Lightspeed VCT及宝石能谱CT对复杂型先天性心血管疾病的临床应用研究
摘要
第一部分个体化CT扫描技术在复杂型先天性心血管病中的临床应用研究
背景和目的：多排螺旋CT(multi-detector spiral computed tomography, MDCT)对复杂型先天性心血管病诊断的临床应用日益成熟,扫描时一般采用回顾性心电门控技术,其优点是不仅可以清晰显示心血管畸形,还可以判断室壁运动及进行心功能测定等,但是其最大的弊端是增加了射线辐射剂量,因此如何在保证图像质量的前提下,以最少的造影剂用量、最低的辐射剂量进行MDCT扫描,这是目前研究的热点问题之一。本研究探讨Lightspeed VCT应用于复杂型先天性心血管病的成像技术和方法,总结个体化扫描方案的技术要点,同时将此方案应用于宝石能谱CT,探讨最合理的复杂型先天性心血管病CT扫描技术及宝石能谱CT在诊断复杂型先心病方面的优势。
材料与方法：将59例患者按扫描方式及造影剂用量的不同分为4组：VCT常规心电门控扫描组(20例)、VCT个体化心电门控扫描组(20例)和宝石能谱CT个体化心电门控扫描组(10例)和VCT非心电门控扫描组(9例)。将所有病例的图像根据需要进行多平面重建(multiple planar reformation, MPR),最大密度投影(maximum intensity projeetion, MIP)、曲面重建(curve planar reformation, CPR)和三维容积再现(volume rendering, VR)等。主观和客观评价各组的图像质量、对比剂用量及射线剂量,并将结果进行统计学分析。
结果：各组图像质量平均分依次为4.78(VCT常规扫描组)、4.73(VCT个体化扫描组)、4.77(宝石CT个体化扫描组)、3.89(VCT非心电门控组一期)和4.37(VCT非心电门控组二期)。VCT非心电门控组扫描一期与二期的图像质量评分有显著性差异(x~2=4.207,P=0.04),VCT非心电门控组图像质量评分较高的二期图像分别与VCT常规扫描组、VCT个体化扫描组和宝石CT个体化扫描组比较,质量评分均有显著性差异(P值分别为0.002、0.009和0.013),而VCT常规扫描组、VCT个体化扫描组和宝石CT个体化扫描组之间图像质量评分比较无显著性差异(P值分别为0.502、0.858和0.733)。VCT个体化扫描组和宝石CT个体化扫描组之间上腔静脉、右心房、右心室、主肺动脉、左心房、左心室、升主动脉和降主动脉的增强CT值无统计学差异(P值为0.563),而VCT常规扫描组、VCT非心电门控组扫描一期、二期与VCT个体化扫描组或宝石CT个体化扫描组之间上腔静脉、右心房、右心室、主肺动脉、左心房、左心室、升主动脉和降主动脉的增强CT值差异存在统计学意义。VCT常规组与VCT非心电门控组扫描一期图像平均噪声、SNR及CNR值之间比较没有统计学意义,而VCT常规扫描组与VCT非心电门控组扫描一期图像平均噪声、SNR及CNR值与VCT个体化扫描组、宝石CT个体化扫描组及VCT非心电门控组扫描二期图像比较差异均有统计学意义,宝石CT个体化扫描组图像平均噪声与VCT个体化扫描组比较没有统计学意义(P值为0.336),而两者的图像噪声与VCT非心电门控组扫描二期图像比较有统计学意义,宝石CT个体化扫描组的SNR及CNR值与VCT个体化扫描组、VCT非心电门控组扫描二期图像相比均有统计学意义,而VCT个体化扫描组SNR及CNR值与VCT非心电门控组扫描二期图像比较均没有统计学意义(P值分别为0.166和0.084)。宝石CT个体化扫描组的射线剂量与VCT非心电门控组比较无统计学差异(P值为0.907),VCT常规组、VCT个体化扫描组与宝石CT个体化扫描组或VCT非心电门控组之间射线剂量差异存在统计学意义。
结论：
1.进行复杂型先天性心血管病检查时应将得到清晰的图像、明确的诊断以及降低射线剂量进行综合考虑,采用最合理的检查方法。
2.回顾性心电门控个体化扫描技术在复杂型先天性心血管病的诊断中在不丢失诊断信息的情况下最大限度的降低了辐射剂量,是值得推广的扫描方法。
3.对复杂型先天性心血管病患者采用非心电门控扫描时应采取双期扫描。
4.采用ASIR技术的宝石能谱CT个体化扫描是检查复杂型先天性心血管病较理想的方法。
第二部分64排螺旋CT对复杂型先天性心血管病的诊断价值研究——与超声心动图及手术结果对照
背景和目的：超声心动图(echocardiograph, ECHO)对于复杂型先心病的诊断在临床处于主导地位,多排螺旋CT (multi-detector spiral computed tomography, MDCT)的临床应用,在诊断复杂型先心病体现出很大的优势。本研究的目的旨在通过研究MDCT诊断先心病影像的资料,并将结果同超声心动图及手术结果进行对照,评价该技术对复杂型先心病的诊断价值及对手术治疗的指导意义。
材料与方法：将59例患者分别进行MDCT和ECHO检查,结果对照研究时将以上病变分为心脏畸形、心脏血管连接部及心脏周围血管畸形两部分。MDCT不同检查方法各组之间进行对照研究时以上病变为一部分进行组间对照研究,其中VCT常规扫描组病变75处,VCT个体化扫描组病变63处,宝石CT个体化扫描组病变31处,VCT非心电门控组病变29处。扫描原始数据需要进行多平而重建,最大密度投影、曲面重建和三维容积再现等。
结果：心脏畸形共129处,与手术结果对照,MDCT检查诊断正确106处,诊断不正确23处,ECHO诊断正确121处,诊断不正确8处,MDCT和ECHO对心脏畸形的诊断准确性分别为82.17%(106/129)和93.79%(121/129),两组比较差异具有统计学意义(x~2=8.249,P=0.004)。心脏血管连接部及心脏周围血管畸形共69处,与手术结果对照,MDCT检查诊断正确67处,诊断不正确2处,ECHO诊断正确50处,诊断不正确19处,MDCT和ECHO对心脏血管连接部及心脏周围血管畸形的诊断准确性分别为97.10%(67/69)和72.46%(50/69),两组比较差异具有统计学意义(x~2=16.232,P=0.000)。MDCT对全部198处心血管畸形诊断正确173处,诊断不正确25处,诊断准确性为87.37%(173/198),ECHO对全部198处心血管畸形诊断正确171处,诊断不正确27处,诊断准确性为86.36%(171/198),两者比较差异没有统计学意义(x2=0.089,P=0.776)。VCT常规扫描组、VCT个体化扫描组、宝石CT个体化扫描组和VCT非心电门控扫描组对心血管畸形的诊断准确性分别为90.67%(68/75)、92.06%(58/63)、96.77%(30/31)和58.62%(17/29),VCT非心电门控扫描组诊断准确性同VCT常规扫描组、VCT个体化扫描组、宝石CT个体化扫描组比较差异具有统计学意义(P值分别为0.000、0.000和0.000),而VCT常规扫描组、VCT个体化扫描组和宝石CT个体化扫描组对心血管畸形的诊断准确性组间两两比较差异均没有统计学意义。VCT常规扫描组、VCT个体化扫描组、宝石CT个体化扫描组、VCT非心电门控扫描组和ECHO对心脏畸形的诊断准确性分别为85.11%(40/47)、87.5%(35/40)、95.24%(20/21)、52.38%(11/21)和93.79%(121/129),VCT非心电门控扫描组诊断准确性同VCT常规扫描组、VCT个体化扫描组、宝石CT个体化扫描组和ECHO比较差异具有统计学意义(P值分别为0.004、0.002、0.002和0.000),而VCT常规扫描组、VCT个体化扫描组、宝石CT个体化扫描组和ECHO对心脏畸形的诊断准确性组间两两比较差异均没有统计学意义。
结论
1. MDCT诊断复杂型先心病首先以原始轴位像为主,发现病变后应该根据病变性质结合多种合适的三维后处理重建技术更有利于病变的显示。
