容积螺旋穿梭技术诊断儿童先天性心脏病伴气管软化

目的 探讨容积螺旋穿梭技术(VHS)在先天性心脏病伴气管软化诊断中的价值.方法 回顾性分析上海交通大学医学院附属上海儿童医学中心2014年10月至2016年8月同时行纤维支气管镜和VHSCT增强扫描的26例患儿临床资料,男16例,女10例.按照纤维支气管镜结果将患儿分为气管软化组(n=7)和非气管软化组(n=19).通过容积重建、最大密度投影重建技术观察评估心内结构、心外大血管解剖,利用最小密度投影技术观察评估气管支气管树解剖结构.利用Mimics 17.0软件对各患儿不同呼吸期相的CT图像进行自动气管分割并测量不同呼吸期相的气管横截面积.以纤维支气管镜及手术结果为金标准,计算VHS CT增强在先天性心脏病的诊断准确性和气管软化的诊断敏感度、特异度和准确度.结果 气管软化组气管塌陷面积百分比与非气管软化组的气管塌陷面积百分比差异有统计学意义(34.23％～74.95％ vs 13.73％～78.87％,P=0.02).VHS CT增强在诊断气管软化的敏感度、特异度和准确度分别为85.71％(6/7)、84.21％(1619)和84.62％(22 / 26),而在先天性心脏病诊断中心内结构和心外大血管结构的准确度分别是91.67％(11/12)和100％(12 12).结论 VHS CT作为一种新的扫描方式,一次扫描可同时评估先天性心脏病和气管软化情况,可以作为一种一站式诊断先天性心脏病伴气管软化的检查方法.

Dynamic multi-detector computer tomography with volume helical shuttle technique for diagnosis of congenital heart disease with tracheomalacia in children

Objective To explore the diagnostic value of dynamic multi-detector computer tomography (MDCT) with volume helical shuttle (VHS) technique in children with congenital heart disease (CHD) combined with tracheomalacia. Methods We retrospectively analyzed the imaging and clinical data of 26 patients (16 males, 10 females) with CHD who underwent both MDCT with VHS technique and fiber bronchoscope between Oct. 2014 and Aug. 2016. According to the Results of fiber bronchoscope, the patients were divided into tracheomalacia (n=7) and non-tracheomalacia (n=19) groups. The intracardiac structures and the anatomy of the great arteries were demonstrated by maximum intensity projection (MIP) and volume render (VR) reconstruction. The patterns of the tracheobronchial tree were demonstrated using minimum intensity projection (MinIP) reconstruction.The Mimics 17.0 software was employed to automatically segment the CT images of different respiratory phases of each patient and to measure the cross sectional area of the airway. According to the golden-standard of fiber bronchoscopic findings and operative results, we calculated the diagnostic accuracy of VHS for CHD and the sensitivity, specificity and accuracy for tracheomalacia. Results Compared with non-tracheomalacia group, the patients in tracheomalacia group showed significantly greater cross-sectional area change of the trachea (34.23%-74.95% vs 13.73%-78.87%, P=0.02). The diagnostic sensitivity, specificity and accuracy of VHS technique for tracheomalacia were 85.71%(6/7), 84.21%(16/19) and 84.62%(22/26), respectively. VHS showed accuracies of 100%(12/12) and 91.67%(11/12) in diagnosing extracardiac and intracardiac defects, respectively. Conclusion Dynamic MDCT with VHS technique can provide a one-step diagnosis of tracheomalacia with CHD in children.