包括:房间隔缺损、室间隔缺损、动脉导管未闭等。7例患者有不同程度的气管/支气管狭窄。15例中9例采用前瞻性心电门控CT扫描的CTDI平均值2.78±0.15 m Gy、DLP平均值29.35±1.73m Gy·cm2、ED平均值0.73±0.42 m Sv;图像均符合诊断要求。结论多层螺旋CT能准确地诊断双主动脉弓及并发畸形,以及合并的气道狭窄,诊断符合率明显优于超声,对制定治疗方案有重要的价值。Objective To compare the value of echocardiography （UCG） and multi-slice spiral CT for diagnosing double aortic arch （DAA） and associated cardiac anomalies. Methods The clinical records of 15 patients with double aortic arch were analyzed retrospectively. The UCG and CT imaging diagnosis was correlated with surgical findings. Results CT diagnosis in 15 patients with DAA was consistent with surgical findings including type I open DAA （13） with large right arch （9）, large left arch （2）, and balanced arch （2） as well as type Ⅱ DAA with atretic left arch （2）. UCG diagnosis was correct in 9 patients. In the remaining 6 patients, 3 type I open double arch with large right arch and 2 typeⅡ DAA with atretic left arch were erroneously diagnosed on UCG as right-sided aortic arch. One patient with type I open double arch and large left arch was misdiagnosed on UCG as left-sided aortic arch. Of 15 DAA, 13 were associated with one or more cardiac anomalies including atrial septal defect （how many cases）, ventricular septal defect （how many cases）, and patent ductus arteriosus （how many cases）. All cardiac anomalies were detected on CT and UCG. Seven patients also had varying degrees of tracheal and bronchial stenosis. Conclusion CT is superior to UCG for accurately depicting the types of DAA, associated cardiac anomalies and airway stenosis.

关 键 词：双主动脉弓 体层摄影术 X线计算机 心血管造影术 

分 类 号：R540.45[医药卫生—心血管疾病] R726.5[医药卫生—内科学] R816.92[医药卫生—临床医学]