2. ECHO对于心脏畸形的诊断准确性很高,是可以信赖的一种检查手段,但是心脏畸形缺损较小、局部血液分流较大或左右分流不明显且合并多种畸形时ECHO检查容易漏诊。
3. MDCT对于复杂型先心病的诊断与ECHO没有显著差异,MDCT对于心脏血管连接部及心脏周围血管畸形的诊断要优于ECHO,而ECHO对心脏畸形尤其是缺损畸形及瓣膜病变的诊断价值要好于MDCT。
4. MDCT采用心电门控扫描技术对心脏畸形的诊断价值与ECHO没有显著差异。
第三部分：64排螺旋CT对房间隔缺损、室间隔缺损不同时相面积测值的临床价值研究——与超声心动图及手术结果对照
背景和目的：本研究旨在通过MDCT不同扫描时相的图像测量房间隔缺损和室间隔缺损的面积,并将结果同超声心动图及手术结果进行对照,评价MDCT对房间隔缺损和室间隔缺损测量的意义及最佳时相,为复杂型先心病的进一步的治疗提供准确的影像数据,同时也为将来对同种类型的复杂型先心病患者选择最佳前瞻性心电门控MDCT扫描时相或回顾性心电门控MDCT个体化扫描提供原始理论数据。
材料与方法：对房间隔缺损20例、室间隔缺损组16例采用回顾性心电门控MDCT扫描,扫描原始数据进行10个时相的图像重建(5%-95%),然后根据需要进行多平面重建,最大密度投影、曲面重建和三维容积再现等。
结果：20例房间隔缺损大小的手术结果均值为402.83±356.12,MDCT5％时相测量均值为82.86±71.91,15%时相测量均值为93.58±81.01,25%时相测量均值为135.44±125.64,35%时相测量均值为203.09±194.79,45%时相测量均值为375.79±335.63,55%时相测量均值为402.69±354.25,65%时相测量均值为374.74±332.44,75%时相测量均值为212.99±216.59,85%时相测量均值为180.96±179.33,95%时相测量均值为102.77±111.81,手术结果均值与MDCT45％时相测量均值、55%时相测量均值、65%时相测量均值比较差异没有统计学意义(P值分别为0.722、0.999和0.712),MDCT55％时相测量均值与手术结果均值最接近,手术结果均值与MDCT5％时相测量均值、15%时相测量均值、25%时相测量均值、35%时相测量均值、75%时相测量均值、85%时相测量均值、95%时相测量均值之间比较差异统计学意义(P值分别为0.000、0.000、0.000、0.001、0.013、0.004和0.000),MDCT5％时相测量均值与手术结果均值差别最大。ECHO测量均值为385.52±340.69,手术结果均值与MDCT55％时相测量均值、ECHO测量均值之间差异没有统计学意义(P值分别为0.999和0.876),而MDCT55％时相测量均值、ECHO测量均值之间差异也没有统计学意义(P值为0.877)。室间隔缺损大小的手术结果均值为180.77±202.24,MDCT5％时相测量均值为183.58±205.93,15%时相测量均值为169.76±194.65,25%时相测量均值为108.27±122.09,35%时相测量均值为73.96±83.31,45%时相测量均值为59.87±66.48,55%时相测量均值为47.61±48.05,65%时相测量均值为66.23±75.98,75%时相测量均值为81.32±93.59,85%时相测量均值为107.72±124.04,95%时相测量均值为170.54±196.51,手术结果均值与MDCT5％时相测量均值、MDCT15％时相测量均值、MDCT25％时相测量均值、MDCT35％时相测量均值、MDCT75％时相测量均值、MDCT85％时相测量均值、MDCT95％时相测量均值比较差异没有统计学意义(P值分别为0.957、0.835、0.341、0.094、0.114、0.321和0.846),MDCT5％时相测量均值与手术结果均值最接近；手术结果均值与MDCT45％时相测量均值、MDCT55％时相测量均值、MDCT65％时相测量均值之间比较差异统计学意义(P值分别为0.025、0.012和0.033),MDCT55％时相测量均值与手术结果均值差别最大；ECHO测量均值为174.91±198.48,手术结果均值与MDCT 5%时相测量均值、ECHO测量均值之间差异没有统计学意义(P值分别为0.969和0.935),而MDCT5%时相测量均值、ECHO测量均值之间差异也没有统计学意义(P值为0.904)。
结论
1. MDCT对房间隔缺损、室间隔缺损大小的测量与ECHO、手术结果比较没有统计学意义,说明采用回顾性心电门控及个体化CT扫描技术对房间隔缺损、室间隔缺损的测量结果是可靠的。
2. MDCT对房间隔缺损、室间隔缺损面积测量表明房间隔缺损面积最大值出现在55%时相(减慢射血期),最小值出现在5%时相(心房收缩期),室间隔缺损面积最大值出现在5%时相(心房收缩期),最小值出现在55%时相(减慢射血期)。
3.本研究对房间隔缺损、室间隔缺损成像的最佳时相发现,在今后对房间隔缺损、室间隔缺损患者进行CT扫描时,不论采用回顾性还是前瞻性心电门控技术都有很好的指导价值,这很有可能会成为MDCT个体化、人性化扫描的发展方向。
PartⅠ:The individuation CT scanning technique studies in clinical application of the complex congenital cardiovascular disease
Background and objective:The multi-detector spiral computed tomography(MDCT) diagnoses the complex type congenital cardiovascular disease of the clinical application is mature day by day, while scanning general adopt the retrospective electrocardiography (ECG)-gated technique. Its merit is not only can clear display cardiovascular abnormal, also can judge heart chamber wall running and function measuring etc, but its biggest disadvantage is to raise the radiation agent quantity. Consequently how to get the pefect image with minimum of contrast medium dosage set and lowermost radiation quantity carry on MDCT scanning is one of the hot spot questions that studies currently. This research was to evaluate the technique and method of individuation scanning scheme in Lightspeed VCT and gemstones spectral CT appling to complex congenital cardiovascular disease. The most reasonable CT scanning technique and advantage of gemstones spectral CT in diagnosing complex congenital cardiovascular disease were discussed.
