CAJ | 학술논문

目的研究高清CT(HDCT)容积螺旋穿梭技术(VHS)对儿童法洛四联症(TOF)的诊断能力及其在临床路径中的价值.方法 88例术前行HDCT VHS扫描及超声心动图(ECHO)检查诊断为TOF的学龄前儿童,男51例,女37例,年龄1个月～10岁,中位年龄1岁.60例经手术证实,对比分析HDCT VHS与ECHO对TOF基本畸形,血流动力学及其他心内、外病变的显示能力,计算HDCT辐射剂量(mSv).结果室间隔缺损(VSD)位置,HDCT诊断符合率95.0％ (57/60),ECHO诊断符合率90.0％ (54/60);测量VSD大小,HDCT数值小于ECHO,P＜0.05,差异有统计学意义.判断TOF畸形VSD血流方向时,HDCT均显示VSD右向左分流,符合率100％(60/60),15例同时显示左向右分流,而ECHO均显示双向低速分流.右心室心肌肥厚性狭窄、流出道狭窄、肺动脉瓣狭窄畸形共99处,HDCT、ECHO与手术三者基本一致.McGoon比值,HDCT测量值大于ECHO,P＜0.01,差异有统计学意义.主动脉骑跨畸形,HDCT与ECHO骑跨程度符合率均为98.3％ (59/60),各误诊1例.其他心内畸形,如房间隔缺损、卵圆孔未闭等共37处,VHS漏诊25处,ECHO漏诊8处.其他心外畸形如一侧肺动脉的狭窄或闭锁、体-肺侧支血管、冠状动脉异常及动脉导管未闭等共88处,HDCT诊断符合率98.8％ (87/88),ECHO诊断符合率59.1％(52/88).HDCT平均有效剂量为(1.58±0.43)mSv.结论 HDCT VHS诊断TOF有明显的优势,多组扫描数据能准确、直观地反映心内、外解剖畸形,辐射剂量在可接受的范围内.HDCT VHS与ECHO结合可作为儿童TOF术前确诊与鉴别诊断以及制定手术方案的临床路径.
목적 연구고청CT(HDCT)용적라선천사기술(VHS)대인동법락사련증(TOF)적진단능력급기재림상로경중적개치.방법 88례술전행HDCT VHS소묘급초성심동도(ECHO)검사진단위TOF적학령전인동,남51례,녀37례,년령1개월～10세,중위년령1세.60례경수술증실,대비분석HDCT VHS여ECHO대TOF기본기형,혈류동역학급기타심내、외병변적현시능력,계산HDCT복사제량(mSv).결과 실간격결손(VSD)위치,HDCT진단부합솔95.0％ (57/60),ECHO진단부합솔90.0％ (54/60);측량VSD대소,HDCT수치소우ECHO,P＜0.05,차이유통계학의의.판단TOF기형VSD혈류방향시,HDCT균현시VSD우향좌분류,부합솔100％(60/60),15례동시현시좌향우분류,이ECHO균현시쌍향저속분류.우심실심기비후성협착、류출도협착、폐동맥판협착기형공99처,HDCT、ECHO여수술삼자기본일치.McGoon비치,HDCT측량치대우ECHO,P＜0.01,차이유통계학의의.주동맥기과기형,HDCT여ECHO기과정도부합솔균위98.3％ (59/60),각오진1례.기타심내기형,여방간격결손、란원공미폐등공37처,VHS루진25처,ECHO루진8처.기타심외기형여일측폐동맥적협착혹폐쇄、체-폐측지혈관、관상동맥이상급동맥도관미폐등공88처,HDCT진단부합솔98.8％ (87/88),ECHO진단부합솔59.1％(52/88).HDCT평균유효제량위(1.58±0.43)mSv.결론 HDCT VHS진단TOF유명현적우세,다조소묘수거능준학、직관지반영심내、외해부기형,복사제량재가접수적범위내.HDCT VHS여ECHO결합가작위인동TOF술전학진여감별진단이급제정수술방안적림상로경.
Objective To discuss the value of volume helical shuttle(VHS) of high-definition CT(HDCT) in diagnosis and clinical path of tetralogy of Fallot(TOF).Methods 88 preschool children with TOF were examined with VHS of HDCT and echocardiography(ECHO).60 children were received surgery.Based on surgical data,the results of VHS of HDCT were compared with that of ECHO,assessing the display ability of basic deformity of TOF,the intra-cardiac lesion,extra-cardiac lesion and hemodynamics.The radiation dose(mSy) were calculated.Results The diagnostic accuracy of HDCT was 95.0％ and the ECHO was 90.0％ on the positional display.The results of HDCT were slightly smaller than ECHO on the measure of size of VSD,P ＜ 0.05,the difference was significant between the two methods.The display on right-to-left shunt of VSD using HDCT were all coincided with ECHO.One quarter of the cases showed the left-to-right shunt simultaneously.Whereas all the cases were showed slow bi-directional shunt by ECHO.There are 99 deformity in pulmonary artery stenosis,including right ventricular hypertrophy,outflow tract stenosis,pulmonary stenosis.The results of HDCT,ECHO and the operation showed no difference.All the McGoon ratio of HDCT were obviously higher than ECHO,P ＜0.01.Statistical difference was significant.The coincidence rates in aortic straddles by HDCT and ECHO both were 98.3％.Each has one case misdiagnosed.37 other intra-cardiac lesions,for example,foramen ovale and atrial septal defect.VAS has 25 misdiagnosed places and ECHO has 8.88 other extra-cardiac lesions,such as one side of pulmonary artery stenosis or atresia,collateral circulation between systemic and pulmonary circulation,coronary artery abnormal,patent ductus arteriosus(PDA) and so on.The diagnostic accuracy of HDCT was 98.8％ and the ECHO was 59.1％.Average effective dose with HDCT was(1.58 ± 0.43) mSv.Conclusion VHS of HDCT scan has obvious advantages in the diagnosis of TOF.Multiple data can reflect intra-cardiac lesion,extra-cardiac lesion accurately and intuitively.The radiation dose was in the acceptable range.Combining the HDCT VHS and the ECHO will become the clinical path of preoperative diagnosis,differential diagnosis and making the operation scheme in children with TOF.