双源CT超低管电压结合迭代重建技术在婴幼儿肺静脉异位引流术前评估中应用价值

目的 比较双源CT(dual-source computed tomography,DSCT)超低管电压结合迭代重建技术与经胸超声心动图(trans-thoracic echocardiography,TTE)检查对婴幼儿复杂先天性心脏病肺静脉异位引流(anomalous pulmonary venous connec...

Application of dual-source CT ultra-low tube voltage technique combined with iterative reconstruction in assessing infant anomalous pulmonary venous connection

Objective To compare the accuracies of dual-source computed tomography(DSCT) with ultra-low tube voltage SAFIRE iterative reconstruction algorithm technology and trans-thoracic echocardiography(TTE) in the diagnosis of infants anomalous pulmonary venous connection(APVC), and to investigate the value of DSCT with ultra-low tube voltage SAFIRE iterative reconstruction algorithm technology to the diagnosis of APVC in infants. Methods Forty-six infants with suspected APVC received palliative or radical surgery. DSCT and TTE were performed one week before surgery. DSCT adopted Flash-70 kV voltage tube technique combination SAFIRE iterative reconstruction algorithm technology to evaluate DSCT image quality and calculate radiation dose. Taking the surgical outcome as gold standard, the accuracies of DSCT and TTE on APVC were compared. Results The image quality of DSCT was excellent in 25 patients, good in 19, and poor in 2. The effective radiation dose was(0.20±0.07) mSv. All these 46 cases were confirmed total APVC(TAPVC) by surgery, including 16 cases of supracardiac type, 18 cases of intracardiac type, 6 cases of infracardiac type and 6 cases of mixed type. There were 152 total anomalous drainage pulmonary veins and 82 malformations. DSCT found 146 anomalous drainage pulmonary veins, with a diagnostic rate of 96.1%(146/152), and 78 other concomitant abnormalities, with a diagnostic rate of 95.1%(78/82);all diagnoses were correct except 2 cases of mixed TAPVC misdiagnosed as pure intracardiac type. TTE found 130 malformed drainage pulmonary veins, with a diagnosis rate of 85.5%(130/152), and 80 other malformations, with a diagnosis rate of 97.6%(80/82);one child with multiple complex malformations of TAPVC was missed diagnosed, 3 cases of subcardiac TAPVC were not clearly classified, 6 cases of mixed TAPVC were misdiagnosed as simple TAPVC, and the rest diagnoses were correct. The diagnostic rate of DSCT for the number of anomalous drainage pulmonary veins(96.1%)and the classification accuracies of infracardiac and mixed TAPVC(100.0%,66.7%)were higher than those of TTE(85.5%,50.0%,0)(P<0.05).Conclusion Compared with TTE,DSCT Flash-70 kV voltage tube technique combined with SAFIRE iterative reconstruction algorithm technology has higher diagnostic accuracy and diagnostic value.