Materials and methods:59 cases were divided into 4 groups according to using the different CT scanning method and contrast medium dosage set. There were the VCT routine ECG-gated group(20 cases), the individuation VCT ECG-gated group (20 cases), the CT individuation gemstones spectral CT ECG-gated group(10 cases) and VCT non-ECG-gated group (9 cases). All icons of cases according to needing to carry on multiple planar reformation(MPR), maximum intensity projeetion(MIP), curve planar reformation(CPR) and volume rendering(VR) etc. CT imge quality, contrast medium dosage and radiation quantity were evaluated and the results were carried on statistics analysis.
Results:The average scores of CT image were 4.78(VCT routine scanning group), 4.73(VCT individuation scanning group),4.77(the gemstone spectral CT individuation scanning group),3.89(VCT non-ECG-gated scanning groupl) and 4.37(VCT non-ECG-gated scanning group 2). The image scores between non-ECG-gated group 1 and group 2 were significant difference (x 2=4.207, P=0.04). There were significant difference in image scores compared with the non-ECG-gated group 2, VCT routine scanning group, VCT individuation scanning group and the gemstone spectral CT individuation scanning group(P value were 0.002、0.009 and 0.013, respectively). There were no significant differences in image scores among VCT routine scanning group, VCT individuation scanning group and the gemstone spectral CT individuation scanning group(P value were 0.502、0.858 and 0.733, respectively). There was no statistically significance between VCT individuation scanning group and the gemstone spectral CT individuation scanning group in enhancement CT value in superior vena cava, the right atrium, right ventricle, the main pulmonary artery, left atrium, left ventricle, ascending and the descending aorta (P value was 0.563). There were no statistical significances among the VCT routine scanning group, non-ECG-gated group 1 and 2, VCT individuation scanning group and the gemstone spectral CT individuation scanning group in enhancement CT values in superior vena cava, the right atrium, right ventricle, the main pulmonary artery, left atrium, left ventricle, ascending and the descending aorta. The average noise of image scanning, SNR and CNR between VCT routine scanning group and non-ECG-gated group 1 wasn't statistical significance, but those between VCT routine scanning group, non-ECG-gated group 1 and VCT individuation scanning group, the gemstone spectral CT individuation scanning group, non-ECG-gated group 2 was statistically significant. There was no statistically significant (P value was 0.907) in radiation dose between the gemstone spectral CT individuation scanning group and non-ECG-gated group, but those two groups compared with VCT routine scanning group and VCT individuation scanning group were statistically significant.
Conclusions:
1. We should adopt the most reasonable check method for paitients with complex congenital cardiovascular disease. The factors such as image quality, clear diagnosis and radiation dose should be comprehensive considered.
2. The retrospectively ECG-gated in individual scanning is worth extending scanning methods in diagnosis of complex congenital cardiovascular disease because information is not lost under the condition of the utmost reduced the radiation dose.
3. We should adopt double phases in non-ECG-gated scanning for diagnosing complex congenital cardiovascular disease.
4. Gemstone spectral CT scan using ASIR technology is a ideal method for examing complex congenital cardiovascular disease.
PartⅡ:The diagnostic value of 64 detector spiral CT in complex congenital cardiovascular disease--echocardiographic and surgical results controls
Background and objective:Echocardiography (ECHO) for the diagnosis of congenital heart disease factors in clinical is in the leading position. But nowadays multi-detector spiral computed tomography (MDCT) in diagnosis of complex congenital heart disease reflect huge advantage. The purpose of this study aims to study the MDCT image datas of congenital heart disease and compared with the echocardiography and surgical results, then evaluate the diagnostic value of MDCT for diagnosing complex congenital heart disease and guiding significance for surgical treatment.
Materials and methods:Fifty-nine patients were taken the MDCT and ECHO examination separately and will be divided into two parts(cardiac anomalies part, cardiovascular connection and peripheral vascular anomaly part). MDCT different examing methods when comparing research between groups set for part of above lesions controlled studies, in which VCT conventional scanning group 75 lesions, VCT individualized scanning group 63 lesions, gemstone CT scanning group 31 lesions, lnon-ECG-gated VCT individuation scanning group 29 lesions. The scanning data according to needing to carry on multiple planar reformation(MPR), maximum intensity projeetion(MIP), curve planar reformation(CPR) and volume rendering(VR) etc.
