CT横断序列辅助三维容积测量技术评估房间隔缺损的可行性研究  

Feasibility of three-dimensional CT axial sequence assisted volumetric measurement for atrial septal defect evaluation

作　　者：宋会军[1] 刘琼[1] 金敬琳[1] 张旌 李世国[1] 闫朝武[1] 宋宜萤 徐亮[1] 万俊义 Song Huijun;Liu Qiong;Jin Jinglin;Zhang Jing;Li Shiguo;Yan Chaowu;Song Yiying;Xu Liang;Wan Junyi(Center for Structural Heart Disease,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Cardiac Surgery,Fuwai Hospital,Chinese Academy of Medical Sciences,Shenzhen,Shenzhen 518057,China;Department of Ultrasonography,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院结构性心脏病中心,北京100037 [2]中国医学科学院阜外医院深圳医院心脏外科,深圳518057 [3]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院超声科,北京100037

出　　处：《中华放射学杂志》2022年第1期68-73,共6页Chinese Journal of Radiology

摘　　要：目的:探讨CT横断序列辅助三维容积测量(CTAS)技术评估房间隔缺损(ASD)的可行性。方法:回顾性收集2016年1月至2019年12月在阜外医院成功行介入治疗的单发继发孔型ASD患者。患者于封堵前及封堵后第2天均行冠状动脉CT血管成像(CTA)检查,且ASD封堵术中行DSA检查。最终入组52例,其中37例为缺损后下缘长度≤ 3 mm,15例为采用带孔封堵器治疗的合并重度肺动脉高压患者。将患者术前及术后的CT资料进行三维容积重建。应用CTAS技术在术前评估ASD的解剖结构,测量其长径和短径,并利用椭圆的等效圆公式推算ASD的等效圆直径;在术后CT三维容积重建图像上测量封堵后的封堵器腰部直径;并基于CT三维容积重建图像测量封堵前后房间隔缺损各边缘的长度。在术中用DSA工作站通过模拟ASD的球囊测量法来测量封堵后的封堵器腰部直径。将上述相应测量参数进行配对 t检验及一致性分析。 结果:术前CTAS测量的ASD等效圆直径为(32.3±5.4)mm;封堵术后,DSA与CTAS测量的封堵器腰部直径分别为(32.5±4.9)和(32.6±4.9)mm;三者间两两差异均无统计学意义( P均>0.05),且一致性好(ICC>0.75);同时,除房间隔上下径及下腔静脉侧边缘外,封堵前后CT测量的ASD各边缘长度差异亦无统计学意义( P均>0.05)。 结论:CTAS技术在测量ASD大小和缺损边缘方面结果准确,可以替代球囊测量以指导封堵器选择。Objective To explore the feasibility of three-dimensional CT axial sequence assisted volumetric measurement(CTAS)in evaluating atrial septal defect(ASD).Methods The patients with single secundum ASD who successfully underwent interventional therapy in Fuwai Hospital from January 2016 to December 2019 were retrospectively collected.The patients underwent coronary CT angiography(CTA)before and on the second day after closures,and DSA examinations during operation.A total of 52 cases met the inclusion conditions,among them,there were 37 patients with large defects which had deficient inferior rims≤3 mm,and 15 patients with severe pulmonary arterial hypertension that occluded with fenestrated ASD occluder.The CT data of patients before and after operation were reconstructed by CTAS.Then the anatomical structure of ASD before the operation was evaluated,including the long diameter and short diameter of ASD,and the CT three-dimensional volume diameter of ASD was calculated by using the equivalent circle conversion formula of ellipse.The waist diameter of occluder and rims of the ASD were measured after occlusion on postoperative CT three-dimensional volume reconstruction images.Meanwhile,the deployed occluder waist dimension was measured in DSA examination during the operation by simulating the balloon measurement of ASD.Lastly,paired t-test and consistency analysis were carried out among the values of parameters.Results Before operation,the equivalent circle diameter of ASD was(32.3±5.4)mm measured by CTAS.After ASD occlusion,the size of the waist dimension measured by DSA and CTAS were(32.5±4.9)mm and(32.6±4.9)mm.There were no significant differences between them(P>0.05).There were also no significant differences for each rims of the ASD pre and post operation on CTAS except for the inferior rims and the total length of atrial septum in superior-inferior direction(P>0.05).Conclusion As an alternative to balloon sizing,CTAS can be used as a reference standard to conduct ASD interventional treatment.

关 键 词：房间隔缺损 血管造影术 成像 三维 心脏导管插入术 间隔封堵器 

分 类 号：R541[医药卫生—心血管疾病] R816.2[医药卫生—内科学]