双源CT前瞻性心电门控技术在小儿主动脉缩窄诊断中的应用

目的 探讨双源CT(DSCT)前瞻性心电门控技术在小儿主动脉缩窄诊断中的价值.方法 对16例临床怀疑为主动脉缩窄的患儿行DSCT前瞻性心电门控心胸联合血管成像及心脏彩色多普勒血流显像(CDFI)检查.以手术或DSA结果为标准,采用x2检验比较DSCT和CDFI的诊断准确率.结果 DSCT诊断主动脉缩窄16例,其中伴房间隔缺损(ASD)4例、室间隔缺损(VSD)9例、大动脉转位1例、主动脉弓发育不良3例、动脉导管未闭( PDA)7例、冠状动脉起源异常1例、支气管动脉扩张l例.CDFI诊断主动脉缩窄15例,主动脉弓离断1例,伴ASD 4例、VSD 9例、二叶型主动脉瓣(BAV)2例、大动脉转位1例、主动脉弓发育不良2例、PDA 7例、支气管动脉扩张1例,未发现冠状动脉起源异常.与手术或DSA结果对照:DSCT和CDFI诊断准确率分别为97.2％(140/144)、97.9％ (141/144),两者差异无统计学意义(x2=0.00,P＞0.05),DSCT和CDFI诊断敏感度均为93.2％ (41/44),特异度分别为99.0％ (99/100)和100.0％ (100/100).DSCT前门控平均有效辐射剂量为0.42 mSv.结论 DSCT前瞻性心电门控技术是诊断小儿主动脉缩窄的首选检查方法.     

多层螺旋CT在小儿先天性心脏病诊断中的应用

目的 探讨16层螺旋CT在小儿先天性心脏病(CHD)诊断中的临床应用.方法 采用多层螺旋CT(MSCT)对20例CHD患儿进行检查,患者平均年龄1岁10个月(1 d～7岁7个月),所有患儿均行超声心动图检查,3例患儿行心血管造影检查.对患儿的影像学检查结果进行回顾性分析.结果 20例CHD中肺动脉吊带2例,主动脉弓褶叠1例,主动脉缩窄4例,主动脉弓离断2例,左、右肺动脉缺如4例,左肺动脉起始处狭窄及部分性肺静脉异位引流4例,单纯型动脉导管未闭(PDA)1例,主动脉窦瘤1例.结论 MSCT可以清晰显示CHD的病理解剖形态,特别是对主动脉、肺动脉及肺静脉畸形的显示具有明显优势,是一种可靠的CHD影像学诊断方法.     

双源CT在儿童肺动脉发育异常中的诊断价值

目的探讨双源CT(DSCT)在评估儿童肺动脉发育异常中的诊断价值。资料与方法心脏超声拟诊为先天性心脏病合并肺动脉发育畸形及临床怀疑有肺动脉发育异常的36例患儿,行DSCT心胸联合血管成像。所得图像全部传入后处理工作站,进行多平面重组(MPR)、最大密度投影(MIP)及容积再现(VR)等后处理,以显示肺动脉及其分支形态及密度,并与手术及X线心血管造影检查结果进行对照。结果 36例患儿术前DSCT血管造影均获得满意图像,运用5点法评价所得平均主观图像质量评分为(4.3±0.6)分;准确诊断肺动脉发育异常41处,漏诊1处为两肺动脉分叉处远端周围肺动脉狭窄,准确率为97.6%;所得平均有效辐射剂量为(1.78±0.31)mSv。结论 DSCT在肺动脉发育异常的诊断中可以保证图像质量,满足诊断的需要。     

升主动脉远端分支供应肺血的肺动脉闭锁并室间隔缺损:第五主动脉弓的鉴别诊断

大多数肺动脉闭锁并室间隔缺损患者通过主动脉与肺动脉间侧支血管或/和动脉导管未闭获得肺血供应。主动脉与肺动脉间的侧支血管常从降主动脉发生,偶尔也可从头臂动脉干起源,但罕见起源于升主动脉者。升主动脉起源的侧支血管被认为是永存第五主动脉弓。作者报道1例罕见病例。 15岁男孩,经心导管证实肺动脉闭锁和室间隔缺损,曾认为肺血供应来源于动脉导管未闭和降主动脉水平的主动脉与肺动脉间侧支血管。3岁和7     

