双源计算机断层摄影对先天性心脏病的诊断Dual-source Computed Tomography for the Diagnosis of Patients with Congenital Heart Disease
王怡宁;孔令燕;苗齐;方理刚;李烁;周慷;王志伟;徐凯;樊红苓;金征宇;
WANG Yi-ning1, KONG Ling-yan1, MIAO Qi2, FANG Li-gang3, LI Shuo1, ZHOU Kang1, WANG Zhi-wei1, XU Kai1, FAN Hong-ling1, JIN Zheng-yu1 1Department of Radiology,2Department of Cardiac Surgery,3Department of Cardiolory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
摘要(Abstract):
目的探讨双源计算机断层摄影(dual-source computed tomography,DSCT)诊断先天性心脏病(先心病)的临床应用价值。方法 DSCT增强扫描检查先心病患者20例,年龄4个月~53岁,平均19岁;所有病例均以心脏超声(echocardiography,ECHO)为对照,并经手术证实。结果 20例患者经手术证实的心内外结构畸形共63处,DSCT检出59处,诊断敏感性为93·7%;ECHO检出55处,诊断敏感性87·3%,两种方法诊断敏感性比较差异无统计学意义(χ2=1·474,P=0·225)。63处结构畸形中,心脏部分畸形41处,DSCT检出37处(90·2%),ECHO检出37处(90·2%),两者敏感性相当(P=1·000);心脏-大血管连接处畸形9处,DSCT检出9处(100%),ECHO检出8处(88·9%),差异无统计学意义(P>0·05);大血管部分畸形13处,DSCT检出13处(100%),ECHO检出10处(76·9%),差异无统计学意义(P>0·05)。结论 DSCT能够显示心内外结构畸形,具有较高的诊断敏感性,对先天性心脏病,特别是合并心外大血管畸形的诊断有重要价值。
Objective To evaluate the value of dual-source computed tomography (DSCT) in the diagnosis of congenital heart disease. Methods Twenty patients aged 4 months to 53 years (mean age 19 years) with congenital heart disease underwent contrast-enhanced DSCT. The results were compared with those of echocardiography (ECHO) and confirmed by surgery. Results Among the 20 patients, DSCT detected 59 of 63 (93.7%) anomalies that confirmed by surgery, and ECHO detected 55 of 63 (87.3%) (χ2=1.474, P=0.225). In the 41 intracardiac anomalies, DSCT was as sensitive as ECHO (both 90.2%, P=1.000). In the 9 heart-vessel conjunction deformities, no significant difference was found between the sensitivities of two modalities (100% vs. 88.9%, P>0.05). In the 13 great vessel deformities, no significant difference was found between the sensitivities of two modalities (100% vs. 76.9%, P>0.05). Conclusion DSCT detects intraand extra-cardiac anomalies with high sensitivity and has an important value in the diagnosis of congenital heart disease especially those with extra-cardiac anomoalies.
