多层CT在新生儿及婴儿先天性主动脉异常分类中的诊断价值

目的 研究多层CT对新生儿及婴儿先天性主动脉异常分类中的诊断价值.方法 回顾性分析2007年4月至2009年6月东南大学附属中大医院有手术结果的120例先天性心脏病患儿(≤1岁)的64层CT增强检查资料,观察其诊断先天性主动脉异常的敏感性、特异性及准确性,并与心脏超声及多普勒结果进行对比.患儿随机采用80 kV(n=72)及100 kV(n=48)两组扫描,观察其图像质量的差异.结果 多层CT共发现36例(36/120,30%)先天性主动脉异常,其类型分别为双主动脉弓2例,左位主动脉弓伴迷走右锁骨下动脉2例;右位主动脉弓22例(右位主动脉弓伴迷走左锁骨下动脉6例,右位主动脉弓伴镜像分支12例),主动脉缩窄10例.64层CT诊断新生儿及婴儿先天性主动脉异常的敏感性、特异性及准确性分别为100%、100%、100%,心脏超声及多普勒诊断的敏感性、特异性及准确性分别为27.8%、97.6%、76.7%.80 kV及100 kV管电压组的图像质量评分分别为4.69±0.52、4.58±0.58,两组图像质量差异无统计学意义(t=1.08,P=0.28).结论 多层CT心血管成像能满意地观察并鉴别先天性主动脉异常的类型,可作为先心病常规心脏超声检查的重要补充手段,为手术计划的制定提供重要的信息.1岁以下先天性心脏病患儿多层CT检查时可常规选择80 kV扫描以减少射线剂量.

Diagnostic value of 64 multislice CT in typing of congenital aortic anomaly in neonates and infants

Objective To study diagnostic value of 64 multislice CT in typing of congenital aortic anomaly in neonates and infants.Methods 120 pediatric patients (under one year of age) with congenital heart disease (CHD) underwent 64 contrast-enhanced MSCT before a corrective operations.The diagnostic sensitivity,specificity and accuracy of 64 MSCT were evaluated and also compared with those of echocardiography with Doppler.The patients were randomly assigned to two groups (72 and 48 persons)respectively according to tube tension of 80 and 100 kV.The differences of the image qualities were compared between them.Results 36 congenital aortic anomalies were found (36/120,30%) by 64 MSCT,which were furtherly distinguished into 2 cases in double aortic arch,2 cases in left-sided aortic arch with aberrant right subclavian artery,22 cases in right aortic arch (6 cases in right-sided aortic arch with aberrant left subclavian artery,12 cases in right aortic arch with mirror image branching),10 cases in coarctation ofaorta.Diagnostic sensitivity,specificity and accuracy of 64 MSCT were all 100%.By contrast,those of echocardiography with Doppler were 27.8%,97.6%,76.7%,respectively.The quality scores were 4.69 ±0.52,4.58±0.58 at 80 kV and 100 kV,respectively.No significant statistical difference was found between them(t = 1.08,P = 0.28 ).Conclusion MSCT allows a detailed assessment of the anatomy of congenital aortic anomaly,which can be used as an important supplementary method in diagnosing CHD and offer important information for operation.80 kV should be selected in CHD patients less than one year old for CT examination to reduce radiation exposure.