宽体探测器CT血管造影与超声心动图对小儿先天性心脏病的诊断效能  

Diagnostic Efficacy of Wide-body Detector CT Angiography and Ultrasound Cardiogram in Congenital Heart Disease in Chil-dren

作　　者：祁冬[1] 李娟[2] 孙景巍[3] 董楠 贾媛 沈艳 QI Dong;LI Juan;SUN Jingwei;DONG Nan;JIA Yuan;SHEN Yan(Department of Medical Imaging,Bengbu First People′s Hospital,Bengbu Anhui 233000,China;不详)

机构地区：[1]蚌埠市第一人民医院医学影像科,安徽蚌埠233000 [2]蚌埠市第一人民医院神经内科,安徽蚌埠233000 [3]蚌埠市第一人民医院儿内科,安徽蚌埠233000 [4]蚌埠市第一人民医院超声科,安徽蚌埠233000

出　　处：《联勤军事医学》2024年第1期22-25,35,共5页Military Medicine of Joint Logistics

基　　金：安徽省卫生健康委员会科研重点项目(AHWJ2022a040);蚌埠市科技创新指导类项目(20220105);蚌埠医学院科技项目(2022byzd154)。

摘　　要：目的探讨宽体探测器CT血管造影(computer tomography angiography,CTA)与超声心动图(ultrasound cardiogram,UCG)在小儿先天性心脏病(congenital heart disease,CHD)的诊断效能。方法回顾性分析2019-08/2023-09月作者医院收治的65例疑似CHD患儿的影像学资料,所有患儿均行心脏CTA及UCG检查。对两种检查方式的图像质量进行主观评价并比较其差异;以手术或数字减影血管造影(digital subtraction angiography,DSA)为“金标准”,对比两种检查方式在诊断CHD的灵敏度、特异度、阳性预测值、阴性预测值及准确率的差异,并应用Kappa检验比较与“金标准”结果的一致性;采用受试者工作特征(receiver operating characteristic,ROC)曲线分析两种检查方式对小儿CHD的诊断效能。结果CTA诊断小儿CHD心外畸形图像质量主观评分明显高于UCG,二者比较差异具有统计学意义(P<0.05),心内畸形图像质量主观评分二者比较差异无统计学意义(P>0.05)。两名医师对图像质量主观评分的一致性较好(κ=0.802)。CTA、UCG诊断小儿CHD心内畸形准确率比较差异无统计学意义(P>0.05);CTA诊断小儿CHD心外畸形准确率为96.43%,显著高于UCG 50.00%,组间比较差异具有统计学意义(P<0.05)。CTA诊断小儿CHD的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为90.00%、60.00%、96.43%、33.33%及87.69%,与手术或DSA结果一致性较好(κ=0.766);UCG诊断CHD的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为83.33%、20.00%、92.59%、9.09%及79.81%,与手术或DSA结果一致性一般(κ=0.522)。CTA、UCG两种检查方式诊断小儿CHD的灵敏度、特异度、阴性预测值及准确率差异比较均有统计学意义(P均<0.05)。ROC曲线分析结果显示,CTA与UCG诊断小儿CHD的曲线下面积(area under the cure,AUC)分别为0.853和0.773,二者比较差异有统计学意义(P<0.05)。结论宽体探测器CTA在小儿CHD心外畸形方面的诊断效能优�Objective To investigate the diagnostic efficacy of wide-body detector computer tomography angiogra-phy(CTA)and ultrasound cardiogram(UCG)in congenital heart disease(CHD)in children.Methods Imaging data of 65 children with suspected CHD admitted to authors'hospital from August 2019 to September 2023 were retrospectively analyzed,and all children underwent cardiac CTA and UCG.The image quality of the two examination methods was sub-jectively evaluated and those differences were compared;using surgery or digital subtraction angiography(DSA)as the"gold standard",the differences in sensitivity,specificity,positive predictive value,negative predictive value and accura-cy between the two modalities in the diagnosis of CHD were compared,the consistency with"gold standard"results was compared by applying the Kappa test;and the diagnostic efficiency of the two methods for CHD in children was analyzed by receiver operating characteristic(ROC)curve.Results The subjective score of image quality of CTA diagnosing chil-dren with CHD for extracardiac malformations was significantly higher than that of UCG,and the difference was statistically significant(P<0.05),there was no sig-nificant difference in the subjective image quality score of intracardiac malformation between the two groups(P>0.05).The consistency of subjective scores of image qual-ity between the two radiologists was good(κ=0.802).There was no significant difference between CTA and UCG in the accuracy of diagnosing intracardiac malformations(P>0.05);the accuracy of CTA diagnosing children with CHD for extracardiac malformations was 96.43%,which was significantly 50.00%higher than that of UCG,and there was no significant difference between the two groups(P<0.05).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy for CTA diagnosing children with CHD were 90.00%,60.00%,96.43%,33.33%and 87.69%respectively,with good concordance with surgical or DSA results(κ=0.766);the sensitivity,spe-cificity,positive predictive value,negativ

关 键 词：先天性心脏病 超声心动图 宽体探测器CT CT血管造影 

分 类 号：R445[医药卫生—影像医学与核医学]