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目的 :评价电子束计算机断层摄影术 (EBCT)在小儿复杂先天性心脏病 (先心病 )诊断中的价值。 方法 :对 2 6例患者经胸常规超声心动图 (TTE)诊断为复杂先心病 ,同时做 EBCT增强单层容积扫描 ,并由计算机工作站进行图像三维重建。其中 9例又做了常规心血管造影 ,11例经外科手术 ,进行对照研究。 结果 :全组 11种复杂先心病共 6 1处畸形 ,其中心内畸形 2 1处 ,EBCT与 TTE均作出正确诊断。然而 ,心外大血管畸形及心室—大血管连接异常诊断中两者有明显差别 ,在 40处畸形中 ,EBCT过多诊断 1处 (动脉导管未闭 ) ,手术证实为假阳性 ,EBCT诊断符合率为 97.5 % (39/ 40 ) ;TTE诊断 35处 (误诊 1处 ,漏诊 4处 ) ,TTE诊断符合率 87.5 % (35 / 40 )。EBCT与TTE诊断的正确率有显著差异 (χ2 =3.936 ,P<0 .0 5 )。TTE与 EBCT相结合使诊断的总准确率提高到 98.4% (6 0 / 6 1)。 结论 :EBCT对复杂先心病中某些畸形的检出优于 TTE。EBCT血管造影与 TTE及心血管造影相结合 ,可提高对复杂先心病诊断的准确率 ,以指导手术。
Objective: To evaluate the value of electron beam computed tomography (EBCT) in the diagnosis of complex congenital heart disease (CHD) in children. Methods: Twenty-six patients were diagnosed as complicated congenital heart disease by transthoracic routine echocardiography (TTE). At the same time, EBCT enhanced monolayer volume scanning was performed. The images were reconstructed by computer workstation. Nine of them underwent routine cardiovascular angiography and 11 underwent surgical resection. Results: Sixteen deformities were found in eleven complex congenital heart diseases, of which 21 were intracardiac malformations. Both EBCT and TTE were correctly diagnosed. However, extracardiac macrovascular malformations and ventricular-macroangiopancreatic connections were significantly different between the two. Of the 40 deformities, one was diagnosed with excessive EBCT (patent ductus arteriosus), the procedure proved to be false-positive, and the diagnosis of EBCT was consistent The rate of diagnosis of TTE was 35.5% (39/40). TTE was diagnosed in 35 places (misdiagnosed 1, missed 4), and the diagnostic coincidence rate of TTE was 87.5% (35/40). The diagnostic accuracy of EBCT and TTE were significantly different (χ2 = 3.936, P <0.05). TTE combined with EBCT increased the diagnostic accuracy to 98.4% (60/61). Conclusion: EBCT is superior to TTE in detecting some abnormalities in complex congenital heart disease. EBCT angiography combined with TTE and cardiovascular angiography can improve the accuracy of diagnosis of complex congenital heart disease to guide the operation.