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目的评价MSCT对肺静脉异位引流的诊断价值。资料与方法回顾性分析35例经外科手术证实的肺静脉异位引流患者的临床和影像检查资料。以术中所见作为参考标准,评价MSCT、经胸超声心动(TTE)和心导管造影检查对肺静脉异位引流患者的诊断准确性。同时评估异位引流肺静脉的形态。结果 35例肺静脉异位引流患者中有25例为复杂性肺静脉异位引流,10例为单纯性肺静脉异位引流。MSCT正确诊断了所有肺静脉异位引流的患者,单纯性和复杂性肺静脉异位引流患者中MSCT与外科结果的一致性均为100%。心导管造影检查未能诊断5例复杂性肺静脉异位引流,单纯性和复杂性肺静脉异位引流患者中心导管造影与外科结果的一致性分别为100%和75%。TTE检查中有9例与外科结果不符,其中8例为复杂性肺静脉异位引流,单纯性和复杂性肺静脉异位引流患者中TTE与外科结果的一致性分别为90%和68%。在单纯性肺静脉异位引流中,MSCT和TTE(χ2=0.48,P=0.52)、MSCT和心导管(χ2=1.07,P=0.30)诊断一致性的差异均无统计学意义。在复杂性肺静脉异位引流中,MSCT和TTE(χ2=7.29,P=0.007)、MSCT和心导管(χ2=4.73,P=0.030)诊断一致性的差异均有统计学意义。MSCT清楚显示了11例异位引流肺静脉发育不良。结论 MSCT评价复杂性肺静脉异位引流的价值优于TTE和心导管造影检查。
Objective To evaluate the value of MSCT in the diagnosis of pulmonary venous drainage. Materials and Methods Retrospective analysis of 35 patients with surgically proven pulmonary venous drainage in patients with clinical and imaging examination data. The intraoperative findings as a reference standard, evaluation of MSCT, transthoracic echocardiography (TTE) and cardiac catheterization in patients with pulmonary venous drainage diagnosis accuracy. Simultaneous assessment of ectopic drainage of pulmonary vein morphology. Results Of the 35 patients with pulmonary venous drainage, 25 patients had complicated pulmonary venous heterotopic drainage and 10 patients had simple pulmonary venous drainage. MSCT correctly diagnosed all patients with aortic venous drainage, MSCT and surgical findings were 100% identical in patients with simple and complex pulmonary venous drainage. Cardiac catheterization failed to diagnose 5 cases of complex pulmonary venous anomalous drainage, 100% and 75% consistency of central catheter angiography and surgical findings in patients with simple and complex pulmonary venous drainage. Nine of the TTE examinations did not match the surgical findings, eight of whom were complicated by heterotopic pulmonary venous drainage. The agreement between TTE and surgical findings was 90% and 68%, respectively, in patients with simple and complex pulmonary venous drainage. There was no significant difference in concordance between MSCT and TTE (χ2 = 0.48, P = 0.52), MSCT and cardiac catheter (χ2 = 1.07, P = 0.30) in simple pulmonary venous drainage. In the complicated pulmonary venous drainage, there were significant differences in the diagnostic consistency between MSCT and TTE (χ2 = 7.29, P = 0.007), MSCT and cardiac catheterization (χ2 = 4.73, P = 0.030) MSCT clearly showed that 11 cases of ectopic drainage pulmonary veins dysplasia. Conclusion The value of MSCT in evaluating complex pulmonary venous drainage is superior to TTE and cardiac catheterization.