双源螺旋CT在小儿先天性心脏病诊断中的应用价值
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摘要
目的：
探讨双源螺旋CT(DSCT)在小儿先天性心脏病(简称先心病)诊断中的临床应用价值。方法：
回顾分析2007年2月到2009年12月在我院住院的38例先心病患儿DSCT心脏大血管造影资料,其中男29例,女9例,年龄37天～11岁,平均年龄2.1岁。所有患儿行DSCT检查前均行经胸超声心动图(TTE)检查,32例行开胸手术治疗,6例放弃手术。以手术结果为标准,对32例经手术证实的DSCT与TTE检查结果进行对比分析。38例患儿临床诊断为主动脉缩窄14例、法洛四联症9例、肺静脉异位引流3例、右室双出口3例、动脉导管未闭2例及肺动脉闭锁伴室间隔缺损、肺动脉起源异常伴动脉导管未闭、室间隔缺损伴主动脉弓畸形、肺动脉狭窄伴房间隔缺损、右旋心、单心室、冠状动脉起源异常各1例。结果：
38例先心病患儿均顺利完成DSCT检查,对造影剂无不良反应。扫描时间平均为5～7s,X线辐射剂量约4.5～7.4mSv。32例接受手术治疗的患儿,手术效果良好,无1例死亡。经手术证实的心脏及大血管结构异常共128处,DSCT检出110处,TTE检出115处,DSCT与TTE的诊断准确率分别为85.94%和89.84%。其中,心脏畸形共57处,DSCT检出40处,漏诊17处,DSCT检出率70.18%；TTE全部检出,检出率100%,DSCT的检出率低于TTE (P＜0.05);心脏-大血管连接处畸形共20处,DSCT与TTE均全部检出；大血管畸形共51处,DSCT检出50处,漏诊1处,检出率98.04%；TTE检出38处,漏诊12处,误诊1处,检出率74.51%,DSCT的检出率显著高于TTE(P<0.05)。
结论：
对于小儿先天性心脏病,双源螺旋CT是一种安全、方便、快捷、有效的无创影像检查技术,能够清晰显示心脏尤其是大血管的解剖结构,弥补超声心动图检查的不足,具有重要的临床价值。
Objective:
To determine the value of dual-source spiral CT (DSCT) in the diagnosis of congenital heart disease (CHD) in children.
Materials and Methods:
DSCT angiographic datas of 38 cases (including 29 male and 9 female and age range from 37 days to 11 years with mean age of 2.1 years) with CHD were analyzed retrospectively. All of the cases were performed with transthoracic echocardiography (TTE) before DSCT.32 of 38 cases underwent open heart surgery. The results of DSCT were compared with TTE and surgery. Clinical principle diagnosis included 14 cases with coarctation of the aorta,9 cases with tetralogy of Fallot,3 cases with anomalous pulmonary venous connection,3 cases with double outlet of right ventricle,2 cases with patent ductus arteriosus, as well as every single case of pulmonary atresia with ventricular septal defect, anomalous origin of pulmonary artery with patent ductus arteriosus, ventricular septal defect with anomalous aortic arch, pulmonary stenosis with atrial septal defect, dextrocardia, single ventricle, and congenital malformations of coronary arteries.
Results:
It was favorable in the process of CT scanning, and no adverse reactions of the contrast agent happened. The average scanning time was 5 to 7 seconds, and the X-ray radiation dose was about 4.5 to 7.4mSv. Surgeries were all effective with no deaths. In the 32 surgical patients, there were 128 deformities confirmed by operation. The accuracy of DSCT and TTE were 85.94% and 89.84%. There were 57 intracardiac deformities,40 of 57 (70.18%) deformities were detected by DSCT while 17 missed,57 of 57 (100%) deformities were detected by TTE and none missed. The diagnosis accuracy of DSCT for intracardiac deformities was inferior to TTE(P＜0.05). There were 20 heart-vessel conjunction deformities. All of them were detected by DSCT and TTE. There were 51 great vessel deformities,50 of 51 (98.04 %) were detected by DSCT and 38 of 51 (74.51%) were detected by TTE. The definite diagnosis rate of DSCT for great vessel deformities was superior to TTE(P＜0.05).
Conclusion:
For children with CHD, DSCT is a safe, convenient, fast, effective and non-invasive imaging technique, which can clearly demonstrate the pathological morphology of cardiac and in particular extracardiac vascular abnormalities and compensate for TTE. Therefore, DSCT has an important diagnostic value.
