16层螺旋CT在肺静脉异位引流的诊断应用

目的 探讨16层螺旋CT血管造影对肺静脉异位引流的诊断价值.方法 对18例16层螺旋CT诊断为肺静脉异位引流病例进行回顾性分析,对其中12例手术患者进行手术结果与超声心动图(US)、16层螺旋CT对比.16层螺旋CT采用对比增强容积扫描,于工作站进行多平面重建(MPR)、最大密度投影(MIP)、容积再现(VR).结果 16层螺旋CT诊断完全型肺静脉异位引流(TAPVD)10例,其中心上型7例、心脏型2例及心下型1例.部分型肺静脉异位引流(PAPVD)8例,心脏型5例,心上型3例.与手术结果对照,16层螺旋CT对肺静脉异位引流及其并发畸形诊断准确性高于US.结论 16层螺旋CT能够准确诊断肺静脉异位引流及其合并畸形,有重要的临床应用价值.     

64层螺旋CT对肺静脉异位引流的诊断价值

目的 探讨64层螺旋CT血管造影(MSCTA)及三维重组在诊断肺静脉异位引流(anomalous pulmonary venous drainage,APVD)中的临床应用价值.资料与方法 回顾性分析18例手术证实的APVD患儿的64层螺旋CT的影像资料.结果 18例中完全性APVD 15例,其中心上型6例,心内型6例,心下型2例,混合型1例,部分性APVD 3例.MSCTA诊断与手术结果一致.结论 MSCTA及三维重组对APVD诊断准确性高,是一种可靠的无创检查方法.     

64层螺旋CT血管成像对儿童肺静脉异位引流的诊断价值

目的：研究64层螺旋CT血管成像（MSCTA）在儿童肺静脉异位引流（APVD）中的应用价值。方法：回顾性分析18例APVD患者的MSCTA资料,常规行多平面重组（MPR）、薄层最大密度投影（MIP）和容积再现（VR）等后处理,并与经胸超声心动图（TE）进行对照研究。结果：所有患儿MSCTA均显示肺静脉回流异常,17例完整显示引流静脉行径,17例患儿引流位置诊断明确,显示率均高于TE。重组图像能直观明确的显示引流静脉的整体形态。结论：MSCTA结合后处理技术对APVD诊断价值高于TE,能全面的评价患儿状况并指导治疗。     

64层螺旋CT对肺静脉异位引流的诊断价值

目的 探讨肺静脉异位引流的64层螺旋CT及后处理图像征象,以提高对该病的诊断价值.资料与方法 回顾性分析16例先天性肺静脉异位引流患者的64层螺旋CT图像在工作站进行多半面重组(MPR)、最大密度投影(MIP)和容积再现(VR)等后处理资料,观察异位引流肺静脉的位置、形态、其异位连接(心腔或静脉)以及合并的心脏畸形,并对8例行手术治疗病例的CT诊断、超声心动图检查与手术结果进行比较.结果 64层螺旋CT诊断完全性肺静脉异位引流8例,其中心上型5例,心内型3例;部分性肺静脉异位引流8例,其中心上型4例,心内型4例.8例手术病例CT诊断与手术结果完全相符.结论 64层螺旋CT在诊断肺静脉异位引流中具有重要作用,是肺静脉异位引流的有效、无创检查方法.     

多层螺旋CT肺静脉解剖成像及进展

肺静脉的解剖结构存在着一定的共性,但是也常发生变异。随着医疗技术的不断发展和对肺静脉相关疾病的逐渐认识,充分了解肺静脉的正常解剖关系及变异显得越发重要。因此,对MSCT技术在肺静脉成像中的应用现状、优缺点和进展作一综述患者。     

肺静脉分型的多层螺旋CT解剖研究

目的 探讨肺静脉的多层螺旋CT解剖分型.方法 120例应用多层螺旋CT行冠状动脉CTA检查,对原始横断面图像进行容积重建(VR)和多平面重建(MPR).按照肺静脉开口数目、肺静脉数目、肺静脉共同开口及副肺静脉出现情况对肺静脉进行分型,统计各型的出现率.对肺静脉共同开口、副肺静脉出现率的性别差异进行统计学分析.结果 本组人群中,肺静脉共同开口的出现率为22.5%,副肺静脉的出现率为15.8%,均无性别差异.肺静脉可分为4型,其中标准型最常见,出现率为62.5%,肺静脉共同开口型为21.7%,副肺静脉型为15.0%,混合变异型为0.8%.结论 多层螺旋CT对肺静脉的解剖观察,可为临床提供解剖信息.     