64层螺旋CT在先天性主动脉缩窄和主动脉弓离断诊断中的价值

目的 探讨64层螺旋CT(MSCT)在先天性主动脉缩窄(COA)和主动脉弓离断(IAA)诊断中的应用价值.方法 对21例经手术或DSA证实的COA(18例)和IAA(3例)影像学表现进行回顾性分析,探讨64层螺旋CT增强扫描方法及后处理对其病理分型与合并畸形的诊断价值.结果 (1)18例COA术前CT均诊断正确,诊断准确率100%.对合并的畸形,如单心室、动脉导管未闭(PDA)、主动脉骑跨、大动脉转位、体肺侧枝循环术前CT均正确诊断,有2例二尖瓣狭窄、1例主动脉瓣狭窄、2例肺动脉高压(PH)、1例室间隔缺损(VSD)及1例房间隔缺损(ASD)漏诊.(2) CT诊断3例IAA,均为A型,均合并有VSD、PDA及PH,除1例ASD漏诊外其他畸形与手术完全符合.结论 64层螺旋CT作为一种无创性血管造影技术,对于COA和IAA及其合并的其他畸形,具有重要的诊断价值,因而可作为患者检查的首选.     

产前超声诊断胎儿右位主动脉弓

目的 探讨胎儿右位主动脉弓的产前超声诊断方法及声像图特征,提高其产前检出率。方法 回顾性分析我院产前超声诊断的9例右位主动脉弓胎儿的产前超声表现,并对其产前超声特征进行总结分析。结果 9例右位主动脉弓胎儿中5例为单纯性右位主动脉弓,1例为双主动脉弓,1例合并多囊肾,1例合并室间隔缺损型肺动脉闭锁,1例合并室间隔缺损型肺动脉闭锁、右心室双出口和永存左上腔静脉。9例右位主动脉弓在三血管-气管切面上表现为主动脉弓位于气管的右侧,在非标准左心室流出道切面上表现为主动脉弓与升主动脉之间的夹角增大。其中6例为右位主动脉弓合并迷走左锁骨下动脉,与左位动脉导管构成包绕气管和食管的＂U＂型血管环,1例双主动脉弓形成包绕气管和食管的＂O＂形血管环,2例为右位主动脉弓合并头臂动脉镜像分支、动脉导管连接于左锁骨下动脉,未形成血管环。9例中4例引产后经尸体解剖证实,5例经产后超声心动图检查证实。结论 胎儿右位主动脉弓具有特征性的产前超声诊断图像,掌握右位主动脉弓的产前超声图像特征,可有效检出胎儿右位主动脉弓,三血管-气管切面和非标准左心室流出道切面是产前筛查和诊断右位主动脉弓的重要切面。     

双源CT对先天性心脏病纵隔静脉异常的诊断

目的 探讨双源CT(DSCT)心血管成像对先天性心脏病(先心病)纵隔静脉异常的诊断价值.资料与方法 搜集存在纵隔静脉异常的先心病患者62例,男39例,女23例,年龄17天～29岁.使用Siemens双源CT扫描机扫描,运用多种图像后处理方法,重点观察上腔静脉、头臂静脉、奇静脉、半奇静脉、肺静脉及冠状静脉等有无异常.结果 62例中共存在纵隔静脉异常63处(其中1例同时合并永存左上腔静脉和半奇静脉异常),DSCT均正确诊断,可分为6类:永存左上腔静脉29处,24处经冠状静脉窦汇入右心房,4处直接汇入左心房,1处双上腔静脉分别汇入单心房;左头臂静脉异常15处,包括:主动脉弓下左头臂静脉12处、无名动脉后左头臂静脉1处、食管后左头臂静脉1处、左头臂静脉分为上下2支1处;肺静脉畸形引流15处,包括完全型11处和部分型4处;肺静脉曲张1处,为室问隔缺损并肺动脉高压患儿;无顶冠状静脉窦2处,均为法洛四联症患者;下腔静脉中断并半奇静脉扩张、异常引流入永存左上腔静脉1处.结论 DSCT在先心病纵隔静脉异常的诊断及术前评估中具有重要的应用价值.     