探讨双源螺旋CT(DSCT)在小儿先天性心脏病(简称先心病)诊断中的临床应用价值。方法：
回顾分析2007年2月到2009年12月在我院住院的38例先心病患儿DSCT心脏大血管造影资料,其中男29例,女9例,年龄37天～11岁,平均年龄2.1岁。所有患儿行DSCT检查前均行经胸超声心动图(TTE)检查,32例行开胸手术治疗,6例放弃手术。以手术结果为标准,对32例经手术证实的DSCT与TTE检查结果进行对比分析。38例患儿临床诊断为主动脉缩窄14例、法洛四联症9例、肺静脉异位引流3例、右室双出口3例、动脉导管未闭2例及肺动脉闭锁伴室间隔缺损、肺动脉起源异常伴动脉导管未闭、室间隔缺损伴主动脉弓畸形、肺动脉狭窄伴房间隔缺损、右旋心、单心室、冠状动脉起源异常各1例。结果：
38例先心病患儿均顺利完成DSCT检查,对造影剂无不良反应。扫描时间平均为5～7s,X线辐射剂量约4.5～7.4mSv。32例接受手术治疗的患儿,手术效果良好,无1例死亡。经手术证实的心脏及大血管结构异常共128处,DSCT检出110处,TTE检出115处,DSCT与TTE的诊断准确率分别为85.94%和89.84%。其中,心脏畸形共57处,DSCT检出40处,漏诊17处,DSCT检出率70.18%；TTE全部检出,检出率100%,DSCT的检出率低于TTE (P＜0.05);心脏-大血管连接处畸形共20处,DSCT与TTE均全部检出；大血管畸形共51处,DSCT检出50处,漏诊1处,检出率98.04%；TTE检出38处,漏诊12处,误诊1处,检出率74.51%,DSCT的检出率显著高于TTE(P<0.05)。
结论：
对于小儿先天性心脏病,双源螺旋CT是一种安全、方便、快捷、有效的无创影像检查技术,能够清晰显示心脏尤其是大血管的解剖结构,弥补超声心动图检查的不足,具有重要的临床价值。
Objective:
To determine the value of dual-source spiral CT (DSCT) in the diagnosis of congenital heart disease (CHD) in children.
Materials and Methods:
DSCT angiographic datas of 38 cases (including 29 male and 9 female and age range from 37 days to 11 years with mean age of 2.1 years) with CHD were analyzed retrospectively. All of the cases were performed with transthoracic echocardiography (TTE) before DSCT.32 of 38 cases underwent open heart surgery. The results of DSCT were compared with TTE and surgery. Clinical principle diagnosis included 14 cases with coarctation of the aorta,9 cases with tetralogy of Fallot,3 cases with anomalous pulmonary venous connection,3 cases with double outlet of right ventricle,2 cases with patent ductus arteriosus, as well as every single case of pulmonary atresia with ventricular septal defect, anomalous origin of pulmonary artery with patent ductus arteriosus, ventricular septal defect with anomalous aortic arch, pulmonary stenosis with atrial septal defect, dextrocardia, single ventricle, and congenital malformations of coronary arteries.
Results:
It was favorable in the process of CT scanning, and no adverse reactions of the contrast agent happened. The average scanning time was 5 to 7 seconds, and the X-ray radiation dose was about 4.5 to 7.4mSv. Surgeries were all effective with no deaths. In the 32 surgical patients, there were 128 deformities confirmed by operation. The accuracy of DSCT and TTE were 85.94% and 89.84%. There were 57 intracardiac deformities,40 of 57 (70.18%) deformities were detected by DSCT while 17 missed,57 of 57 (100%) deformities were detected by TTE and none missed. The diagnosis accuracy of DSCT for intracardiac deformities was inferior to TTE(P＜0.05). There were 20 heart-vessel conjunction deformities. All of them were detected by DSCT and TTE. There were 51 great vessel deformities,50 of 51 (98.04 %) were detected by DSCT and 38 of 51 (74.51%) were detected by TTE. The definite diagnosis rate of DSCT for great vessel deformities was superior to TTE(P＜0.05).
