第三代双源CT前门控序列扫描模式对复杂性先心病临床诊断价值研究

Value of third-generation dual-source CT prospective ECG-gated sequence scanning mode in the diagnosis of complex congenital heart disease

摘要:

目的：探讨第三代双源CT前门控序列扫描模式对复杂性先心病临床诊断价值。方法：收集经临床确诊为复杂性先心病并手术的患者43例，以此结果为参考金标准对比术前心脏双源CT前瞻性心电门控序列成像和超声心动图检查，分析2种方法的检出率及总体诊断效能。结果：43例病例手术后共发现187处畸形，双源CT成像检出155处，超声心动图检出153处，双源CT成像与超声心动图总检出率分别为82.89%和81.82%，差异无统计学意义（ ?字２=0.074，P=0.786）；其中心脏血管连接处畸形部分：双源CT成像与超声心动图检出率分别为100%和90.91%，差异无统计学意义（ ?字２=2.095，P=0.148）；心内畸形部分：双源CT成像与超声心动图检出率分别为62.35%和81.18%，差异有统计学意义（ ?字２=7.430，P=0.006）；心脏周围血管畸形部分：双源CT成像与超声心动图检出率分别100%和80.00%，差异有统计学意义（ ?字２=17.778，P=0.001）。第三代双源CT成像组总体的阳性预测值、阴性预测值、精度、特异度、敏感度分别为98.05%、96.43%、96.64%、99.69%、80.75%，超声心动图组分别为99.35%、96.52%、96.90%、99.90%、81.28%。结论：双源CT成像相比超声心动图对于复杂性先心病心脏周围血管畸形的诊断具有明显优势。双源CT成像与超声心动图对病变总体检出没有统计学差异。

Abstract:

Objective：To investigate the clinical value of the third-generation dual-source CT prospective ECG-gated sequence scan－ning mode in the diagnosis of complex congenital heart disease. Methods：A total of 43 patients who were clinically diagnosed with complicated congenital heart disease and underwent surgery were enrolled，and the results were used as the gold standard to compare the detection rate and overall diagnostic efficacy of heart dual-source CT prospective ECG-gated sequence scanning and echocardio－graphy. Results：A total of 187 deformities were found in 43 patients after surgery；155 deformities were detected by dual-source CT，and 153 were detected by echocardiography；the overall detection rates of dual-source CT and echocardiography were 82.89% and 81.82%，respectively（ ?字２=0.074，P=0.786）. For deformities at cardiovascular junctions，dual-source CT had a detection rate of 100% and echocardiography had a detection rate of 90.91%（ ?字２=2.095，P=0.148）；for intracardiac malformations，dual-source CT had a detection rate of 62.35% and echocardiography had a detection rate of 81.18%（ ?字２=7.430，P=0.006）；for pericardial vascular malfor－mations，the detection rates of dual-source CT imaging and echocardiography were 100% and 80.00%，respectively，and there was a significant difference between the two methods（ ?字２=17.778，P=0.001）. Third-generation dual-source CT had a positive predictive val－ue of 98.05%，a negative predictive value of 96.43%，an accuracy of 96.64%，a specificity of 99.69%，and a sensitivity of 80.75%，and echocardiography had a positive predictive value of 99.35%，a negative predictive value of 96.52%，an accuracy of 96.90%，a specificity of 99.90%，and a sensitivity of 81.28%. Conclusion：Compared with echocardiography，dual-source CT imaging has obvi－ous advantages in the diagnosis of pericardial vascular malformations in complex congenital heart disease. There is no significant dif－ference in overall detection of lesions between dual-source CT imaging and echocardiography.