128层CT胸部血管三合一成像对突发胸痛的病因诊断

目的 :探讨128层CT胸部血管三合一成像对突发胸痛病因诊断的价值。方法 :对60例临床突发胸痛的患者采用回顾性心电门控技术,行128层CT心胸血管三合一成像,利用图像后处理技术显示冠状动脉、肺动脉、主动脉及胸部其他组织结构。由2名放射科医师对图像进行观察,对疾病进行诊断,并以心血管造影结果为标准进行对照分析。结果:60例行128层CT一站式扫描均能清晰显示双肺动脉、冠状动脉主干及主要分支、胸主动脉及心胸其他组织结构,其中冠状动脉狭窄21例,肺动脉栓塞15例,主动脉夹层4例,其他病变16例,未见异常4例。结论:128层CT胸部血管三合一成像不但能对肺动脉、主动脉、冠状动脉等血管疾病作出诊断,还可明确胸部其他非血管性病变,对突发胸痛的病因诊断有很高的临床价值。     

主动脉弓离断症影像学诊断（附4例报告）

主动脉弓离断症是一种少见的先天性心脏血管畸形 ,我们遇见 4例报告如下。　　例 1　女 ,15岁。活动后心悸 ,气促 10年 ,喜蹲踞。查体 :发育差 ,紫绀 ,心前区隆起 ,心界向左扩大 ,心尖弥散于左锁骨中线第六前肋间 ,胸骨左缘第 2～ 3前肋间可闻及Ⅳ级收缩期杂音 ,Ｐ2 亢进。正位胸片示 :气管中线位 ,未见主动脉弓所致压迹 ,肺动脉段凸出 ,心外形中度增大 ,升主动脉及主动脉结显示不清 (图 1)。心血管造影示 :主肺动脉瘤样扩张 ,左右肺动脉及其分枝明显增粗 ,造影剂经肺循环后显示主动脉弓于左锁骨下动脉远端离断 ,诊断为主动脉弓离断症并动脉…     

多层螺旋CT血管成像诊断主动脉离断和缩窄的初步应用

目的:探讨多层螺旋CT血管成像(MSCTA)对主动脉弓离断(IAA)和缩窄(CoA)的诊断价值,并与超声检查进行比较。方法:回顾性分析11例术前临床疑诊IAA和CoA患者的MSCTA和超声检查结果,并与手术结果进行对比分析。11例中IAA3例,CoA7例,主动脉折曲1例;合并动脉导管未闭(PDA)5例,室间隔缺损(VSD)4例。结果:11例中MSCTA诊断IAA3例,疑诊1例;诊断CoA6例、假性主动脉缩窄1例。超声检出IAA2例,其中1例为疑诊,漏诊IAA1例;诊断CoA8例,其中1例为误诊。MSCTA检出VSD2例,PDA3例;超声检出VSD5例,PDA6例。MSCTA可较好显示主动脉离断和缩窄的部位、程度及其合并的心内外畸形和侧支循环的情况。结论:MSCTA是诊断主动脉离断和缩窄的重要方法,为临床提供直观参考,结合超声检查可提高对合并心内畸形的诊断。     

