双源CT冠状动脉成像在卵圆孔未闭中的诊断价值  

The value of dual source coronary CT angiography in diagnosis of patent foramen ovale

作　　者：刘乙锦 郑冲 耿文磊 孙丽杰 李静[3] 卢洁[1,2] LIU Yijin;ZHENG Chong;GENG Wenlei;SUN Lijie;LI Jing;LU Jie(Department of Radiology and Nuclear Medicine,Xuanwu Hospital Affiliated to Capital Medical University.Beijing 100053,China;Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics.Beijing 100053,China;Department of Geriatric Medicine,Xuanwu Hospital Affiliated to Capital Medical University.Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院放射与核医学科,北京100053 [2]磁共振成像脑信息学北京市重点实验室,北京100053 [3]首都医科大学宣武医院老年医学科,北京100053

出　　处：《医学影像学杂志》2024年第7期31-34,共4页Journal of Medical Imaging

基　　金：首都医科大学宣武医院“汇智”人才工程学者计划项目(编号:HZ2021ZCLJ005)。

摘　　要：目的 探讨双源CT冠状动脉成像(coronary CT angiography, CCTA)对卵圆孔未闭(patent foramen ovale,PFO)的临床诊断价值。方法 选取临床怀疑为PFO患者99例,均接受CCTA和经食管超声心动图(transesophageal echocardiography, TEE)检查,以TEE检查结果作为诊断金标准,CCTA测量原发隔所构成的卵圆孔瓣(free flap valve,FV)的长度,PFO宽度、高度,继发隔(interatrial groove, IAG)的长度、厚度以及卵圆窝(oval fossa,FO)直径。结果 99例患者中,CCTA检查发现PFO 82例。其中,无分流者占PFO患者的30.5%,Ⅰ级分流占42.7%,Ⅱ级分流占20.7%,Ⅲ级分流占6.1%。FV上下长度为(1.23±0.28)cm,PFO宽度为(1.19±0.46)cm,高度为(0.17±0.04)cm,PFO通道右心房入口宽度为(0.18±0.08)cm,IAG厚度为(0.74±0.23)cm,长度为(1.58±0.41)cm,FO的直径为(1.41±0.39)cm。CCTA检测PFO的灵敏度为92.1%,特异度为100%,准确度为92.9%,阳性预测值为100%,阴性预测值为58.8%,Kappa值为0.892。结论 CCTA可显示PFO的精细解剖结构及分流情况,为PFO患者封堵术前评估提供影像学依据。Objective To evaluate the value of dual-source coronary CT angiography(CCTA)in the diagnosis of patent fora‐men ovale(PFO).Methods The clinical data of 99 suspected patients with PFO were retrospectively collected and analyzed.The assessment of PFO by CCTA was determined and compared with the assessment by TEE as the gold standard.Dual source CT was used to measure the length of the free flap valve(FV)consisting of the primary septum,the width of the PFO,the height of the PFO,the length of the secondary septum,the thickness of the secondary septum,and the diameter of the oval fossa(FO).Results Among the 99 patients,PFO was found in 82 patients accounting for 82.8%of the total patients.Among them,30.5%of patients presented without shunts and 69.5%of patients with shunts.Furthermore,42.7%presented with grade I shunt,20.7%with grade II shunt,and 6.1%with grade III shunt.The FV was(1.23±0.28)cm,the width of PFO was(1.19±0.46)cm,the height was(0.17±0.04)cm,the width of right atrium entrance of PFO channel was(0.18±0.08)cm,the thickness of IAG was(0.74±0.23)cm,the length was(1.58±0.41)cm,and the diameter of FO was(1.41±0.39)cm.Among the 99 pa‐tients,PFO was found in 89 patients by TEE.The sensitivity,specificity,accuracy,positive predictive value,and negative pre‐dictive value of CCTA for detecting PFO were 92.1%,100%,92.9%,100%,and 58.8%,respectively.In the PFO diagnosis,the CCTA and TEE results were highly consistent,with a Kappa value of 0.892.Conclusion This study finds that CCTA examina‐tion can provide anatomical details on the size and morphologic features of PFO and its shunts,thereby offering the evaluation be‐fore PFO occlusion with imaging evidence.

关 键 词：卵圆孔未闭 心血管造影 体层摄影术 X线计算机 

分 类 号：R541[医药卫生—心血管疾病] R814.42[医药卫生—内科学]