【作者】 汪洁；

【导师】 王青；

【作者基本信息】 山东大学 ， 影像医学与核医学， 2009， 硕士

【摘要】 目的采用DSCT增强扫描技术,以手术或X线心血管造影结果为标准,通过与心脏超声诊断结果比较,探讨双源CT在先天性心脏病诊断中应用价值。材料与方法采用西门子Siemens Somatom Definition DSCT增强扫描检查先天性心脏病50例,其中40例采用心电门控扫描模式,10例因心率过快采用普通胸部增强扫描模式。采用心电门控的扫描参数:两个球管的电压均为120kV,电流350～438mA,旋转时间0.33s,pitch值随心率变化自动调节范围在0.2～0.5,重建层厚0.75mm,重建间隔0.5mm。采用普通胸部扫描模式的扫描参数:使用单球管,电压120kV,电流50mA,旋转时间0.5s,pitch 1.2,重建层厚0.75mm,重建间隔0.5mm。以1.5～3.5mL/s速率经肘静脉注入非离子型对比剂优维显(370mgI/mL)20～80mL。在同步工作站进行多平面重组(MPR)、最大密度投影(MIP)、容积再现(VR)、表面阴影遮盖成像(SSD)及Inspace 4D电影等后处理技术。50例均行心脏超声检查,其中27例经手术证实、9例经X线心血管造影证实。本组以手术或X线心血管造影结果为标准,比较双源CT和心脏超声的诊断准确率。结果经手术或X线心血管造影证实的36例先天性心脏病中,含单纯房间隔缺损、单纯室间隔缺损、主动脉弓离断、单心室、完全型大动脉错位、肺动脉起源异常、冠状窦无顶综合征各1例,单纯动脉导管未闭、校正型大动脉错位、冠状动脉起源异常、肺动脉闭锁并室间隔缺损、左室双出口各2例,右室双出口4例,主动脉缩窄5例,法洛四联症10例。36例共计107处畸形,均以手术或X线心血管造影结果证实,其中心内畸形30处,双源CT和心脏超声诊断准确率分别为93.33%和96.67%,二者差异无统计学意义(P=1.000)。心外畸形77处,双源CT和心脏超声诊断准确率分别为96.10%和87.01%,双源CT诊断准确率高于心脏超声(x~2=4.117,P=0.042)。双源CT与心脏超声联合诊断准确率为99.21%。结论DSCT增强扫描对先天性心脏病心外畸形的诊断准确率高于心脏超声,而心脏超声在显示心内畸形方面具有优势,而且能提供瓣膜返流及生理方面数据。因此,将DSCT和心脏超声联合应用,可以提高先心病的诊断准确率。更多还原

【Abstract】 ObjectiveThe aim of the study was to explore the clinical value and technology of dual source CT in the diagnosis of congenital heart disease.Surgical operation or X-ray angiography was used as reference standard,and DSCT findings were compared with that of echocardiography.Materials and Methods50 patients with suspected congenital heart disease underwent contrast-enhanced examination on dual source CT. Echocardiograph-gated technology was applied in 40 patients,the following scan parameter were used:two tubes,voltage 120kV,current 350～438mA,rotation time 0.33s,pitch ranged from 0.2 to 0.5 with heart rate,thickness 0.75mm,interval 0.5mm.Common chest technology was applied in 10 patients because of sinus tachycardia,the following scan parameter were used:single tube,voltage 120 kV,current 50mA,rotation time 0.5s,pitch 1.2,thickness 0.75mm,interval 0.5mm.A total of 20～ 80mL intravenous contrast agent was injected at 1.5～3.5mL/s.The multiplannar reformations(MPR),maximum intensity projections (MIP),volume rendering techniques(VRT),surface shaded display(SSD) and Inspace 4 D movies were used at dedicated workstation for image analysis.All the 50 patients underwent echocardiography.27 cases were confirmed by surgical operations and 9 cases confirmed by X-ray angiography.Surgical operation or X-ray angiography was used as reference standard,CT findings were compared with that of echocardiography in 36 patients.Results36 patients include atrial septal defect(1),ventricular septal defect(1), interruption of aortic arch(1),single ventricle(1),complete transposition of great artery(1),abnormal origin of pulmonary artery(1),abnormal coronary sinus(1),patent ductus arteriosus(2),corrected transposition of the great arteries(2),double outlet left ventrical(2),abnormal origin of right coronary artery(2),pulmonary atresia with ventricular septal defect(2),double outlet left ventrical(4),coarctation of aorta(5)and Tetralogy of Fallot(10).107 deformities were confirmed by Surgical operation or X-ray angiography in 36 patients.The accuracy of dual source CT in detecting cardiac deformities was 95.33%.In 30 intracardiac deformities,definite diagnostic rate of dual source CT and echocardiography were 93.33%and 96.67%,dual source CT was as accurate as echocardiography in revealing intracardiac deformities(P =1.000).In 77 extracardiac anomalies,definite diagnostic rate of dual source CT and echocardiography were 96.10%and 87.01%respectively, dual source CT was superior to echocardiography in the identifying extracardiac anomalies(x~2=4.117,P=0.042).Combination of dual source CT and echocardiography could increase the definite diagnostic rate to 99.21%.ConclusionsDual source CT was superior to echocardiography in the identifying extracardiac anomalies.The combination of dual source CT with echocardiography can improve definite diagnostic rate in congenital heart disease.更多还原