主动脉弓离断三联征的放射诊断

目的：分析与评价主动咏弓离断(IAA)三联征的影像学表现及其诊断价值。方法：回顾性分析20例患者的X线平片、心导管检查和心血管造影资料,其中7例行电子束CT检查,11例行手术治疗,逐个分析其X线平片征象并与心血管造影及手术结果对照。结果：X线胸片显示肺血多,肺动脉段明显凸出和心脏增大(n=20);右上纵隔大血管影变窄(n=16);主动脉结观察不清(n=16);侧位或左前斜位见低位主动脉弓(n=12);降主动脉的顶端与主肺动脉处同一水平(n=8)。心导管检查均提示肺动脉高压、主动脉弓畸形、动脉导管未闭。心血管造影诊断IAA(A型)13例,IAA(B型)5例,其中合并主肺间隔缺损4例,合并右室双出口2例,右肺动脉起源异常1例。结论：X线平片对该畸形的诊断有一定的价值,多数病例可作诊断,心血管造影是诊断该病的最可靠方法。     

Congenital thoracic arterial anomalies in adults: a CT overview

Congenital thoracic arterial anomalies can be incidentally detected in adults from imaging studies performed for other indications. Multidetector computed tomography plays a critical role in the noninvasive assessment of these anomalies and associated cardiac, mediastinal, or parencyhmal changes by providing volumetric data. Radiologists should be familiar with imaging findings of these anomalies to avoid misinterpretation and to establish accurate diagnosis. In this article, we review the imaging characteristics of congenital aortic, pulmonary, and aortopulmonary anomalies with an emphasis on multidetector computed tomography findings. We illustrate the CT findings of congenital arterial anomalies such as double aortic arch, right aortic arch, aortic coarctation, pseudocoarctation, interrupted aortic arch, interruption (absence) of the pulmonary artery, pulmonary artery sling, pulmonary artery stenosis, transposition of great vessels, truncus arteriosus, aortopulmonary window, and patent ductus arteriosus.     

Aberrant subclavian arteries: cross-sectional imaging findings in infants and children referred for evaluation of extrinsic airway compression

OBJECTIVE: The purpose of our study was to describe patterns of airway compression identified on cross-sectional imaging in infants and children with either right aortic arch and aberrant left subclavian artery or left aortic arch with aberrant right subclavian artery. MATERIALS AND METHODS: Data from MR imaging and CT performed to evaluate pediatric patients for extrinsic airway compression were reviewed for cases that revealed an aberrant right or left subclavian artery. Clinical, endoscopic, and imaging findings in identified cases were reviewed. Recurrent patterns of extrinsic compression were reviewed among cases. RESULTS: Twelve patients with right aortic arch with aberrant left subclavian artery and nine patients with left aortic arch and aberrant right subclavian artery were identified. All 12 with right aortic arch with aberrant left subclavian artery had airway compression shown, with multiple sites or diffuse compression in six. Of these 12 patients, nine had compression at the level of the arch and aberrant subclavian artery (10 had Kommerell's diverticulum), and nine had compression of the distal airway in association with a midline descending aorta. Five of the nine patients with left aortic arch and aberrant right subclavian artery had airway compression shown, all at the level of the arch and aberrant subclavian artery. None of these compressions was associated with either Kommerell's diverticulum or midline descending aorta. CONCLUSION: Both right and left aberrant subclavian arteries can be associated with symptomatic airway compression, but the patterns of compression are different. The airway compression in right aortic arch with aberrant left subclavian artery is often associated with either Kommerell's diverticulum or midline descending aorta, whereas compression associated with left aortic arch and aberrant right subclavian artery is not.     

Interrupted aortic arch: diagnosis with gadolinium-enhanced 3D MRA

PURPOSE: Our goal was to describe the use of gadolinium-enhanced 3D MR angiography (MRA) in the diagnosis of interrupted aortic arch (IAA). METHOD: A review of our MR data base from a 1 year period yielded three patients (1 day, 8 days, and 16 years old) with IAA. All were referred for evaluation of aortic arch abnormalities, only one of whom had suspected IAA. Patients were imaged at 1.5 T with a 3D spoiled gradient echo pulse sequence (TR/TE 3.8-8/1.3-2.7 ms) following the administration of intravenous gadolinium chelates. Surgical correlation was available in all cases. RESULTS: In the patient with clinically suspected IAA, a previously unsuspected aberrant right subclavian artery was identified that was not seen on preoperative echocardiography. In another patient with a history of previous mediastinal surgery, IAA was diagnosed without concomitant cardiac anomalies, suggesting surgical ligation. In the remaining patient, IAA was detected as well as a patent truncus arteriosus. CONCLUSION: Gadolinium-enhanced 3D MRA may provide for a rapid diagnosis of IAA that may not be possible with other noninvasive modalities. The rapid acquisition time enables unstable pediatric patients to spend minimal time in the MR suite.     