Results:All of 129 lesions of the cardiac anomaly, compared with the surgery results, 106 lesions were correct and 23 lesions incorrect in MDCT diagnosing. There were 121 correct lesions and 8 incorrect lesions in ECHO diagnosing. The diagnosis accuracy of MDCT and ECHO in diagnosing cardiac anomaly were 82.17%(106 /129) and 93.79%(121/129) respectively, two groups are statistical difference (x2= 8.249, P=0.004). All of 69 lesions of the cardiovascular fitting and peripheral vascular anomaly,67 lesions were correct diagnosis and 2 lesions were incorrect diagnosis in MDCT. There were correct diagnosis 50 lesions and incorrect diagnosis 19 lesions in ECHO. The accuracy of MDCT and ECHO in diagnosing cardiovascular fitting and peripheral vascular anomaly were 97.10%(67/69) and 72.46%(50/69) respectively, the difference of two groups was statistical significant (X2=16.232, P=0.000). The diagnosis accuracy of all the 198 lesions in MDCT and ECHO were 87.37%(173/198) and 86.36%(171/198), the difference was statistical significant(x2=0.089, P=0.776). The accuracy of diagnosing the cardioascular anomalies in VCT conventional scanning group, VCT individualized scanning group, gemstone CT scanning group and lnon-ECG-gated VCT individual scanning group were 90.67%(68/75),92.06%(58/63),96.77%(30/31) and 58.62%(17/29) respectively. The diagnosis accuracy between lnon-ECG-gated VCT individual scanning group and VCT conventional scanning group, VCT individualized scanning group, gemstone CT scanning group were statistically significant(P values were 0.000, 0.000 and 0.000), and there were no significant among VCT conventional scanning group, VCT individualized scanning group and gemstone CT scanning group. The accuracy of diagnosing the cardiac anomaly in VCT conventional scanning group, VCT individualized scanning group, gemstone CT scanning group, lnon-ECG-gated VCT individual scanning group and ECHO were 85.11%(40/47),87.6%(35/40), 95.24%(20/21),52.38%(11/21) and 93.79%(121/129) respectively. The diagnosis accuracy between non-ECG-gated VCT individual scanning group and VCT conventional scanning group, VCT individualized scanning group, gemstone CT scanning group, ECHO were statistically significant (P value were 0.004,0.002, 0.002 and 0.000), and among VCT conventional scanning group, VCT individualized scanning group, gemstone CT individualized scanning group and ECHO were not statistically significant differences.
Conclusions:
1. We should depend on MDCT axis images when diagnose the complex congenital heart disease at the first time, then according to the lesions properties combine with appropriate three-dimensional post-processing reconstruction technique is more advantageous to the lesions show.
2. ECHO is a trust examing method for diagnosing cardiac anomalies because of high diagnosis accuracy. But when cardiac anomalies defect lesser, local blood bypass around bigger or not obvious and merger shunt combine with multiple malformations maybe cause the misdiagnosis.
3. The diagnosis of congenital heart disease between MDCT and ECHO is no significant differences, MDCT for cardiovascular fitting and heart peripheral vascular anomaly diagnosis is superior to the ECHO, and ECHO for cardiac anomalies especially defect deformity and diagnosis disease value is better than the MDCT.
4. MDCT using ECG-gated scanning technology to diagnosis cardiac anomaly is not significant different with ECHO.
PartⅢ:The clinical studies of measuring the areas of antral and ventricular septal defect using 64 detector spiral CT--echocardiographic and surgical results controls
Background and objective:The aim of this study was to measure antrial and ventricular septal defect(ASD and VSD) area in MDCT images of different scanning phases, and compared with echocardiography and surgical results, then evaluated the significance of measuring antrial and ventricular septal defect in MDCT image and choosed the best phase in MDCT Scan. For further treatment of congenital heart disease provide accurate image data and raw theoretical data in examing the same type pateints no matter using prospective or retrospective ECG-gated techniques in MDCT scanning.
Materials and methods:20 cases of ASD and 16 cases of VSD were taken the retrospective ECG-gated MDCT scanning. The original data were reconstructed for 10 phases (5%-95%), then on the basis of the need for multiple planar reformation (MPR), maximum intensity projeetion (MIP), curve planar reformation(CPR) and volume rendering(VR).
Results:The 20 cases areas mean of antrial septal defect in surgical results was 402.83±356.12. The mean of MDCT measurement results in 5% phase was 82.86±71.91,15% phase was 93.58±81.01,25% phase was 135.44±125.64,35% phase was 203.09±194.79,45% phase was 375.79±335.63,55% phase was 402.69±354.25,65% phase was 374.74±332.44,75% phase was 212.99±216.59,85% phase was 180.96±179.33,95% phase was 102.77±111.81, respectively. The difference of means between surgical result and 45% phase,55% phase,65% phase in MDCT scanning weren't statistical significant(P values were 0.772,0.999,0.712, respectively). The result of 55% phase in MDCT scanning was most close the surgical result. The difference of means between surgical result and 5% phase,15% phase,25% phase,35% phase,75% phase,85% phase,95% phase in MDCT scanning were statistical significant(P values were 0.000,0.000,0.000,0.001,0.013, 0.004,0.000, respectively). The result of 5% phase in MDCT scanning was biggest difference from the surgical result. The mean of ECHO measurement was 385.52±340.69. The difference of means between surgical result and 55% phase in MDCT scanning, ECHO result weren't statistical significant(P values were 0.999 and 0.876), and the difference of means between 55% phase in MDCT scanning and ECHO result also weren't statistical significant(P values was 0.877). The 16 cases areas mean of ventricular septal defect in surgical results was 180.77±202.24. The mean of MDCT measurement results in 5% phase was 183.58±205.93,15% phase was 169.76±194.65,25% phase was 108.27±122.09,35% phase was 73.96±83.31, 45% phase was 59.87±66.84,55% phase was 47.61±48.05,65% phase was 66.23±75.98,75% phase was 81.32±93.59,85% phase was 107.72±24.04,95% phase was 170.54±196.51, respectively. The difference of means between surgical result and 5% phase,15% phase,25% phase,35% phase,75% phase,85% phase, 95% phase in MDCT scanning weren't statistical significant(P values were 0.957, 0.835,0.341,0.094,0.114,0.321,0.846, respectively). The result of 5% phase in MDCT scanning was most close the surgical result. The difference of means between surgical result and 45% phase,55% phase,65% phase in MDCT scanning were statistical significant(P values were 0.025,0.012,0.033, respectively). The result of 55% phase in MDCT scanning was biggest difference from the surgical result. The mean of ECHO measurement was 174.91±198.48. The difference of means between surgical result and 5% phase in MDCT scanning, ECHO result weren't statistical significant(P values were 0.969 and 0.935), and the difference of means between 5% phase in MDCT scanning and ECHO result also weren't statistical significant(P values was 0.904).
Conclusions:
1. The areas measurement results of ASD and VSD using retrospective ECG-gated MDCT scan are reliable because there are no statistically significant among the results of MDCT, ECHO and surgery.
2. Areas measurement results of ASD and VSD in MDCT scanning show that the maximum area of ASD appeare in 55% phase (slowing ejection period), the minimum area of ASD appeare in 5% phase (atrial systolic period), the maximum area of VSD appeare in 5% phase (atrial systolic), the minimum area of VSD appeare in 55% phase (slowing ejection period).
3. The best phases of ASD and VSD imaging were founded in this research has good guiding value in MDCT scanning no matter adopt retrospective or prospective ECG-gated technology, it is likely to become development direction of MDCT individualized and humanized scanning.