关键词(KeyWords):
心脏缺损,先天性;断层摄影术,X线计算机;超声心动描记术
heart defects, congenital; tomography, X-ray computed; echocardiography
基金项目(Foundation):
作者(Author):
王怡宁;孔令燕;苗齐;方理刚;李烁;周慷;王志伟;徐凯;樊红苓;金征宇;
WANG Yi-ning1, KONG Ling-yan1, MIAO Qi2, FANG Li-gang3, LI Shuo1, ZHOU Kang1, WANG Zhi-wei1, XU Kai1, FAN Hong-ling1, JIN Zheng-yu1 1Department of Radiology,2Department of Cardiac Surgery,3Department of Cardiolory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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DOI:
参考文献(References):
- [1]Lambert V,Sigal-Cinqualbre A,Belli E,et al·Preopera-tive and postoperative evaluation of airways compression in pediatric patients with3-dimensional multislice computed to-mographic scanning:effect on surgical management[J]·J Thorac Cardiovasc Surg,2005,129:1111-1118·
- [2]Gilkeson RC,Ciancibello L,Zahka K·Pictorial essay·Multidetector CTevaluation of congenital heartdisease in pe-diatric and adult patients[J]·AJR,2003,180:973-980·
- [3]Ou P,CelermajerDS,Calcagni G,etal·Three-dimensional CTscanning:a new diagnostic modality in congenital heart disease[J]·Heart,2007,93:908-913·
- [4]Khatri S,Varma SK,Khatri P,et al·64-slice multidetecto-rrowcomputed tomographic angiography for evaluating con-genital heart disease[J]·Pediatr Cardiol,2008,29:755-762·
- [5]Hamoir X,Salovic D,Bouziane T,et al·Dual source CT:cardio-pulmonary applications[J]·JBR-BTR,2007,90:77-79·
- [6]Johnson TR,Nikolaou K,Wintersperger BJ,et al·Dual-source CTcardiac imaging:initial experience[J]·Eur Ra-diol,2006,16:1409-1415·
- [7]Leschka S,Oechslin E,Husmann L,et al·Pre-and post-operative evaluation of congenital heart disease in children and adults with64-section CT[J]·Radiographics,2007,27:829-846·
- [8]Paul JF,Rohnean A,Sigal-Cinqualbre A·Multidetector CT for congenital heart patients:what a paediatric radiologist should know[J]·Pediatr Radiol,2010,40:869-875·
- [9]Matt D,Scheffel H,Leschka S,et al·Dual-source CTcor-onary angiography:image quality,mean heart rate,and heart rate variability[J]·AJR,2007,189:567-573·
- [10]Ben Saad M,Rohnean A,Sigal-Cinqualbre A,etal·Evalu-ation of image quality and radiation dose of thoracic and cor-onary dual-source CT in110infants with congenital heart disease[J]·Pediatr Radiol,2009,39:668-676·
- [11]Mikkonen R,Kontkanen T,Kivisaari L·Late and acute ad-verse reactions to iohexol in a pediatric population[J]·Pe-diatr Radiol,1995,25:350-352·
- [12]Katayama H,Yamaguchi K,Kozuka T,etal·Adverse reac-tions to ionic and nonionic contrast media·A report from the Japanese Committee on the Safety of ContrastMedia[J]·Ra-diology,1990,175:621-628·
- [13]Paul JF,Rohnean A,Elfassy E,et al·Radiation dose for thoracic and coronary step-and-shoot CT using a128-slice dual-source machine in infants and small children with con-genital heart disease[J]·Pediatr Radiol,2011,41:244-249·
- [14]De Cecco CN,Buffa V,Fedeli S,et al·Dual-source CT coronary angiography:prospective versus retrospective ac-quisition technique[J]·Radiol Med,2011,116:178-188·
- [15]Hausleiter J,Meyer T,Hermann F,et al·Estimated radia-tion dose associated with cardiac CTangiography[J]·JA-MA,2009,301:500-507·
- 王怡宁
- 孔令燕
- 苗齐
- 方理刚
- 李烁
- 周慷
- 王志伟
- 徐凯
- 樊红苓
- 金征宇
WANG Yi-ning1- KONG Ling-yan1
- MIAO Qi2
- FANG Li-gang3
- LI Shuo1
- ZHOU Kang1
- WANG Zhi-wei1
- XU Kai1
- FAN Hong-ling1
- JIN Zheng-yu1 1Department of Radiology
- 2Department of Cardiac Surgery
- 3Department of Cardiolory
- Peking Union Medical College Hospital
- Chinese Academy of Medical Sciences & Peking Union Medical College
- Beijing 100730
- China
- 王怡宁
- 孔令燕
- 苗齐
- 方理刚
- 李烁
- 周慷
- 王志伟
- 徐凯
- 樊红苓
- 金征宇
WANG Yi-ning1- KONG Ling-yan1
- MIAO Qi2
- FANG Li-gang3
- LI Shuo1
- ZHOU Kang1
- WANG Zhi-wei1
- XU Kai1
- FAN Hong-ling1
- JIN Zheng-yu1 1Department of Radiology
- 2Department of Cardiac Surgery
- 3Department of Cardiolory
- Peking Union Medical College Hospital
- Chinese Academy of Medical Sciences & Peking Union Medical College
- Beijing 100730
- China