Clinical and imaging characteristics of isolated subclavian artery in pediatric patients

ObjectivesTo describe clinical and imaging characteristics of an isolated subclavian artery (ISA) in pediatric patients.BackgroundISA is a rare congenital aortic arch anomaly defined as a loss of connection between the subclavian artery and aorta. The clinical manifestations and complications of ISA in children are unclear.MethodsThis retrospective study included clinical and imaging data of ISA patients younger than 18 years whose data were recorded in the electronic radiology database during January 2006–August 2019.ResultsOf 102 enrolled patients, 59 had been diagnosed in the first year of life. The majority of the patients also had congenital heart diseases, of which tetralogy of Fallot was the most common. The vertebral artery and collateral branch of the descending aorta served as blood flow supplies in 94 and 8 patients with ISA, respectively, as confirmed using computed tomography or magnetic resonance imaging. However, the blood supply did not influence the development of ISA. Eleven patients exhibited mild or moderate stenosis of the ISA, although only two exhibited coldness or a blood pressure gradient in the upper extremities. These two symptomatic patients also presented with patent ductus arteriosus, and this association was significant (P = 0.008).ConclusionISA management is often determined based on symptoms and associated congenital heart diseases. The ISA is prone to stenosis in patients with ipsilateral patent ductus arteriosus. We recommend early surgical ligation or percutaneous closure of the ductus arteriosus in patients with ISA.     

Berry综合征的超声心动图诊断价值分析

目的：分析Berry综合征彩色多普勒超声心动图图像特征,评价多普勒超声心动图对Berry综合征的诊断价值,分析超声心动图漏误诊的原因,旨在提高超声心动图技术对Berry综合征诊断的准确性。方法21例经心外科手术或经核磁共振（M RI）检查明确为Berry综合征的患儿为研究对象,对其超声心动图检查结果进行回顾性分析。结果Berry综合征畸形主要包括远端主肺动脉间隔缺损（21例）、右肺动脉异常起源于升主动脉（21例）、主动脉弓离断（A型19例）及主动脉缩窄（2例）、室间隔完整（21例）;最常见的合并畸形有肺动脉高压（21例）、动脉导管未闭（19例）、房间隔缺损（9例）、卵圆孔未闭（4例）、主动脉瓣狭窄（1例）、二尖瓣狭窄（1例）。21例患儿中,超声诊断符合17例（占81．0％）;超声漏、误诊4例（占19．0％）,其中2例漏诊右肺动脉异常起源于升主动脉、1例漏诊主肺动脉间隔缺损及右肺动脉异常起源于升主动脉;1例主动脉弓中断A型误诊为B型。结论多普勒超声心动图技术可以较准确地诊断Berry综合征的各种组合畸形,但容易漏诊,必要时可行M RI检查。     

Anomalous origin of the right pulmonary artery from the ascending aorta: Diagnosis by magnetic resonance imaging

Anomalous origin of the right pulmonary artery from the ascending aorta is a rare congenital anomaly. Magnetic resonance imaging (MRI) was performed on three patients with anomalous origin of the right pulmonary artery from the ascending aorta. ECG-gated, Tlweighted, spin-echo MRIs and cine MRIs were obtained. In one patient, postoperative MRI was also obtained. Echocardiography and cardiac catheterization were performed in three patients and angiocardiography was performed in two. MRI clearly showed anomalous origin of the right pulmonary artery from the posterior aspect of the ascending aorta, as well as combined anomalies including patent ductus arteriosus, aortopulmonary window, and interruption of the aortic arch in all three patients. Echocardiography missed this anomaly in all three. We suggest that MRI is an accurate imaging modality in diagnosing anomalous origin of the right pulmonary artery from the ascending aorta, obviating the need to perform angiocardiography     