背景和目的：多排螺旋CT(multi-detector spiral computed tomography, MDCT)对复杂型先天性心血管病诊断的临床应用日益成熟,扫描时一般采用回顾性心电门控技术,其优点是不仅可以清晰显示心血管畸形,还可以判断室壁运动及进行心功能测定等,但是其最大的弊端是增加了射线辐射剂量,因此如何在保证图像质量的前提下,以最少的造影剂用量、最低的辐射剂量进行MDCT扫描,这是目前研究的热点问题之一。本研究探讨Lightspeed VCT应用于复杂型先天性心血管病的成像技术和方法,总结个体化扫描方案的技术要点,同时将此方案应用于宝石能谱CT,探讨最合理的复杂型先天性心血管病CT扫描技术及宝石能谱CT在诊断复杂型先心病方面的优势。
材料与方法：将59例患者按扫描方式及造影剂用量的不同分为4组：VCT常规心电门控扫描组(20例)、VCT个体化心电门控扫描组(20例)和宝石能谱CT个体化心电门控扫描组(10例)和VCT非心电门控扫描组(9例)。将所有病例的图像根据需要进行多平面重建(multiple planar reformation, MPR),最大密度投影(maximum intensity projeetion, MIP)、曲面重建(curve planar reformation, CPR)和三维容积再现(volume rendering, VR)等。主观和客观评价各组的图像质量、对比剂用量及射线剂量,并将结果进行统计学分析。
结果：各组图像质量平均分依次为4.78(VCT常规扫描组)、4.73(VCT个体化扫描组)、4.77(宝石CT个体化扫描组)、3.89(VCT非心电门控组一期)和4.37(VCT非心电门控组二期)。VCT非心电门控组扫描一期与二期的图像质量评分有显著性差异(x~2=4.207,P=0.04),VCT非心电门控组图像质量评分较高的二期图像分别与VCT常规扫描组、VCT个体化扫描组和宝石CT个体化扫描组比较,质量评分均有显著性差异(P值分别为0.002、0.009和0.013),而VCT常规扫描组、VCT个体化扫描组和宝石CT个体化扫描组之间图像质量评分比较无显著性差异(P值分别为0.502、0.858和0.733)。VCT个体化扫描组和宝石CT个体化扫描组之间上腔静脉、右心房、右心室、主肺动脉、左心房、左心室、升主动脉和降主动脉的增强CT值无统计学差异(P值为0.563),而VCT常规扫描组、VCT非心电门控组扫描一期、二期与VCT个体化扫描组或宝石CT个体化扫描组之间上腔静脉、右心房、右心室、主肺动脉、左心房、左心室、升主动脉和降主动脉的增强CT值差异存在统计学意义。VCT常规组与VCT非心电门控组扫描一期图像平均噪声、SNR及CNR值之间比较没有统计学意义,而VCT常规扫描组与VCT非心电门控组扫描一期图像平均噪声、SNR及CNR值与VCT个体化扫描组、宝石CT个体化扫描组及VCT非心电门控组扫描二期图像比较差异均有统计学意义,宝石CT个体化扫描组图像平均噪声与VCT个体化扫描组比较没有统计学意义(P值为0.336),而两者的图像噪声与VCT非心电门控组扫描二期图像比较有统计学意义,宝石CT个体化扫描组的SNR及CNR值与VCT个体化扫描组、VCT非心电门控组扫描二期图像相比均有统计学意义,而VCT个体化扫描组SNR及CNR值与VCT非心电门控组扫描二期图像比较均没有统计学意义(P值分别为0.166和0.084)。宝石CT个体化扫描组的射线剂量与VCT非心电门控组比较无统计学差异(P值为0.907),VCT常规组、VCT个体化扫描组与宝石CT个体化扫描组或VCT非心电门控组之间射线剂量差异存在统计学意义。
结论：
1.进行复杂型先天性心血管病检查时应将得到清晰的图像、明确的诊断以及降低射线剂量进行综合考虑,采用最合理的检查方法。
2.回顾性心电门控个体化扫描技术在复杂型先天性心血管病的诊断中在不丢失诊断信息的情况下最大限度的降低了辐射剂量,是值得推广的扫描方法。
3.对复杂型先天性心血管病患者采用非心电门控扫描时应采取双期扫描。
4.采用ASIR技术的宝石能谱CT个体化扫描是检查复杂型先天性心血管病较理想的方法。
第二部分64排螺旋CT对复杂型先天性心血管病的诊断价值研究——与超声心动图及手术结果对照
背景和目的：超声心动图(echocardiograph, ECHO)对于复杂型先心病的诊断在临床处于主导地位,多排螺旋CT (multi-detector spiral computed tomography, MDCT)的临床应用,在诊断复杂型先心病体现出很大的优势。本研究的目的旨在通过研究MDCT诊断先心病影像的资料,并将结果同超声心动图及手术结果进行对照,评价该技术对复杂型先心病的诊断价值及对手术治疗的指导意义。
材料与方法：将59例患者分别进行MDCT和ECHO检查,结果对照研究时将以上病变分为心脏畸形、心脏血管连接部及心脏周围血管畸形两部分。MDCT不同检查方法各组之间进行对照研究时以上病变为一部分进行组间对照研究,其中VCT常规扫描组病变75处,VCT个体化扫描组病变63处,宝石CT个体化扫描组病变31处,VCT非心电门控组病变29处。扫描原始数据需要进行多平而重建,最大密度投影、曲面重建和三维容积再现等。
结果：心脏畸形共129处,与手术结果对照,MDCT检查诊断正确106处,诊断不正确23处,ECHO诊断正确121处,诊断不正确8处,MDCT和ECHO对心脏畸形的诊断准确性分别为82.17%(106/129)和93.79%(121/129),两组比较差异具有统计学意义(x~2=8.249,P=0.004)。心脏血管连接部及心脏周围血管畸形共69处,与手术结果对照,MDCT检查诊断正确67处,诊断不正确2处,ECHO诊断正确50处,诊断不正确19处,MDCT和ECHO对心脏血管连接部及心脏周围血管畸形的诊断准确性分别为97.10%(67/69)和72.46%(50/69),两组比较差异具有统计学意义(x~2=16.232,P=0.000)。MDCT对全部198处心血管畸形诊断正确173处,诊断不正确25处,诊断准确性为87.37%(173/198),ECHO对全部198处心血管畸形诊断正确171处,诊断不正确27处,诊断准确性为86.36%(171/198),两者比较差异没有统计学意义(x2=0.089,P=0.776)。VCT常规扫描组、VCT个体化扫描组、宝石CT个体化扫描组和VCT非心电门控扫描组对心血管畸形的诊断准确性分别为90.67%(68/75)、92.06%(58/63)、96.77%(30/31)和58.62%(17/29),VCT非心电门控扫描组诊断准确性同VCT常规扫描组、VCT个体化扫描组、宝石CT个体化扫描组比较差异具有统计学意义(P值分别为0.000、0.000和0.000),而VCT常规扫描组、VCT个体化扫描组和宝石CT个体化扫描组对心血管畸形的诊断准确性组间两两比较差异均没有统计学意义。VCT常规扫描组、VCT个体化扫描组、宝石CT个体化扫描组、VCT非心电门控扫描组和ECHO对心脏畸形的诊断准确性分别为85.11%(40/47)、87.5%(35/40)、95.24%(20/21)、52.38%(11/21)和93.79%(121/129),VCT非心电门控扫描组诊断准确性同VCT常规扫描组、VCT个体化扫描组、宝石CT个体化扫描组和ECHO比较差异具有统计学意义(P值分别为0.004、0.002、0.002和0.000),而VCT常规扫描组、VCT个体化扫描组、宝石CT个体化扫描组和ECHO对心脏畸形的诊断准确性组间两两比较差异均没有统计学意义。
结论
1. MDCT诊断复杂型先心病首先以原始轴位像为主,发现病变后应该根据病变性质结合多种合适的三维后处理重建技术更有利于病变的显示。
