超声心动图结合Flash CT对肺静脉畸形引流的诊断价值

目的评价超声心动图结合Flash CT对肺静脉畸形引流（APVC）的诊断价值。 方法2011年9月至2015年5月郑州大学第一附属医院收治行心脏畸形矫治的各种不同类型的APVC患者71例。所有患者均经手术确诊。包括完全性肺静脉畸形引流（TAPVC）患者44例，部分性肺静脉畸形引流（PAPVC）患者27例。所有患者术前均行超声心动图与Flash CT检查。记录所有病例的CT剂量指数和剂量长度乘积（DLP），计算有效辐射剂量（ED）。采用Fisher确切概率法比较超声心动图与Flash CT对TAPVC/PAPVC分型、TAPVC/PAPVC合并畸形的诊断准确率差异。 结果超声心动图与Flash CT对TAPVC分型的诊断准确率分别为86.4%（38/44）和97.7%（43/44），差异无统计学意义（P>0.05）。超声心动图与Flash CT对TAPVC合并畸形的诊断准确率分别为100%（62/62）和95.2%（59/62），差异无统计学意义（P>0.05）。Flash CT对PAPVC分型的诊断准确率为96.3%（26/27），高于超声心动图对PAPVC分型的诊断准确率74.1%（20/27），且差异有统计学意义（P<0.05）。超声心动图对PAPVC合并畸形的诊断准确率为97.7%（43/44），高于Flash CT对PAPVC合并畸形的诊断准确率72.3%（34/44），且差异有统计学意义（P<0.01）。71例APVC患者的辐射剂量：平均DLP为（13.5±3.9） mGy ? cm，平均ED值为（0.324±0.065）mSv。 结论超声心动图是诊断APVC传统的可靠方法，尤其对瓣膜病变、肺动脉压力及心功能可以做出全面评价。Flash CT大螺距扫描技术对心脏周围血管畸形的诊断具有独特的优势，在不影响诊断准确率的前提下，大大减少了射线的辐射剂量，尤其对于PAPVC患者，Flash CT诊断准确率要高于超声心动图，对超声心动图起到了很好的补充诊断作用。

Diagnostic value of echocardiography combined with Flash CT for anomalous pulmonary venous connection

ObjectiveTo investigate the diagnostic value of echocardiography combined with Flash CT for anomalous pulmonary venous connection (APVC). MethodsFrom September 2011 to May 2015, 71 patients with APVC in the First Affiliated Hospital of Zhengzhou University were treated with various types of cardiac malformations. All patients were confirmed by surgery, including 44 cases of total anomalous pulmonary venous connection (TAPVC) and 27 cases of partial anomalous pulmonary venous connection (PAPVC). All cases underwent both preoperative echocardiography and Flash CT scanning examination. The CT dose index, dose length product (DLP) and effective radiation dose (ED) were recorded and calculated in all cases. The diagnostic accuracy of echocardiography was compared with Flash CT for TAPVC/ PAPVC typing and TAPVC/ PAPVC combined malformations by using Fisher′s exact test. ResultsThe diagnostic accuracy of echocardiography and Flash CT for TAPVC typing was 86.4% (38/44) and 97.7% (43/44), and the difference was not statistically significant (P>0.05). The diagnostic accuracy of echocardiography and Flash CT for TAPVC combined malformations was 100% (62/62) and 95.2% (59/62), and the difference was not statistically significant (P>0.05). The diagnostic accuracy rate of Flash CT for PAPVC typing was 96.3% (26/27), which was higher than that of echocardiography (74.1%, 20/27), and the difference was statistically significant (P<0.05). The diagnostic accuracy rate of echocardiography for PAPVC combined malformations was 97.7% (43/44), which was higher than that of Flash CT (72.3%, 34/44), and the difference was statistically significant (P<0.01). Statistics of radiation dose in 71 patients with anomalous pulmonary venous connection: the average DLP was (13.5±3.9) mGy?cm, the average ED was (0.324±0.065) mSv. ConclusionsEchocardiography, a traditional reliable method for diagnosis of APVC, can make a comprehensive assessment of valvular disease, pulmonary arterial pressure and heart function. Flash CT scanning technology for the large vascular malformations around heart has unique advantages, which greatly reduce the radiation dose radiation without affecting the diagnostic accuracy. Flash CT diagnostic accuracy is higher than echocardiography, which play a complementary role in diagnosis, especially in PAPVC.