64层螺旋CT血管造影在小儿室间隔缺损中的应用研究

目的:探讨64层螺旋CT血管造影(64-SSCTA)在室间隔缺损(VSD)中的应用价值。方法:对20例临床拟诊为法洛四联症(TOF)患儿行64-SSCTA检查,采用多平面重组(MPR)和最大密度投影(MIP)对原始图像进行后处理,以充分显示VSD,将其结果与同期超声检查结果对照,所有TOF患者的VSD均经手术证实。结果:20例中,手术证实有VSD的18例,64-SSCTA诊断出VSD 16例,漏诊2例;超声诊断出所有18例VSD;若以超声检查为金标准,则64-SSCTA诊断VSD的敏感性、特异性、阳性预测值、阴性预测值分别为88.89%、100%、100%、50.00%;64-SSCTA及超声对VSD的检出率分别为80%(16/20)和90%(18/20),其差异无统计学意义(χ2=0.784,P=0.376);64-SSCTA测量VSD最大径与超声测值分别为(4.98±0.29)mm和(4.96±0.31)mm,两者比较差异无统计学意义(t=0.257 7,P=0.800 2)。结论:64-SSCTA可较好显示VSD的形态改变,能对大于2mm的VSD大小进行较为准确的评估,对术前手术方案的制定有重要价值。

Application study of 64-slice spiral CT angiography in ventricular septal defect in children

Objective： To approach the application value of 64 slice spiral computed tomography angiography（64-SSCTA）in ventricular septal defect（VSD）in children. Methods： 20 pediatric patients with Tetralogy of Fallot （TOF） suspected by clinic underwent 64-SSCTA. The original images of all the patients were reconstructed using multiplanar reconstruction （MPR） and maximum intensity projection （MIP）. All of 64-SSCTA diagnostic information was compared with that of ultrasound （US）. All the diagnosis of VSD was confirmed by operation. Results： O5 all the 20 patients, 18 cases o5 VSD were confirmed by oper-ation and 16 cases were found by 64-SSCTA, missed diagnoses 2 eases. US found all the 18 cases. For the diagnosis of VSD, if US was acted as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value of 64-SSC-TA were 88.89% ,100% ,100%, 50%, respectively. The detection rate for VSD was 80%（16/20）in 64-SSCTA and 90%（18/ 20）in US with no significant difference （%C =0. 784, P =0. 376）. The maximum diameter of VSD was on average （4.98±0.29） mm in 64-SSCTA, whereas on average （4.96±0.31）mm in US. There was no significant difference between the two methods （ t =0. 2577, P = 0. 8002）. Conclusion： 64-SSCTA can clearly shows morphological changes of VSD in children with TOF, and accurately assess the size of VSD above 2mm. It has great value for planning the preoperative surgery programs.