房间隔缺损大小二维经胸超声心动图、二维及三维CT血管造影测量对比研究  

Discrepancies and correlations for measurement of atrial septal defect among two-dimensional transthoracic echocardiography,cardiac CT angiography and three-dimensional cardiac CT axial sequence assisted imaging techniques

作　　者：宋会军 刘琼[1] 金敬琳[1] 宋宜萤 李世国[1] 闫朝武[1] 徐亮 万俊义 徐仲英[1] SONG Hui-jun;LIU Qiong;JIN Jing-lin;SONG Yi-ying;LI Shi-guo;YAN Chao-wu;XU Liang;WAN Jun-yi;XU Zhong-ying(Department of Strctural Heart Disease,State Key Laboratory of Cardiovascular Disease,Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,National Center for Cardiovascular Diseases,Beijing 100037,China)

机构地区：[1]国家心血管病中心北京协和医学院心血管疾病国家重点实验室中国医学科学院阜外医院结构性心脏病中心,北京100037 [2]国家心血管病中心北京协和医学院心血管疾病国家重点实验室中国医学科学院阜外医院超声影像科,北京100037

出　　处：《中国介入心脏病学杂志》2021年第6期318-323,共6页Chinese Journal of Interventional Cardiology

摘　　要：目的比较二维经胸超声心动图(2D-TTE)、二维CT血管造影(2D-CTA)及三维CT横断序列辅助(3D-CTAS)技术测量房间隔缺损(ASD)大小的准确性及相关性,探讨二维与三维测量偏倚产生的原因。方法回顾性研究2015年1月至2019年12月成功行介入治疗的不合并房间隔瘤的单发继发孔型ASD患者,患者于封堵前和封堵后第2天均行心电门控CT血管造影(CTA)检查。分别利用2D-TTE、2D-CTA和3D-CTAS技术测量ASD的最大横径(a)和上下径(b),并利用转换公式推算各技术测得的ASD直径[等效圆直径(ED)=短径+2×(长径–短径)/3]。在术后复查CTA图像上测量封堵器腰部直径(DCT-POD),以此作为ASD直径的参考标准,并据此将患者分为A组(DCT-POD<20 mm)及B组(DCT-POD≥20 mm)。将上述相应测量值进行比较。结果共纳入72例(平均年龄46岁,范围18~72岁)患者,其中A组22例,B组50例。对于ASD直径,2D-TTE、2D-CTA和3D-CTAS测得的ED(ED-TTE、ED-CTA和ED-CTAS)与DCT-POD均有良好的相关性(r=0.93、r=0.97及r=0.98),ED-TTE和ED-CTA均明显小于DCT-POD[(–5.09±3.45)mm,P<0.05;(–1.74±2.26)mm,P<0.05],ED-CTAS与DCT-POD相比则差异无统计学意义[(–0.13±1.89)mm,P=0.56]。横径a:2D-TTE与3D-CTAS测量值在A组中[(–1.83±2.37)mm,P<0.001]及B组中[(–2.64±4.69)mm,P<0.001]的差异均有统计学意义,但其差值在两组间差异无统计学意义(P=0.611)。上下径b:2D-TTE与3D-CTAS测量值在A组中[(–2.23±2.30)mm,P<0.001]及B组中[(–7.31±5.22)mm,P<0.001]的差异均有统计学意义,且其差值在两组间差异有统计学意义(P<0.001);A组2D-CTA与3D-CTAS测量值的差异无统计学意义[(–0.28±1.34)mm,P=0.341],B组则差异有统计学意义[(–2.64±4.36)mm,P<0.001],且其差值在两组间差异有统计学意义(P<0.001)。结论3D-CTAS测量ASD大小与金标准没有明显差异,其优于二维测量技术的关键是能准确测量ASD上下径并消除其薄弱边缘。Objective To validate the accuracy of atrial septal defect(ASD)measurement by three dimensional cardiac CT axial sequence assisted measurement(3D-CTAS)and elucidate the discrepancies of twodimensional transthoracic echocardiography(2D-TTE)and two-dimensional cardiac CT angiography(2D-CTA).Methods We retrospectively investigated the patients successfully performed transcatheter closure of ASDs from January 2015 to December 2019.The included patients were evaluated with gated cardiac CTA twice at pre-and postpercutaneous closures respectively.The maximum dimension in axial planes(a)and maximum dimension in superiorinferior direction(b)were assessment by 2D-TTE,2D-CTA,and 3D-CTAS.The dimension of the ASD by these imaging techniques were arbitrary determined according to the formulation[effi cient diameter=minor axis+2×(major axis–minor axis)/3,ED,ED-TTE,ED-CTA,ED-CTAS].The postoperative occluder-waist dimension (POD)was measured on CT (DCT-POD) and regarded as the reference standard of the ASD size,according to which the patients were divided into two groups:group A (DCT-POD<20 mm) and group B (DCT-POD≥20 mm).The data obtained from 2D-TTE,2D-CTA,and 3D-CTAS were compared to investigate accuracy and correlations with paired and independent sample t tests.Results A total of 72 patients (mean age:46 years old,range from 18–72years old) were included in the study,including 22 patients in Group A,and 50 patients in group B.With respect to ASD diameters,ED-TTE,ED-CTA,and ED-CTAS were well correlated with DCT-POD (r=0.93,0.97,and0.98,respectively);both ED-TTE and ED-CTA were less than DCT-POD significantly[(–5.09±3.45)mm,P<0.05;(–1.74±2.26)mm,P<0.05],and there was no significant difference between ED-CTAS and DCT-POD[(–0.13±1.89)mm,P=0.56].As for a,both groups had signifi cant diff erences comparing 2D-TTEa and3D-CTASa[(–1.83±2.37)mm,P<0.001;(–2.64±4.69)mm,P<0.001],while the difference was no signifi cant between two groups (P=0.611).As for b,both groups had signifi cant diff erence comparing 2D-TTEb

关 键 词：房间隔缺损 心脏CT 经胸超声心动图 间隔封堵器 

分 类 号：R543[医药卫生—心血管疾病]