2. ECHO对于心脏畸形的诊断准确性很高,是可以信赖的一种检查手段,但是心脏畸形缺损较小、局部血液分流较大或左右分流不明显且合并多种畸形时ECHO检查容易漏诊。
3. MDCT对于复杂型先心病的诊断与ECHO没有显著差异,MDCT对于心脏血管连接部及心脏周围血管畸形的诊断要优于ECHO,而ECHO对心脏畸形尤其是缺损畸形及瓣膜病变的诊断价值要好于MDCT。
4. MDCT采用心电门控扫描技术对心脏畸形的诊断价值与ECHO没有显著差异。
第三部分：64排螺旋CT对房间隔缺损、室间隔缺损不同时相面积测值的临床价值研究——与超声心动图及手术结果对照
背景和目的：本研究旨在通过MDCT不同扫描时相的图像测量房间隔缺损和室间隔缺损的面积,并将结果同超声心动图及手术结果进行对照,评价MDCT对房间隔缺损和室间隔缺损测量的意义及最佳时相,为复杂型先心病的进一步的治疗提供准确的影像数据,同时也为将来对同种类型的复杂型先心病患者选择最佳前瞻性心电门控MDCT扫描时相或回顾性心电门控MDCT个体化扫描提供原始理论数据。
材料与方法：对房间隔缺损20例、室间隔缺损组16例采用回顾性心电门控MDCT扫描,扫描原始数据进行10个时相的图像重建(5%-95%),然后根据需要进行多平面重建,最大密度投影、曲面重建和三维容积再现等。
结果：20例房间隔缺损大小的手术结果均值为402.83±356.12,MDCT5％时相测量均值为82.86±71.91,15%时相测量均值为93.58±81.01,25%时相测量均值为135.44±125.64,35%时相测量均值为203.09±194.79,45%时相测量均值为375.79±335.63,55%时相测量均值为402.69±354.25,65%时相测量均值为374.74±332.44,75%时相测量均值为212.99±216.59,85%时相测量均值为180.96±179.33,95%时相测量均值为102.77±111.81,手术结果均值与MDCT45％时相测量均值、55%时相测量均值、65%时相测量均值比较差异没有统计学意义(P值分别为0.722、0.999和0.712),MDCT55％时相测量均值与手术结果均值最接近,手术结果均值与MDCT5％时相测量均值、15%时相测量均值、25%时相测量均值、35%时相测量均值、75%时相测量均值、85%时相测量均值、95%时相测量均值之间比较差异统计学意义(P值分别为0.000、0.000、0.000、0.001、0.013、0.004和0.000),MDCT5％时相测量均值与手术结果均值差别最大。ECHO测量均值为385.52±340.69,手术结果均值与MDCT55％时相测量均值、ECHO测量均值之间差异没有统计学意义(P值分别为0.999和0.876),而MDCT55％时相测量均值、ECHO测量均值之间差异也没有统计学意义(P值为0.877)。室间隔缺损大小的手术结果均值为180.77±202.24,MDCT5％时相测量均值为183.58±205.93,15%时相测量均值为169.76±194.65,25%时相测量均值为108.27±122.09,35%时相测量均值为73.96±83.31,45%时相测量均值为59.87±66.48,55%时相测量均值为47.61±48.05,65%时相测量均值为66.23±75.98,75%时相测量均值为81.32±93.59,85%时相测量均值为107.72±124.04,95%时相测量均值为170.54±196.51,手术结果均值与MDCT5％时相测量均值、MDCT15％时相测量均值、MDCT25％时相测量均值、MDCT35％时相测量均值、MDCT75％时相测量均值、MDCT85％时相测量均值、MDCT95％时相测量均值比较差异没有统计学意义(P值分别为0.957、0.835、0.341、0.094、0.114、0.321和0.846),MDCT5％时相测量均值与手术结果均值最接近；手术结果均值与MDCT45％时相测量均值、MDCT55％时相测量均值、MDCT65％时相测量均值之间比较差异统计学意义(P值分别为0.025、0.012和0.033),MDCT55％时相测量均值与手术结果均值差别最大；ECHO测量均值为174.91±198.48,手术结果均值与MDCT 5%时相测量均值、ECHO测量均值之间差异没有统计学意义(P值分别为0.969和0.935),而MDCT5%时相测量均值、ECHO测量均值之间差异也没有统计学意义(P值为0.904)。
结论
1. MDCT对房间隔缺损、室间隔缺损大小的测量与ECHO、手术结果比较没有统计学意义,说明采用回顾性心电门控及个体化CT扫描技术对房间隔缺损、室间隔缺损的测量结果是可靠的。
2. MDCT对房间隔缺损、室间隔缺损面积测量表明房间隔缺损面积最大值出现在55%时相(减慢射血期),最小值出现在5%时相(心房收缩期),室间隔缺损面积最大值出现在5%时相(心房收缩期),最小值出现在55%时相(减慢射血期)。
3.本研究对房间隔缺损、室间隔缺损成像的最佳时相发现,在今后对房间隔缺损、室间隔缺损患者进行CT扫描时,不论采用回顾性还是前瞻性心电门控技术都有很好的指导价值,这很有可能会成为MDCT个体化、人性化扫描的发展方向。
PartⅠ:The individuation CT scanning technique studies in clinical application of the complex congenital cardiovascular disease
Background and objective:The multi-detector spiral computed tomography(MDCT) diagnoses the complex type congenital cardiovascular disease of the clinical application is mature day by day, while scanning general adopt the retrospective electrocardiography (ECG)-gated technique. Its merit is not only can clear display cardiovascular abnormal, also can judge heart chamber wall running and function measuring etc, but its biggest disadvantage is to raise the radiation agent quantity. Consequently how to get the pefect image with minimum of contrast medium dosage set and lowermost radiation quantity carry on MDCT scanning is one of the hot spot questions that studies currently. This research was to evaluate the technique and method of individuation scanning scheme in Lightspeed VCT and gemstones spectral CT appling to complex congenital cardiovascular disease. The most reasonable CT scanning technique and advantage of gemstones spectral CT in diagnosing complex congenital cardiovascular disease were discussed.