MSCT诊断新生儿肺静脉异位引流的临床价值

目的 探讨多层螺旋CT(MSCT)在新生儿肺静脉异位引流中的应用价值.方法 对15例肺静脉异位引流患儿进行MSCT扫描,并进行分型.结果 MSCT能很好显示肺静脉异位引流的引流途径、开口位置及并发畸形,确诊15例,诊断准确率100％,诊断伴发畸形准确率为86.7％.结论 MSCT(MPR、CPR、MIP、VR)重建图像所显示的肺静脉异位引流情况与术中所见一致,可作为新生儿肺静脉异位引流术前的重要检查手段.     

肺栓塞的多层螺旋CT诊断价值

目的 分析肺栓塞的MSCT的影像表现,探讨螺旋CT对其诊断价值.方法 回顾性分析25例肺栓塞的CT表现. 全部病例均行胸部CT平扫及CT肺血管成像.结果 肺栓塞的直接征象为肺血管成像显示肺动脉内充盈缺损.本组25例肺栓塞共累及肺动脉191支,其中,中心型44支(23.0%),偏心型115支(60.2%),附壁型7支(3.7%),闭塞型25支(13.1%).间接征象包括不规则实变影15例;片状磨玻璃影6例;局限性索条状影4例;"马赛克"征5例;胸腔积液16例;心包少量积液3例;3例除栓子外未见异常.结论 CTAP是诊断肺栓塞快速、安全有效、无创的诊断方法,具有较高的诊断价值.     

多层螺旋CT对孤立性肺结节的诊断价值

目的 探讨多层螺旋CT鉴别孤立性肺良恶性结节的诊断价值.方法 回顾性分析2005-10-2007-12在本院接受治疗的临床与病理资料完整的肺孤立性结节(SPN)患者76例,以手术或穿刺活组织检查的病理结果作为诊断金标准.以动态扫描中增强值＞20 HU为界值计算出CT诊断SPN的敏感性、特异性、准确性、阳性预测值和阴性预测值.结果 多层螺旋CT对良性孤立性肺结节诊断的敏感度、特异度、准确性、阳性预测值、阴性预测值分别为92.6%,89.8%,90.8%,83.3%,95.7%.对恶性孤立性肺结节诊断的敏感度、特异度、准确性、阳性预测值、阴性预测值分别为83.7%,80.5%,82.9%,89.1%,73.3%.结论 多层螺旋CT诊断良恶性孤立性肺结节具有较高的敏感性、特异性和准确性,可作为诊断孤立性肺结节首选的非侵入性检查方法.     

部分型肺静脉异位引流1例

患者女,70岁。因阵发性房颤入院。查体：心界略大,各瓣膜区未闻及明显病理性杂音。超声检查：轻度肺动脉高压伴中度三尖瓣反流;轻度二尖瓣反流;主动脉瓣钙化伴轻度主动脉瓣反流。左房肺静脉CT成像：左房大小正常。左房及左心耳未见充盈缺损。左下肺静脉及右上、下肺静脉走行正常,汇人左房（图1）。左上肺静脉未进入左房,由左上纵隔旁垂直静脉引流入左头臂静脉,汇入上腔静脉（图2～4）。CT诊断：部分型肺静脉异位引流（心上型）。     

MSCTA对肺静脉异位引流的诊断价值

目的：比较多层螺旋CT血管成像（MSCTA）和经胸超声心动图（TTE）对肺静脉异位引流的诊断价值。方法：对2007年9月～2009年5月22例临床怀疑先天性肺静脉异位引流的患儿行MSCTA检查及TTE检查,并与手术结果相对照。结果：经手术证实22例病例中,完全性肺静脉异位引流13例,其中心上型6例,心内型5例,心下型2例;部分肺静脉异位引流9例,其中心上型8例,心内型1例。MSCTA和TTE的诊断符合率分别为96%和73%。结论：MSCTA是诊断先天性肺静脉异位引流的重要手段。     

