经胸超声心动图、CT及二者联合诊断缩窄性心包炎的价值比较
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摘要
目的比较经胸超声心动图(TTE)、CT及二者联合应用对缩窄性心包炎(CP)的诊断价值。方法回顾性分析经手术病理证实的54例CP患者的TTE及CT表现,绘制TTE、CT及二者联合应用诊断CP的ROC曲线,计算曲线下面积,比较各方法的诊断价值。结果与CT比较,TTE对CP心房扩大、室间隔抖动征、心室舒张功能降低的检出率均较高,差异均有统计学意义(均P<0.05);而CT对心包钙化的检出率较TTE高,差异有统计学意义(P<0.05)。TTE、CT及二者联合诊断CP的ROC曲线下面积分别为0.948、0.912、0.981,TTE与CT诊断CP的曲线下面积比较差异无统计学意义(P=0.1799),二者联合应用与单独TTE或与单独CT诊断CP的曲线下面积比较差异均有统计学意义(P=0.0420、0.0112)。结论 TTE可作为临床诊断CP的首选检查方法,CT可作为补充手段;二者联合应用能为CP的诊断与治疗提供更加可靠的依据。
Objective To investigate the diagnostic value of constrictive pericarditis(CP) by transthoracic echocardiography(TTE),CT and their combination.Methods Data of 54 cases of clinicly confirmed CP patients were collected in this retrospective study. Image findings of both TTE,CT were compared and analyzed.The ROC curves of CP were drawn using the data of TTE,CT and their combination,the area under the ROC curve was calculated,the dignostic value of each method was compared. Results Compared with CT,TTE had a significantly higher detection rate in diagnosing CP atrial enlargement,ventricular septal jitter and ventricular diastolic function reduction(all P<0.05). However,CT had a significantly higher detection rate for pericardial calcification than TTE(P<0.05).The area under the ROC curve of TTE,CT and their combination were 0.948,0.912 and 0.981,respectively.The area under the curve of TTE and CT for CP dagnosis was no statistical difference(P=0.1799).The detection rate for CP dagnosis using the curve of the CT and TTE combination was more higher than that of using the area under the TTE curve or the CT curve alone(P=0.0420,0.0112). Conclusion TTE can be used as the preferred examination method for CP diagnosis,and CT can be used as a supplementary diagnostic method.The combined application of the two can provide more reliable imformation for CP diagnosis and treatment.
Objective To investigate the diagnostic value of constrictive pericarditis(CP) by transthoracic echocardiography(TTE),CT and their combination.Methods Data of 54 cases of clinicly confirmed CP patients were collected in this retrospective study. Image findings of both TTE,CT were compared and analyzed.The ROC curves of CP were drawn using the data of TTE,CT and their combination,the area under the ROC curve was calculated,the dignostic value of each method was compared. Results Compared with CT,TTE had a significantly higher detection rate in diagnosing CP atrial enlargement,ventricular septal jitter and ventricular diastolic function reduction(all P<0.05). However,CT had a significantly higher detection rate for pericardial calcification than TTE(P<0.05).The area under the ROC curve of TTE,CT and their combination were 0.948,0.912 and 0.981,respectively.The area under the curve of TTE and CT for CP dagnosis was no statistical difference(P=0.1799).The detection rate for CP dagnosis using the curve of the CT and TTE combination was more higher than that of using the area under the TTE curve or the CT curve alone(P=0.0420,0.0112). Conclusion TTE can be used as the preferred examination method for CP diagnosis,and CT can be used as a supplementary diagnostic method.The combined application of the two can provide more reliable imformation for CP diagnosis and treatment.
引文
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[3] Tabata T,Kabbani SS,Murray RD,et al.Difference in the respiratory variation between pulmonary venous and mitral inflow Doppler velocities in patients with constrictive pericarditis with and without atrial fibrmation[J].J Am Coll Cardiol,2001,37(3):1936-1942.
[4] Cremer PC,Kwon DH.Multimodality imaging of pericardial disease[J].Curr Cardiol Rep,2015,17(4):24.
[5] Syed FF,Schaff HV,Oh JK.Constrictive pericarditis——a curable diastolic heart failure[J].Nat Rev Cardiol,2015,12(12):682-684.
[6]王海燕,马振申,丁红宇,等.缩窄性细胞炎的超声、CT与MRI联合研究[J].中国超声医学杂志,2014,30(2):125-130.
[7] Rajiah P,Kanne JP. Computed tomography of the pericardium and pericardial disease[J].J Cardiovasc Comput Tomogr,2010,4(1):3-18.
[8] Talreja DR,Edwards WD,Danielson GK,et al.Constrictive pericarditis in 26 patients with histologically normal pericardial thickness[J].Circulation,2003,108(15):1852-1857.
[9]刘景旺,许美,赵振兴,等.缩窄性心包炎的螺旋CT诊断[J].实用放射学杂志,2007,23(7):1003-1004.