Materials and methods:59 cases were divided into 4 groups according to using the different CT scanning method and contrast medium dosage set. There were the VCT routine ECG-gated group(20 cases), the individuation VCT ECG-gated group (20 cases), the CT individuation gemstones spectral CT ECG-gated group(10 cases) and VCT non-ECG-gated group (9 cases). All icons of cases according to needing to carry on multiple planar reformation(MPR), maximum intensity projeetion(MIP), curve planar reformation(CPR) and volume rendering(VR) etc. CT imge quality, contrast medium dosage and radiation quantity were evaluated and the results were carried on statistics analysis.
Results:The average scores of CT image were 4.78(VCT routine scanning group), 4.73(VCT individuation scanning group),4.77(the gemstone spectral CT individuation scanning group),3.89(VCT non-ECG-gated scanning groupl) and 4.37(VCT non-ECG-gated scanning group 2). The image scores between non-ECG-gated group 1 and group 2 were significant difference (x 2=4.207, P=0.04). There were significant difference in image scores compared with the non-ECG-gated group 2, VCT routine scanning group, VCT individuation scanning group and the gemstone spectral CT individuation scanning group(P value were 0.002、0.009 and 0.013, respectively). There were no significant differences in image scores among VCT routine scanning group, VCT individuation scanning group and the gemstone spectral CT individuation scanning group(P value were 0.502、0.858 and 0.733, respectively). There was no statistically significance between VCT individuation scanning group and the gemstone spectral CT individuation scanning group in enhancement CT value in superior vena cava, the right atrium, right ventricle, the main pulmonary artery, left atrium, left ventricle, ascending and the descending aorta (P value was 0.563). There were no statistical significances among the VCT routine scanning group, non-ECG-gated group 1 and 2, VCT individuation scanning group and the gemstone spectral CT individuation scanning group in enhancement CT values in superior vena cava, the right atrium, right ventricle, the main pulmonary artery, left atrium, left ventricle, ascending and the descending aorta. The average noise of image scanning, SNR and CNR between VCT routine scanning group and non-ECG-gated group 1 wasn't statistical significance, but those between VCT routine scanning group, non-ECG-gated group 1 and VCT individuation scanning group, the gemstone spectral CT individuation scanning group, non-ECG-gated group 2 was statistically significant. There was no statistically significant (P value was 0.907) in radiation dose between the gemstone spectral CT individuation scanning group and non-ECG-gated group, but those two groups compared with VCT routine scanning group and VCT individuation scanning group were statistically significant.
Conclusions:
1. We should adopt the most reasonable check method for paitients with complex congenital cardiovascular disease. The factors such as image quality, clear diagnosis and radiation dose should be comprehensive considered.
2. The retrospectively ECG-gated in individual scanning is worth extending scanning methods in diagnosis of complex congenital cardiovascular disease because information is not lost under the condition of the utmost reduced the radiation dose.
3. We should adopt double phases in non-ECG-gated scanning for diagnosing complex congenital cardiovascular disease.
4. Gemstone spectral CT scan using ASIR technology is a ideal method for examing complex congenital cardiovascular disease.
PartⅡ:The diagnostic value of 64 detector spiral CT in complex congenital cardiovascular disease--echocardiographic and surgical results controls
Background and objective:Echocardiography (ECHO) for the diagnosis of congenital heart disease factors in clinical is in the leading position. But nowadays multi-detector spiral computed tomography (MDCT) in diagnosis of complex congenital heart disease reflect huge advantage. The purpose of this study aims to study the MDCT image datas of congenital heart disease and compared with the echocardiography and surgical results, then evaluate the diagnostic value of MDCT for diagnosing complex congenital heart disease and guiding significance for surgical treatment.
Materials and methods:Fifty-nine patients were taken the MDCT and ECHO examination separately and will be divided into two parts(cardiac anomalies part, cardiovascular connection and peripheral vascular anomaly part). MDCT different examing methods when comparing research between groups set for part of above lesions controlled studies, in which VCT conventional scanning group 75 lesions, VCT individualized scanning group 63 lesions, gemstone CT scanning group 31 lesions, lnon-ECG-gated VCT individuation scanning group 29 lesions. The scanning data according to needing to carry on multiple planar reformation(MPR), maximum intensity projeetion(MIP), curve planar reformation(CPR) and volume rendering(VR) etc.