多普勒超声心动图诊断部分性肺静脉异位引流

目的:评价多普勒超声心动图诊断部分性肺静脉异位引流(PAPVC)的价值。方法:回顾分析132例经心外科手术确诊为PAPVC患者的超声心动图诊断情况。结果:根据Brody分型,132例患者中A型14例,超声诊断11例,诊断正确率78.6%;B型103例,超声诊断57例,正确率55.3%;C型4例,超声诊断3例,诊断正确率75%;D型3例,混合型8例,术前超声均未能做出正确诊断。132例患者中右侧肺静脉异位引流90.1%;左侧肺静脉异位引流7.4%,双侧占2.5%。合并房间隔缺损(ASD)121例(91.7%),其中静脉窦型ASD 40例(33.1%),功能性单心房(大型ASD)或单心房18例(14.9%),继发孔型ASD 63例(52%);9例房间隔完整(6.8%),2例冠状静脉窦隔缺损(1.5%)。结论:彩色多普勒超声心动图可以清晰显示肺静脉的回流情况,准确诊断PAPVC。     

混合型完全性肺静脉异位引流的CT及MRI诊断

目的探讨CT及MRI对混合型完全性肺静脉异位引流的诊断价值。方法以手术证实为混合型完全性肺静脉异位引流的26例患儿为研究对象,回顾性分析其CT及MRI影像。结果 26例患儿的CT及MRI影像均清晰显示肺静脉异位引流的途径,诊断的正确率为100%。26例混合型完全性肺静脉异位引流可分为两类,①"3+1"型:3支肺静脉回流入右心房或冠状静脉窦或体循环静脉,而另1支肺静脉则回流入另一侧的体循环静脉,此类共22例;②"2+2"型:指两侧的肺静脉分别回流入不同的位置,此类共2例。另有2例异位引流的肺静脉超过4支。结论 CT及MRI能够准确地诊断混合型完全性肺静脉异位引流。     

Computed tomography of partial anomalous pulmonary venous connection in adults

OBJECTIVES: To systematically describe the imaging features and clinical correlates of a partial anomalous pulmonary venous connection diagnosed on computed tomography (CT) in adults. METHODS: Twenty-nine adults with a partial anomalous pulmonary venous connection on CT were retrospectively identified. There were 19 women and 10 men, with a mean age of 53 (range: 19-83) years. Four cases were identified by review of 1825 consecutive chest CT reports from July 2000-July 2001, and 25 cases were culled from chest radiology teaching files at 3 institutions. Inclusion criteria were availability of CT images and medical charts. Chest radiographs (25 of 29 cases) were reviewed for mediastinal contour abnormalities, heart size, and pulmonary vascular pattern. Chest CT scans were reviewed for location, size, and drainage site of the anomalous vein; presence or absence of a pulmonary vein in the normal location; cardiac size and configuration; and pulmonary vasculature. Charts were reviewed for evidence of pulmonary and cardiovascular disease, history of congenital heart disease, and results of other cardiac imaging. RESULTS: The prevalence of a partial anomalous pulmonary venous connection was 0.2% (4 of 1825 chest CT reports). Seventy-nine percent (23 of 29 patients) had an anomalous left upper lobe vein connecting to a persistent left vertical vein, only 5% (1 of 23 patients) of whom had a left upper lobe vein in the normal location. Seventeen percent (5 of 29 patients) had an anomalous right upper lobe vein draining into the superior vena cava, 60% (3 of 5 patients) of whom also had a right upper lobe pulmonary vein in the normal location. One patient (3%) had an anomalous right lower lobe vein draining into the suprahepatic inferior vena cava. Chest radiographic findings were abnormal left mediastinal contour in 64% (15 of 25 patients), abnormal right mediastinal contour in 8% (2 of 25 patients), and cardiomegaly in 24% (6 of 25 patients). Computed tomography findings were cardiomegaly in 48% (14 of 29 patients), right atrial enlargement in 31% (9 of 29 patients), right ventricular enlargement in 31% (9 of 29 patients), and pulmonary artery enlargement in 14% (4 of 29 patients). Pulmonary or cardiovascular symptoms were present in 69% (20 of 29 patients), 55% (11 of 20 patients) of whom had specific alternative diagnoses (excluding congestive heart failure and pulmonary hypertension) to explain the symptoms. Only 1 patient (3%) was diagnosed with a secundum atrial septal defect. CONCLUSIONS: A partial anomalous pulmonary venous connection was seen in 0.2% of adults on CT. In contrast to previous series focusing on children, the anomalous vein in adults was most commonly from the left upper lobe, in women, and infrequently associated with atrial septal defects.     

