MSCT多维重组技术对肺动脉闭锁的诊断价值

摘要

目的 探讨多层螺旋CT(MSCT)多维重组技术对肺动脉闭锁(PA)的诊断价值.方法 回顾性分析9例肺动脉闭锁(PA)患儿的薄层CT增强扫描资料,将数据传至工作站进行多平面重组(MPR)、容积再现技术(VRT)及最大密度投影(MIP),结合手术与超声心动图(UCG)结果分析PA的影像学特点.结果 9例中PA合并室间隔缺损(VSD)者5例;PA不合并VSD者4例,其中3例右心室发育不良及三尖瓣狭窄或闭锁,1例右心室体积基本正常合并三尖瓣重度反流.UCG对PA检出率为77 8%,2例肺动脉瓣闭锁(PVA)均正确诊断,7例肺动脉干闭锁(PTA)正确诊断2例(28.6%),3例误诊为PVA,2例漏诊.MSCT血管成像(MSCTA)对PA诊断准确率为88.8%,其对2例PVA 1例正确诊断,另1例疑诊;对7例PTA均正确诊断.6例PA存在侧支血管,MSCTA均能显示侧支来源、数量、走行及直径,UCG均漏诊,其中1例PDA误诊为侧支血管.结论 MSCT多维重组技术对充分显示PA全貌和伴发的心外血管畸形与体肺侧支循环具有重要的诊断价值,UCG对细小心内畸形及心瓣膜的显示可为MSCT提供补充,两者结合应用对包括手术在内的临床治疗具有重要的指导作用.%Objective To evaluate the diagnostic value of multi - slice CT ( MSCT) and multi - dimensional reconstructions for congenital pulmonary atresia ( PA) . Methods The enhanced thin CT imaSes of 9 patients with PA were retrospectively analyzed. The data were transmitted to the workstation for multi - planar reformation ( MPR) , volume rendering technique ( VRT) and maximum intensity projection ( MIP). The CT imaging features of PA were analyzed combining with operation and Ultrasonic Cardiogram ( UCG). Results In all cases, 5 cases were PA with ventricular septal defect ( VSD) . 4 cases were PA without VSD, including 3 cases with reduced right ventricular volume combined with right ventricular dysplasia and tricuspid stenosis or atresia, 1 case with normal right ventricular volume and severe tricuspid regurgitation. The diagnostic rate of UCG on PA was 77. 8％ . Two cases of PVA were correctly diagnosed. In 7 cases of PTA, UCG correctly diagnosed 2 cases (28.6％ ) , missed 2 cases, and misdiagnosed 3 cases as PVA. The diagnostic accuracy rate of MSCTA on PA was 88.8％. In 2 cases of PVA, 1 case was correctly diagnosed, the other one was suspected of it. All 7 cases of PTA were correctly diagnosed. Six cases of PA had collateral vessels. MSCTA could demonstrate the origin, numher, course and diameter of all collateral vessels UCG missed all 6 patients, and 1 patient was misdiagnosed PDA as collateral vessels. Conclusion MSCT and multi -dimensional reconstruction can well display the whole picture of pulmonary artery, extra - cardiac vascular malformations and collateral circulations between aorta and pulmonary artery in PA. It combined with the ability of UCG in discover the tiny intra - cardiac malformatians and valve disease can further improve the diagnostic accuracy of cardiac malformation, give more comprehensive information for surgical and clinical treatment.