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目的探讨多层螺旋CT(MSCT)在先天性主动脉缩窄(COA)和主动脉弓离断(IAA)诊断中的应用。资料与方法搜集23例经手术或心导管证实的COA(17例)和IAA(7例)患者资料(年龄28天～26岁),总结和分析其MSCT增强扫描及使用多平面重组(MPR)、曲面重组(CPR)、最大密度投影(MIP)、容积再现(VR)图像后处理结果。结果23例患者术前MSCT均诊断正确,其中COA 17例,4例经DSA证实,13例手术证实,诊断准确率100%。对于合并其他畸形,如肺动脉高压(PH)、室间隔缺损(VSD)、单心室、动脉导管未闭(PDA)、主动脉弓发育不良、肺动脉骑跨、大动脉转位、左室流出道狭窄、体肺侧支循环MSCT均能正确诊断,诊断符合率100%。但2例二尖瓣狭窄和2例主动脉瓣狭窄未能诊断。3例有房间隔缺损(ASD)者漏诊1例,诊断准确率为66.67%。彩色超声心动图有4例导管前型轻至中度狭窄未诊断(未手术),1例导管旁型未诊断,1例导管旁型误诊为IAA,诊断准确率为64.7%,1例肺动脉骑跨超声心动图未诊断,其余均与MSCT诊断相符。MSCT诊断IAA 6例,其中B型4例,A型2例,所有病例均合并有VSD、PDA及PH,其中合并永存动脉干者1例,房间隔缺损2例,合并右锁骨下动脉迷走1例,左室流出道狭窄1例,除1例ASD漏诊外其他畸形与手术完全符合,IAA的诊断准确率为100%,均手术证实。彩超有1例IAA合并右锁骨下动脉迷走未诊断,符合率为83%。结论MSCT作为一种无创性诊断方法,对于COA和IAA及其合并的其他畸形,具有重要的诊断价值,值得广泛推广。
Objective To investigate the application of multislice spiral CT (MSCT) in the diagnosis of congenital aortic constriction (COA) and aortic arch disconnection (IAA). Materials and Methods Collecting data of 23 patients with COA (17 cases) and IAA (7 cases) confirmed by surgery or cardiac catheterization (age range, 28 days to 26 years), summarizing and analyzing MSCT enhanced scan and multiplanar reorganization (MPR) , Surface reconstruction (CPR), maximum density projection (MIP), volume rendering (VR) image post-processing results. Results All 23 patients were correctly diagnosed by MSCT. Among them, 17 were COA, 4 were confirmed by DSA, and 13 were confirmed by surgery. The diagnostic accuracy was 100%. For patients with other deformities such as pulmonary hypertension (PH), ventricular septal defect (VSD), single ventricle, patent ductus arteriosus (PDA), aortic arch dysplasia, pulmonary artery bypass, aortic transposition, left ventricular outflow tract stricture, Collateral circulation MSCT can be correctly diagnosed, the diagnostic coincidence rate of 100%. However, 2 cases of mitral stenosis and 2 cases of aortic stenosis failed to diagnose. In 3 cases, there was 1 missed diagnosis of atrial septal defect (ASD), the diagnostic accuracy was 66.67%. Four cases of pre-catheter mild to moderate stenosis were not diagnosed (no surgery) in color echocardiography. One case of ductal type was not diagnosed and one case of ductal type was misdiagnosed as IAA. The diagnostic accuracy rate was 64.7%. One case of pulmonary artery riding Echocardiography was not diagnosed, and the rest were consistent with MSCT diagnosis. MSCT diagnosis of IAA in 6 cases, including 4 cases of type B, 2 cases of type A, all cases were associated with VSD, PDA and PH, of which 1 case of permanent artery aneurysm, atrial septal defect in 2 cases, with right subclavian artery vagal 1 Cases, 1 case of left ventricular outflow tract stricture, in addition to 1 case of ASD missed diagnosis of other deformities and surgery in full compliance with the diagnosis of IAA was 100% accuracy, were confirmed by surgery. One case of color Doppler ultrasound IAA right subclavian artery vagus is not diagnosed, with a rate of 83%. Conclusion As a noninvasive diagnostic method, MSCT is of great diagnostic value for COA and IAA and other combined deformities and should be widely disseminated.