Dual connection of single pulmonary vein in partial anomalous pulmonary venous return

We present the case of a 6-month-old infant born premature at 29 weeks with perinatal stroke and postnatal hypoxia. Echocardiogram was suspicious for partial anomalous pulmonary venous return (PAPVR). Cardiac CT showed an unusual variant of PAPVR, with a vertical vein having a dual connection superiorly to the left innominate vein and inferiorly to the morphologic left atrium. This unusual variant has the potential for right-to-left flow with a possibility of systemic hypoxia and paradoxical embolism.     

MSCT对肺真菌病的诊断价值

目的：探讨肺真菌病的多层螺旋CT表现,以提高对本病的诊断水平.方法：回顾分析23例肺真菌病患者的病例资料,其中经手术病理证实9例、痰和脑脊液培养证实7例、经皮穿刺活检证实2例、纤支镜刷检5例.全部痛例均行全肺MSCT扫描,14例行病灶处HRCT检查.结果：23例中表现为肺内散在结节影4例,直径1～3 cm,密度均匀,周围见＂晕轮征＂;肿块及空洞影6例,肿块直径〉3 cm,密度较高,周围可见＂晕轮征＂,其中4例有空洞形成,内壁光滑;肺部炎症样改变8例,多位于两肺中下部,病变可融合呈地图状或蜂窝样实变影,侵犯一个肺段或肺叶,似肺段性或大叶性肺炎的表现,其中胸膜下楔形实变影3例,不规则片状实变影5例;曲菌球5例,表现为空洞内边缘光滑的球形致密影,随体位而变化,并见＂空气半月征＂.结论：肺部真菌感染的MSCT表现复杂,病变分布广泛,呈多种性质、多灶性及多形性改变,MSCT能准确显示病灶的细节,是观察肺真菌感染的重要手段.     

Total anomalous pulmonary venous connection

Total anomalous pulmonary venous connection (TAPVC), where the pulmonary venous circulation drains into the systemic venous circulation rather than into the left atrium, may present a number of problems at autopsy. A 5-week-old infant is reported who died suddenly and unexpectedly who was found at autopsy to have infradiaphragmatic TAPVC into the portal vein. The only associated anomalies were a tri-lobed left lung, a patent ductus arteriosus, and drainage of the inferior vena cava into the both the right and left atria. This case demonstrates particular features that may lead to difficulties in establishing the diagnosis of TAPVC. Sudden death in the absence of symptoms in this age group raises the possibilities of sudden infant death syndrome (SIDS) and inflicted injury, both of which were discounted in this case. An autopsy approach is outlined to maximize chances of diagnosing this entity that includes meticulous inspection and dissection of cardiac vascular connections before evisceration, with photographic documentation of findings. Concurrent cardiovascular abnormalities, including valve atresias, septal defects, and left heart hypoplasia are likely in the presence of asplenia/polysplenia syndrome. Extracardiac anomalies may be present in the form of Holt-Oram, Ellis-van Creveld, and cat eye syndromes. Careful examination of the common draining vein for obstructive features is an important part of the postmortem assessment. The possibility of heritable cases requires referral of the family for genetic evaluation.     

The Scimitar syndrome: CT findings in partial anomalous pulmonary venous return

An anomalous pulmonary vein draining into the subdiaphragmatic inferior vena cava was initially demonstrated on computed tomographic (CT) scans. The diagnosis of scimitar syndrome was confirmed with digital subtraction angiography. In retrospect, the anomalous vein and dextroposition of the heart were shown on chest radiographs.     

Computed tomography diagnosis of partial anomalous pulmonary venous drainage

A case of the rarely occurring partial anomalous pulmonary venous drainage of the right upper lobe into the azygos arch is presented. Computed tomography (CT) clearly demonstrated the abnormal vessel coursing through the right upper lobe and draining into the azygos arch.