Conclusion:
For children with CHD, DSCT is a safe, convenient, fast, effective and non-invasive imaging technique, which can clearly demonstrate the pathological morphology of cardiac and in particular extracardiac vascular abnormalities and compensate for TTE. Therefore, DSCT has an important diagnostic value.
引文
[1]周爱卿,蒋世良.先天性心脏病经导管介入治疗指南[J].中华儿科杂志,2004,42(3)：234-239.
[2]柳宏波,韩波,王锡明.多层螺旋CT在先天性心脏病诊断中的应用进展[J].中国实用儿科杂志,2006,21(9)：709-711.
[3]Sklansky M. Advances in fetal cardiac imaging[J]. Pediatr Cardiol,2004,25: 307-321.
[4]李向民,周旭辉,杨有优,等.电子束CT诊断婴幼儿先天性心脏病并与超声心动图及手术对照[J].中华放射学杂志,2003,37(7)：644-647.
[5]郭苏晋,尤志军,石明国.64层双源螺旋CT原理[J].医疗卫生装备,2008,29(6)： 91-93.
[6]郑玲,顾海峰,杨刚,等.双源CT成像技术及其临床应用的新进展[J].医学研究生报,2008,21(4)：404-411.
[7]李峰,杨刚,朱宗明.双源CT的技术原理与临床应用的探讨[J].医疗卫生装备,2009,30(2)：112-113.
[8]刘涛,胡可,袁芳.双源CT的辐射剂量研究[J].中国医疗设备,2008,23(10)：157-158.
[9]陈翔骏,杨刚.双源C T工作原理及在心血管疾病方面的临床应用[J].东南国防医药,2007,9(6)：444-445.
[10]Rajesh K. The role of MRI and CT in congenital heart disease[J]. Pediatr Cardiol,2009,39(2):196-204.
[11]Kawano T, Ishii M, Takagi J, et al. Three-dimensional helical computed tomographic angiography in neonates and infants with complex congenital heart disease[J]. American Heart Journal,2000,139(4):653-660.
[12]曲岷.双源螺旋CT在心脏冠状动脉成像中的应用研究[J].实用医技杂志,2007,14(3)：292-293.
[13]于德新,马祥兴,王茜,等.双源CT成人正常心脏结构的测量及瓣膜的显 示[J].实用放射学杂志,2009,25(2)：172-175.
[14]Hall EJ. Lessons We Have Learned from Our Children:Cancer Risks from Diagnostic Radiology[J]. Pediatr Radiol,2002,32(10):700-706.
[1]周泽俊,高斌.双源CT结构成像原理及临床应用[J].安徽医学,2009,30(8)：977-979.
[2]Flohr TG, McCollough CH, Bruder H, et al. First performance evaluation of a dual-source CT(DSCT) system[J]. Eur Radiol,2006,16(2):256-268.
[3]Flohr TG, Stierstorfer K, Ulzheimer S, et al. Image reconstruction and image quality evaluation for a 64-slice scanner with z-flying focal apot[J]. Med Phys,2005, 32:2536-2547.
[4]Raff G L, Gallagher M J, O Neill W W, et al. Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography[J]. J Am Coll Cardiol,2005,46:552-557.
[5]钱英.双源CT技术优势分析[J].医疗设备信息,2008,23(8)：57-58.
[6]Moon J Y, Chung, Choi BW, et al. The utility of multiple detector row spiral CT for detection of coronary stenoses[J]. Yonsei Med,2005,46(1):86-94.
[7]Schoep F UJ, Becher CR, Ohnesorge BM, et al. CT of coronary artery disease. Radiology,2004,232(1):18-37.
[8]Scholosser T, Hunold P, Schmermund A, et al. Cornonary calcium score:influence of reconstruction interval at 16 detector row CT with retrospective electrocardiographic gating[J]. Radiology,2004,233:586-589.
[9]Leber AW, Knez A, Becher A, et al. Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atheroscherotic plaques:a comparative study with intracoronary ultrasound[J]. Am Coll Cardiol,2004,43:1241-1247.
[10]Wang Y, Zhang Z, Kong L, et al. Dual-source CT coronary angiography in patients with atrial fibrillation:comparison with single-source CT[J]. Eur J Radiol.2008,68(3):434-441.
[11]沈建芬,田文,李佩玲,等.双源CT诊断冠心病和指导危险分层的价值[J].山东医药,2008,48(37)：20-22.
