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目的探讨容积螺旋穿梭技术(VHS)在先天性心脏病伴气管软化诊断中的价值。方法回顾性分析上海交通大学医学院附属上海儿童医学中心2014年10月至2016年8月同时行纤维支气管镜和VHS CT增强扫描的26例患儿临床资料,男16例,女10例。按照纤维支气管镜结果将患儿分为气管软化组(n=7)和非气管软化组(n=19)。通过容积重建、最大密度投影重建技术观察评估心内结构、心外大血管解剖,利用最小密度投影技术观察评估气管支气管树解剖结构。利用Mimics 17.0软件对各患儿不同呼吸期相的CT图像进行自动气管分割并测量不同呼吸期相的气管横截面积。以纤维支气管镜及手术结果为金标准,计算VHS CT增强在先天性心脏病的诊断准确性和气管软化的诊断敏感度、特异度和准确度。结果气管软化组气管塌陷面积百分比与非气管软化组的气管塌陷面积百分比差异有统计学意义(34.23%~74.95%vs 13.73%~78.87%,P=0.02)。VHS CT增强在诊断气管软化的敏感度、特异度和准确度分别为85.71%(6/7)、84.21%(16/19)和84.62%(22/26),而在先天性心脏病诊断中心内结构和心外大血管结构的准确度分别是91.67%(11/12)和100%(12/12)。结论 VHS CT作为一种新的扫描方式,一次扫描可同时评估先天性心脏病和气管软化情况,可以作为一种一站式诊断先天性心脏病伴气管软化的检查方法。
Objective To investigate the value of volume helical shuttle technique (VHS) in the diagnosis of congenital heart disease with tracheal softening. Methods A retrospective analysis of Shanghai Children’s Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine from October 2014 to August 2016 with fibrobronchoscopy and VHS CT enhanced 26 cases of children with clinical data, 16 males and 10 females. The children were divided into tracheostomy group (n = 7) and non-tracheal softening group (n = 19) according to the result of fibrobronchoscopy. Through volume reconstruction, the maximum density projection reconstruction technique was used to observe the intracardiac structure and extracardiac macrovascular anatomy, and the minimal density projection technique was used to evaluate the anatomy of the tracheobronchial tree. Mimics 17.0 software was used to perform automatic tracheal segmentation on CT images of different respiratory phases in children and to measure the tracheal cross-sectional area at different respiratory phases. The diagnostic accuracy, specificity and accuracy of VHS CT in the diagnosis of congenital heart disease and tracheal softening were calculated by using bronchofibroscopy and surgical findings as the gold standard. Results The percentages of tracheal collapse area in tracheal softening group and tracheal collapse area in non-tracheal softening group were significantly different (34.23% -74.95% vs 13.73% -78.87%, P = 0.02). The sensitivity, specificity and accuracy of VHS CT in the diagnosis of tracheal softening were 85.71% (6/7), 84.21% (16/19) and 84.62% (22/26), respectively. However, in the diagnostic center of congenital heart disease The accuracy of internal structure and extracardiac macrovascular structures were 91.67% (11/12) and 100% (12/12), respectively. Conclusion As a new scanning method, VHS CT can evaluate congenital heart disease and tracheal atrophy simultaneously with one scan. It can be used as a one-stop method to diagnose congenital heart disease with tracheal softening.