Results:All of 129 lesions of the cardiac anomaly, compared with the surgery results, 106 lesions were correct and 23 lesions incorrect in MDCT diagnosing. There were 121 correct lesions and 8 incorrect lesions in ECHO diagnosing. The diagnosis accuracy of MDCT and ECHO in diagnosing cardiac anomaly were 82.17%(106 /129) and 93.79%(121/129) respectively, two groups are statistical difference (x2= 8.249, P=0.004). All of 69 lesions of the cardiovascular fitting and peripheral vascular anomaly,67 lesions were correct diagnosis and 2 lesions were incorrect diagnosis in MDCT. There were correct diagnosis 50 lesions and incorrect diagnosis 19 lesions in ECHO. The accuracy of MDCT and ECHO in diagnosing cardiovascular fitting and peripheral vascular anomaly were 97.10%(67/69) and 72.46%(50/69) respectively, the difference of two groups was statistical significant (X2=16.232, P=0.000). The diagnosis accuracy of all the 198 lesions in MDCT and ECHO were 87.37%(173/198) and 86.36%(171/198), the difference was statistical significant(x2=0.089, P=0.776). The accuracy of diagnosing the cardioascular anomalies in VCT conventional scanning group, VCT individualized scanning group, gemstone CT scanning group and lnon-ECG-gated VCT individual scanning group were 90.67%(68/75),92.06%(58/63),96.77%(30/31) and 58.62%(17/29) respectively. The diagnosis accuracy between lnon-ECG-gated VCT individual scanning group and VCT conventional scanning group, VCT individualized scanning group, gemstone CT scanning group were statistically significant(P values were 0.000, 0.000 and 0.000), and there were no significant among VCT conventional scanning group, VCT individualized scanning group and gemstone CT scanning group. The accuracy of diagnosing the cardiac anomaly in VCT conventional scanning group, VCT individualized scanning group, gemstone CT scanning group, lnon-ECG-gated VCT individual scanning group and ECHO were 85.11%(40/47),87.6%(35/40), 95.24%(20/21),52.38%(11/21) and 93.79%(121/129) respectively. The diagnosis accuracy between non-ECG-gated VCT individual scanning group and VCT conventional scanning group, VCT individualized scanning group, gemstone CT scanning group, ECHO were statistically significant (P value were 0.004,0.002, 0.002 and 0.000), and among VCT conventional scanning group, VCT individualized scanning group, gemstone CT individualized scanning group and ECHO were not statistically significant differences.
Conclusions:
1. We should depend on MDCT axis images when diagnose the complex congenital heart disease at the first time, then according to the lesions properties combine with appropriate three-dimensional post-processing reconstruction technique is more advantageous to the lesions show.
2. ECHO is a trust examing method for diagnosing cardiac anomalies because of high diagnosis accuracy. But when cardiac anomalies defect lesser, local blood bypass around bigger or not obvious and merger shunt combine with multiple malformations maybe cause the misdiagnosis.
3. The diagnosis of congenital heart disease between MDCT and ECHO is no significant differences, MDCT for cardiovascular fitting and heart peripheral vascular anomaly diagnosis is superior to the ECHO, and ECHO for cardiac anomalies especially defect deformity and diagnosis disease value is better than the MDCT.
4. MDCT using ECG-gated scanning technology to diagnosis cardiac anomaly is not significant different with ECHO.
PartⅢ:The clinical studies of measuring the areas of antral and ventricular septal defect using 64 detector spiral CT--echocardiographic and surgical results controls
Background and objective:The aim of this study was to measure antrial and ventricular septal defect(ASD and VSD) area in MDCT images of different scanning phases, and compared with echocardiography and surgical results, then evaluated the significance of measuring antrial and ventricular septal defect in MDCT image and choosed the best phase in MDCT Scan. For further treatment of congenital heart disease provide accurate image data and raw theoretical data in examing the same type pateints no matter using prospective or retrospective ECG-gated techniques in MDCT scanning.
Materials and methods:20 cases of ASD and 16 cases of VSD were taken the retrospective ECG-gated MDCT scanning. The original data were reconstructed for 10 phases (5%-95%), then on the basis of the need for multiple planar reformation (MPR), maximum intensity projeetion (MIP), curve planar reformation(CPR) and volume rendering(VR).
Results:The 20 cases areas mean of antrial septal defect in surgical results was 402.83±356.12. The mean of MDCT measurement results in 5% phase was 82.86±71.91,15% phase was 93.58±81.01,25% phase was 135.44±125.64,35% phase was 203.09±194.79,45% phase was 375.79±335.63,55% phase was 402.69±354.25,65% phase was 374.74±332.44,75% phase was 212.99±216.59,85% phase was 180.96±179.33,95% phase was 102.77±111.81, respectively. The difference of means between surgical result and 45% phase,55% phase,65% phase in MDCT scanning weren't statistical significant(P values were 0.772,0.999,0.712, respectively). The result of 55% phase in MDCT scanning was most close the surgical result. The difference of means between surgical result and 5% phase,15% phase,25% phase,35% phase,75% phase,85% phase,95% phase in MDCT scanning were statistical significant(P values were 0.000,0.000,0.000,0.001,0.013, 0.004,0.000, respectively). The result of 5% phase in MDCT scanning was biggest difference from the surgical result. The mean of ECHO measurement was 385.52±340.69. The difference of means between surgical result and 55% phase in MDCT scanning, ECHO result weren't statistical significant(P values were 0.999 and 0.876), and the difference of means between 55% phase in MDCT scanning and ECHO result also weren't statistical significant(P values was 0.877). The 16 cases areas mean of ventricular septal defect in surgical results was 180.77±202.24. The mean of MDCT measurement results in 5% phase was 183.58±205.93,15% phase was 169.76±194.65,25% phase was 108.27±122.09,35% phase was 73.96±83.31, 45% phase was 59.87±66.84,55% phase was 47.61±48.05,65% phase was 66.23±75.98,75% phase was 81.32±93.59,85% phase was 107.72±24.04,95% phase was 170.54±196.51, respectively. The difference of means between surgical result and 5% phase,15% phase,25% phase,35% phase,75% phase,85% phase, 95% phase in MDCT scanning weren't statistical significant(P values were 0.957, 0.835,0.341,0.094,0.114,0.321,0.846, respectively). The result of 5% phase in MDCT scanning was most close the surgical result. The difference of means between surgical result and 45% phase,55% phase,65% phase in MDCT scanning were statistical significant(P values were 0.025,0.012,0.033, respectively). The result of 55% phase in MDCT scanning was biggest difference from the surgical result. The mean of ECHO measurement was 174.91±198.48. The difference of means between surgical result and 5% phase in MDCT scanning, ECHO result weren't statistical significant(P values were 0.969 and 0.935), and the difference of means between 5% phase in MDCT scanning and ECHO result also weren't statistical significant(P values was 0.904).
Conclusions:
1. The areas measurement results of ASD and VSD using retrospective ECG-gated MDCT scan are reliable because there are no statistically significant among the results of MDCT, ECHO and surgery.
2. Areas measurement results of ASD and VSD in MDCT scanning show that the maximum area of ASD appeare in 55% phase (slowing ejection period), the minimum area of ASD appeare in 5% phase (atrial systolic period), the maximum area of VSD appeare in 5% phase (atrial systolic), the minimum area of VSD appeare in 55% phase (slowing ejection period).
3. The best phases of ASD and VSD imaging were founded in this research has good guiding value in MDCT scanning no matter adopt retrospective or prospective ECG-gated technology, it is likely to become development direction of MDCT individualized and humanized scanning.
引文
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