[12]Stephan Achenbach. Contrast-enhanced coronary artery visualization by dual-source computed tomography-initial experience[J]. European Journal of Radiology,2006:1-5.
[13]冯越,杨光钊,黄小仙,等.新生儿及婴儿复杂先天性心脏病的双源CT诊断[J].中国医学计算机成像杂志,2008,14(4)：308-313.
[14]Lu GM, Zhang LJ, Guo H, et al. Comparison of Myocardial Bridging by Dual-Source CT With Conventional Coronary Angiography[J]. Circ J,2008,72(7): 1079-1085.
[15]Zhang LJ, Lu GM, Guo H, et al. Myocardial bridging on dual-source CT: comparison with conventional coronary angiography[J]. Zhonghua Yi Xue Za Zhi, 2008,88(12):826-829.
[16]郑玲,张龙江,黄伟,等.双源CT心肌桥的检出率及其价值[J].临床放射学杂志,2008,27(2)：186-189.
[17]蔡军,张宗军,郑玲,等.双源CT主动脉成像的临床应用研究[J].医学研究生学报,2008,21(2)：159-164.
[18]周代全,黎川,戴明德,等.双源CT在肢体动脉损伤中的应用价值[J].医疗卫生装备,2008,29(10)：236-238.
[19]Bastarrika G, Arraiza M, Pueyo JC, et al. Quantification of left ventricular function and mass in cardiac Dual-Source CT (DSCT) exams:comparison of manual and semiautomatic segmentation algorithms[J]. Eur Radiol,2008,18(5):939-946.
[20]Puesken M, Fischbach R, Wenker M, et al. Global left-ventricular function assessment using dual-source multidetector CT:effect of improved temporal resolution on ventricular volume measurement[J]. Eur Radiol,2008,18(10): 2087-2094.
[21]Johnson TR, Nikolaou K, Fink C, et al. Dual-source CT in chest pain diagnosis[J]. Der Radiologe,2007,47(4):301-309.
[22]相法伟,王荣芳,季乐新,等.双源CT在儿童泌尿系统检查中的应用[J].医疗装备,2009,(1)：31-32.
[23]卢光明.积极开拓双源CT的临床应用范围[J].中华放射学杂志,2008,42(2)：117-118.
[24]王革,俞恒永,勃鲁努德曼.双源CT研究与发展之展望[J].中国医疗器械杂志,2008,32(3)：157-169.
[2]柳宏波,韩波,王锡明.多层螺旋CT在先天性心脏病诊断中的应用进展[J].中国实用儿科杂志,2006,21(9)：709-711.
[3]Sklansky M. Advances in fetal cardiac imaging[J]. Pediatr Cardiol,2004,25: 307-321.
[4]李向民,周旭辉,杨有优,等.电子束CT诊断婴幼儿先天性心脏病并与超声心动图及手术对照[J].中华放射学杂志,2003,37(7)：644-647.
[5]郭苏晋,尤志军,石明国.64层双源螺旋CT原理[J].医疗卫生装备,2008,29(6)： 91-93.
[6]郑玲,顾海峰,杨刚,等.双源CT成像技术及其临床应用的新进展[J].医学研究生报,2008,21(4)：404-411.
[7]李峰,杨刚,朱宗明.双源CT的技术原理与临床应用的探讨[J].医疗卫生装备,2009,30(2)：112-113.
[8]刘涛,胡可,袁芳.双源CT的辐射剂量研究[J].中国医疗设备,2008,23(10)：157-158.
[9]陈翔骏,杨刚.双源C T工作原理及在心血管疾病方面的临床应用[J].东南国防医药,2007,9(6)：444-445.
[10]Rajesh K. The role of MRI and CT in congenital heart disease[J]. Pediatr Cardiol,2009,39(2):196-204.
[11]Kawano T, Ishii M, Takagi J, et al. Three-dimensional helical computed tomographic angiography in neonates and infants with complex congenital heart disease[J]. American Heart Journal,2000,139(4):653-660.
[12]曲岷.双源螺旋CT在心脏冠状动脉成像中的应用研究[J].实用医技杂志,2007,14(3)：292-293.
[13]于德新,马祥兴,王茜,等.双源CT成人正常心脏结构的测量及瓣膜的显 示[J].实用放射学杂志,2009,25(2)：172-175.
[14]Hall EJ. Lessons We Have Learned from Our Children:Cancer Risks from Diagnostic Radiology[J]. Pediatr Radiol,2002,32(10):700-706.