MDCT evaluation of thoracic aortic anomalies in pediatric patients and young adults: comparison of axial, multiplanar, and 3D images

OBJECTIVE: The objective of our study was to compare accuracies of axial, multiplanar, and 3D volume-rendered images in the diagnosis of thoracic aortic anomalies in pediatric patients and young adults. MATERIALS AND METHODS: Fourteen patients, 17 days to 20 years old, with thoracic aortic anomalies underwent MDCT using axial, multiplanar, and 3D volume-rendering imaging. All images were reviewed by three radiologists for position of the aortic arch, coarctation, vascular compression of the airway, collateral vessel formation, and aortopulmonary shunts (patent ductus arteriosus). Final diagnosis was determined by echocardiography, conventional angiography, bronchoscopy, or surgery. Diagnostic accuracy, sensitivity, and interobserver agreement were evaluated. RESULTS: Average accuracies (average of the three observers for a correct diagnosis) were greater than or equal to 96% for diagnoses of aortic position and airway narrowing on all image types. For the diagnosis of coarctation, average sensitivities (average of the three observers for a true diagnosis) were 73% for axial, 100% for multiplanar, and 100% for 3D volume-rendered images. For the diagnosis of patent ductus arteriosus, average sensitivities were 78% for axial, 94% for multiplanar, and 89% for 3D volume-rendered images. No patients in this study had collateral vessel formation. For the diagnosis of absence of collateral vessel formation, average sensitivities were 100% for axial, 100% for multiplanar, and 100% for 3D volume-rendered images. There were no significant statistical differences in diagnostic performances, agreement with truth, or confidence scores among observers or imaging formats (p > 0.05). CONCLUSION: Axial, multiplanar, and 3D volume-rendered images serve equally well as methods for assessing the side of the aorta to diagnose anomalies. For evaluation of coarctation and patent ductus arteriosus, multiplanar and 3D volume-rendered images perform slightly better than axial images.     

主动脉缩窄及主动脉弓离断的电子束CT诊断

目的：探讨电子束CT诊断先天性主动脉缩窄和主动脉弓离断的价值。材料和方法：共10例病人，年龄6—18岁，均经手术证实。对所有患儿行EBCT增强扫描，并对图像行三维重建。结果：10例病人术前均得到正确诊断，其中8例为主动脉缩窄，2例为主动脉弓离断。EBCT均显示了全部8例主动脉缩窄及其缩窄的程度、形态，并显示缩窄处与左锁骨下动脉的关系。其中6例（75％）为局限性狭窄，2例（25％）形成中-重度长管状狭窄。合并畸形有：3例合并动脉导管未闭，1例合并室间隔缺损，1例合并肺动脉狭窄，1例合并二尖瓣狭窄，2例同时合并动脉导管未闭和室间隔缺损。2例主动脉弓离断病例，均合并有动脉导管未闭、室间隔缺损和肺动脉狭窄。EBCT均显示升主动脉与降主动脉呈分离状。结论：EBCT作为一种无创性检查方法，对先天性主动脉病变的诊断有重要价值，并能同时显示合并的胸部大血管异常。     

SCTA及CT血管仿真内镜在主动脉弓缩窄和离断的评价(附3例报告)

目的：研究SCTA和血管领导 具内镜在主动脉弓缩窄和离断诊断中的应用价值。检查方法和影像学表现。方法：对3例主动脉弓缩窄和离断的患者进行静脉注射对比剂容积扫描。利用后处理技术重建成三维图像和仿真内镜图像，并经动脉造影和手术证实。结果：CTA清晰显了纵隔内血管的解剖细节，配合血管仿真内镜，可对此二种疾病进行分型及诊断。结论：SCTA及血管仿真内镜作为一种无创性血管造影技术。对诊断主动脉弓缩窄和主动脉弓离断有重要价值。