心血管造影、磁共振成像及经胸超声对先天性胸内大血管畸形诊断.docVIP

心血管造影、磁共振成像及经胸超声对先天性胸内大血管畸形诊断 　【摘要】 目的 比较心血管造影（CAG）、磁共振成像（MRI）、经胸超声（TTE）对先天性胸内大血管畸形（CAITGV）的诊断价值。方法 对沈阳军区总医院1993—1998年期间132例经手术证实的CAITGV病人的MRI，TTE，CAG的诊断结果进行分析。结果 132例患者经手术证实有98例共119处畸形，包括主动脉瓣上狭窄（2处），先天性主动脉窦瘤破裂（13处）、主动脉弓离断（7处）、主动脉弓缩窄（15处）、主动脉弓闭锁（2处）、动脉导管未闭（54处）、主肺动脉隔缺损（4处）、完全性肺静脉异位引流（9处）、冠状动脉心室瘘（13处）。MRI诊断的灵敏度为97.5%，特异度为97.1%；TTE诊断的灵敏度为83.2%，特异度为100%；CAG诊断的灵敏度为98.1%，特异度为100%。MRI对CAITGV的灵敏度优于TTE（Plt;0.05），而与CAG相当(Pgt;0.05)。MRI在主动脉弓畸形、完全性肺静脉异位引流等畸形的细节解剖显示上可以弥补CAG和TTE的不足。结论 MRI可以清晰地显示各种CAITGV病理解剖及其畸形部位，若辅以TTE检查，可以作为一种可靠、实用的无创性方法，能补充CAG检查的不足，对主动脉弓离断、主动脉弓缩窄、主动脉弓闭锁、完全性肺静脉异位引流等可取代有创性的CAG检查。因此MRI可作为各种CAITGV术前诊断的首选检查方法。 【关键词】 先天性畸形 ；心；血管；磁共振成像； 心血管造影 ；超声心动图 　　Abstract： Objective To analyse the advantage and disadvantage of magnetic resonance imaging (MRI), cardioangiography (CAG) and thoracicthrough echocardiography (TTE) in the diagnoses of congenital abnormalities of the intrathoracic great vessels (CAITGV), and to discuss the clinically applicative value of MRI. Methods The diagnoses of 132 doubted patients with CAITGV by MRI, TTE and MRI at General Hospital of Shenyang Military Region from 1993 to 1998 were retrospectively analyzed.Results Of the 132 doubted patients, 98 ones with 119 abnormalities were verified by surgical operation. The sensitivity and the specificity of MRI, TTE and CAG were 97.5% and 97.1%, 83.2% and 100%, and 98.1% and 100%, respectively. The sensitivity of MRI was superior to that of TTE (Plt;0.05) and equal to that of CAG (Pgt;0.05). Conclusion MRI, which can clearly show the location of deformation and the different anatomic details of CAITGV if complicated with TTE, can be used as a complement of CAG examination for some diseases such as interruption of aortic arch, coarctation of aorta, atresia of aorta, total anomalous pulmonary venous drainage, etc. It is concluded that MRI is very useful in the diagnosis of CAITGV clinically. 　　Key words： congenital abnormality; cardiovascular; magnetic resonance imaging; cardioangiography; echocardiograph