复杂型先天性心脏病影像诊断方法的ROC评价

目的 用受试者工作特征(ROC)曲线分析法评价复杂型先天性心脏病(先心病)影像诊断方法的应用价值.方法 由三位医师双盲对28例复杂型先心病的二维超声心动图(2DE)、实时三维超声心动图(RT-3DE)、数字减影心血管造影(DSA)、磁共振成像(MRI)或多层螺旋CT资料进行观察后,对有无心内、大血管根部畸形及心外畸形等作出各自诊断,并以手术诊断为金标准,按完全正确至完全不正确5个诊断精度进行ROC分析法评价.结果 对复杂型先心病心内及大血管根部畸形诊断,RT-3DE的ROC曲线最偏左上角,曲线下面积为RT-3DE(0.96)>2DE(0.92)>MRI/CT(0.91)>DSA(0.89).Z检验示RT-3DE优于2DE(Z=2.30,双侧P=0.021 5)、MRI/CT(Z=2.80,双侧P=0.005 0)、DSA(Z=3.18,双侧P=0.001 5).而对心外畸形的诊断,DSA的ROC曲线最偏左上角,曲线下面积为DSA(0.99)>MRI/CT(0.98)>2DE(0.92).Z检验示DSA优于2DE(Z=2.67,双侧P=0.007 5),但与MRI/CT诊断结果相似(Z=1.52,双侧P=0.129 2),差异无统计学意义(P>0.05).结论 ROC评价提示对复杂型先心病心内及大血管根部畸形诊断首选超声,当要进一步明确畸形空间位置、立体形态时可加做RT-3DE;而对心外血管畸形诊断MRI、多层螺旋CT准确性高,在某种程度上可替代心血管造影.

Value of cardiovascular imaging in diagnosis of complex congenital heart disease:ROC curve analysis

Objective To evaluate the value of cardiovascular imaging in diagnosis of complex congenital heart disease(CHD) in children with receiver operating characteristic(ROC) analysis.Methods Twenty-eight patients with complex CHD were examined by three cardiologists with two-dimensional echocardiography(2DE),real-time three-dimen-sional echocardiography(RT-3DE),magnetic resonance imaging(MRI),multi-slice spiral computed tomography(CT),and digital subtraction angiography(DSA).All the cardiologists involved in the ...