多层螺旋CT在小儿肺静脉畸形引流诊断中的价值

目的　探讨多层螺旋CT(MSCT)对小儿肺静脉畸形引流的诊断价值。方法　对20例MSCT诊断为小儿肺静脉畸形引流的病例进行回顾性分析。年龄11d至12岁,MSCT采用对比增强容积扫描,层厚1 250mm,层间距0 625mm,均行多平面重建(MPR)、薄层最大密度投影(STS MIP)、容积再现(VR)及表面阴影成像法(SSD)重建。所有病例均行超声心动图(US)检查,其中12例行心血管造影(CAG)检查, 14例尚有手术结果对照。结果　MSCT诊断完全型肺静脉畸形引流9例,部分型肺静脉畸形引流11例。心上型5例、心脏型10例、心下型4例、混合型1例。MSCT均清晰显示异常连接肺静脉的数目、分布和位置。CAG漏诊3例,US漏诊10例。14例有手术对照者,MSCT对肺静脉畸形引流的定性、定位诊断全部正确。结论　MSCT较常规CAG及US可明显提高小儿肺静脉畸形引流的检出率,对本病有重要的诊断价值。

Clinical application of MSCT in the diagnosis of anomalous pulmonary venous connection in infants and children

Objective To investigate the clinical usefulness of multislice computed tomography (MSCT) in the diagnosis of anomalous pulmonary venous connection in infants and children.Methods Retrospective analysis on 20 cases with anomalous pulmonary venous connection was performed using contrast-enhanced MSCT volume scan. The age ranged from 11 days to 12 years. The slice thickness and slice interval were 1.250 mm and 0.625 mm, respectively. Three-dimensional reconstructions were performed with multiplanar reformation (MPR), sliding thin-slab maximum intensity projection (STS-MIP), volume rendering (VR), and shade-surface displayment (SSD). Ultrasound echocardiography (US) was performed in all patients. Conventional cardiovascular angiography (CAG) was performed in 12 patients, and 14 cased received operation. Results Of the 20 patients received MSCT, total anomalous pulmonary venous connection was diagnosed in 9, and partial anomalous pulmonary venous connection in 11, including supracardiac type (n=5), cardiac type (n=10), infracardiac type (n=4), and mixed type (n=1). MSCT clearly displayed the number, distribution, and location of anomalous pulmonary venous connection in all patients. Among them, the misdiagnosis by CAG and US were encountered in 3 cases and 10 cases, respectively. The diagnosis by MSCT was compatible with the operative findings in all 14 patients receiving surgery. Conclusion MSCT has significant value in the diagnosis of pediatric anomalous pulmonary venous connection which may not be detectable with echocardiography or even cardiovascular angiography.