[1]周泽俊,高斌.双源CT结构成像原理及临床应用[J].安徽医学,2009,30(8)：977-979.
[2]Flohr TG, McCollough CH, Bruder H, et al. First performance evaluation of a dual-source CT(DSCT) system[J]. Eur Radiol,2006,16(2):256-268.
[3]Flohr TG, Stierstorfer K, Ulzheimer S, et al. Image reconstruction and image quality evaluation for a 64-slice scanner with z-flying focal apot[J]. Med Phys,2005, 32:2536-2547.
[4]Raff G L, Gallagher M J, O Neill W W, et al. Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography[J]. J Am Coll Cardiol,2005,46:552-557.
[5]钱英.双源CT技术优势分析[J].医疗设备信息,2008,23(8)：57-58.
[6]Moon J Y, Chung, Choi BW, et al. The utility of multiple detector row spiral CT for detection of coronary stenoses[J]. Yonsei Med,2005,46(1):86-94.
[7]Schoep F UJ, Becher CR, Ohnesorge BM, et al. CT of coronary artery disease. Radiology,2004,232(1):18-37.
[8]Scholosser T, Hunold P, Schmermund A, et al. Cornonary calcium score:influence of reconstruction interval at 16 detector row CT with retrospective electrocardiographic gating[J]. Radiology,2004,233:586-589.
[9]Leber AW, Knez A, Becher A, et al. Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atheroscherotic plaques:a comparative study with intracoronary ultrasound[J]. Am Coll Cardiol,2004,43:1241-1247.
[10]Wang Y, Zhang Z, Kong L, et al. Dual-source CT coronary angiography in patients with atrial fibrillation:comparison with single-source CT[J]. Eur J Radiol.2008,68(3):434-441.
[11]沈建芬,田文,李佩玲,等.双源CT诊断冠心病和指导危险分层的价值[J].山东医药,2008,48(37)：20-22.
[12]Stephan Achenbach. Contrast-enhanced coronary artery visualization by dual-source computed tomography-initial experience[J]. European Journal of Radiology,2006:1-5.
[13]冯越,杨光钊,黄小仙,等.新生儿及婴儿复杂先天性心脏病的双源CT诊断[J].中国医学计算机成像杂志,2008,14(4)：308-313.
[14]Lu GM, Zhang LJ, Guo H, et al. Comparison of Myocardial Bridging by Dual-Source CT With Conventional Coronary Angiography[J]. Circ J,2008,72(7): 1079-1085.
[15]Zhang LJ, Lu GM, Guo H, et al. Myocardial bridging on dual-source CT: comparison with conventional coronary angiography[J]. Zhonghua Yi Xue Za Zhi, 2008,88(12):826-829.
[16]郑玲,张龙江,黄伟,等.双源CT心肌桥的检出率及其价值[J].临床放射学杂志,2008,27(2)：186-189.
[17]蔡军,张宗军,郑玲,等.双源CT主动脉成像的临床应用研究[J].医学研究生学报,2008,21(2)：159-164.
[18]周代全,黎川,戴明德,等.双源CT在肢体动脉损伤中的应用价值[J].医疗卫生装备,2008,29(10)：236-238.
[19]Bastarrika G, Arraiza M, Pueyo JC, et al. Quantification of left ventricular function and mass in cardiac Dual-Source CT (DSCT) exams:comparison of manual and semiautomatic segmentation algorithms[J]. Eur Radiol,2008,18(5):939-946.
[20]Puesken M, Fischbach R, Wenker M, et al. Global left-ventricular function assessment using dual-source multidetector CT:effect of improved temporal resolution on ventricular volume measurement[J]. Eur Radiol,2008,18(10): 2087-2094.
[21]Johnson TR, Nikolaou K, Fink C, et al. Dual-source CT in chest pain diagnosis[J]. Der Radiologe,2007,47(4):301-309.
[22]相法伟,王荣芳,季乐新,等.双源CT在儿童泌尿系统检查中的应用[J].医疗装备,2009,(1)：31-32.
[23]卢光明.积极开拓双源CT的临床应用范围[J].中华放射学杂志,2008,42(2)：117-118.
[24]王革,俞恒永,勃鲁努德曼.双源CT研究与发展之展望[J].中国医疗器械杂志,2008,32(3)：157-169.