十字交叉心的磁共振及多排螺旋CT影像诊断

目的:分析十字交叉心(Criss-cross Heart,CCH)在磁共振平扫、增强血管成像(MRI,MRA)及多排螺旋CT(MSCT)的影像特点,探讨其诊断价值。方法:对4例十字交叉心的患者进行MRI检查,3例行64-MSCT检查。按照节段分析的方法和思路,MRI利用多序列多角度多体位成像方法,64-MSCT运用不同的后处理重建方法包括:三维容积再现(VR)、最大密度投影(MIP)及多平面重组(MPR)),来充分显示CCH心的解剖畸形。结果:本组病例中,单纯行MRI及MRA 2例;只做MSCT 1例;2种检查均作的2例。MRI及MSCT显示左位心4例,单发右位心1例。5例形态学右心室均位于形态学左心室之上,呈水平室间隔,合并巨大室间隔缺损。2组房室瓣均呈前上-后下垂直排列,两心室流入道血流在空间位置上呈十字交叉。心室-大动脉连接关系正常的1例;连接关系异常的4例,其中完全性大动脉错位1例;右心室双出口3例。此外,4例合并肺动脉瓣及瓣下狭窄;1例合并肺动脉高压;1例并存房间隔缺损;1例右位主动脉弓及降主动脉;1例主动脉缩窄合并缩窄后动脉导管未闭。其中64-MSCT诊断冠状动脉单冠畸形1例。结论:十字交叉心在两心室结构呈上下排列,存在水平室间隔的前提下,2侧房室瓣呈前上-后下垂直排列,两心室流入血流在空间位置上十字交叉,是MRI及MSCT对本症诊断关键。MRI加冠状动脉造影可以明确诊断CCH的解剖畸形;而64-MSCT可以一站式解决上述问题。MRI和MSCT对诊断CCH具有很高的准确性,有重要的临床应用价值。

MRI and MSCT in the diagnosis of criss-cross heart

Objective：To analysis the value of MRI and MRA and MSCT in diagnosis of criss-cross heart （CCH） .Method： Four cases diagnosed as CCH received MRI examination. Three ones were examined by 64-MSCT. According to the methods and thoughts of segmental analysis, multiple sequences and multiple angles and multiple positions scan on MRI and different post processing metions （including VR and MIP and MPR ） on 64-MSCT were used, in order to show complicated anatomical malformations of CCH. Result： In all patients, atrioventricular connection was concordant. Both atrioventricular valves were aligned vertically from the anterior-superior to the posterior-inferior vertico in four patients. The blood streams in the inlet of both ventriculs crossed in the midheart. The morphologic right ventricle was superior positioned the morphologic left ventricle. There was horizontal ventrlcular septum and huge VSD in all patients. The ventriculoarterial connections were discordant, included that Total Transposition of Great Arteries in one patient, Double-outlet Right Ventricle in there patients. In addition, associated anomalies included that there Pulmonary Stenosis （ n = 3）, one Pulmonary Hypertension （ n = 1 ）, one ASD （ n = 1 ） and right aortic arch and one decending aorta （ n = 1 ）. Another, single of Coronary Artery Malformantion （ n = 1 ） was found on the 64-MSCT. Conclusion： CCH is a completed congenital abnormality of the cardiac anatomy that features a unique morphology. The superior-inferior positioning of the two ventricles and horizontal ventricular septum, the blood streams in the inlet of both ventriculs crossed in the midheart what are the diagnosis keys of Criss-Cross Heart on MRI and 64-MSCT. They are apparent that CCH essentially consists of twisting of the apical portions of the ventricles along the long axis of the heart, while the great vessels and the atrioventricular valves remain substantially in the positions. Anatomical malformations of CCH can be showed by cardiac MRI and co