超声心动图鉴别诊断部分型和完全型肺静脉异位引流及对肺循环压力和引流静脉狭窄的判定OA北大核心CSTPCD
Differential diagnosis of partial and complete anomalous pulmonary venous drainage and determination of pulmonary circulation pressure and drainage venous stenosis by echocardiography
目的:研究多普勒超声心动图(CDE)鉴别诊断部分型和完全型肺静脉异位引流的价值及对肺循环压力和引流静脉狭窄的判定.方法:以 2020 年 2 月—2023 年 2 月在本院诊断的 120 例肺静脉异位引流患儿为研究对象,其中部分型肺静脉异位引流患儿 71 例,完全型肺静脉异位引流患儿 49 例,所有患儿均行CT血管成像(CTA)及CDE检查.比较CTA及CDE联合诊断效能、两组患儿伴引流静脉狭窄的情况及肺循环压力之间的差异.结果:CTA判定肺静脉异位引流分型的准确率明显高于CDE(P<0.05);ROC曲线分析显示,CTA及CDE联合诊断的曲线下面积显著高于单独检测;CTA及CDE联合检查对于引流静脉狭窄的诊断与金标准的一致性较强,其中完全型患儿中,25 例与金标准诊断一致(Kappa值=0.556),部分型患儿中,24 例与金标准诊断一致(Kappa值=0.618);完全型肺静脉异位引流患儿的三尖瓣反流峰值压差显著高于部分型肺静脉异位引流患儿(t=3.153,P=0.002),左室舒张末期前后径显著低于部分型肺静脉异位引流患儿(t=9.123,P=0.000).结论:CDE及CTA联合诊断部分型和完全型肺静脉异位引流与金标准的一致性较强,通过对肺循环压力和引流静脉狭窄的有效判定,可进一步指导临床治疗.
Objective:To study the differential diagnosis of partial and complete anomalous pulmonary venous drainage by color Doppler echocardiography(CDE)and the determination of pulmonary circulation pressure and drainage venous stenosis.Methods:This prospective study included 120 children diagnosed with anomalous pulmonary venous drainage in our hospital from February 2020 to February 2023.Among them,71 cases had partial anomalous pulmonary venous drainage and 49 cases had complete anomalous pulmonary venous drainage,and all patients were diagnosed with computed tomography angiography(CTA)and CDE.The combined diagnostic efficacy of CTA and CDE and differences between the two groups in draining venous stenosis severity and pulmonary circulation pressure were explored.Results:The diagnostic accuracy of CTA in diagnosing the classification of pulmonary venous drainage anomalies was significantly higher than that of CDE(P<0.05).According to the ROC curve analysis,the area under the curve of the combined diagnosis of CTA and CDE was significantly higher than that of the single detection.The combination of CTA and CDE examination had strong consistency with gold standard for the diagnosis of drainage vein stenosis.Among the patients with complete anomalous pulmonary venous drainage,25 cases were consistent with the gold standard(Kappa value=0.556),and among the patients with partial anomalous pulmonary venous drainage,24 cases were consistent with the gold standard(Kappa value=0.618).The peak pressure difference of tricuspid regurgitation in the chil-dren with complete anomalous venous drainage was significantly higher than that in the partial anomalous venous drainage group(t=3.153,P=0.002),and the left ventricular end-diastolic diameter was significantly lower than that in the partial venous drainage group(t=9.123,P=0.000).Conclusion:The differential diagnosis of partial and complete anomalous pulmonary anoma-lous venous drainage by the combined diagnosis of CDE and CTA is in good agreement with the gold standard,which can further guide the clinical treatment by effectively determining the pulmonary circulation pressure and drainage vein stenosis.
彭颖慧;胡原;刘倩君;唐菊;刘金桥;向永华
湖南省儿童医院,湖南 长沙 410007
临床医学
血管疾病肺静脉超声心动描记术计算机体层摄影血管造影术
Vascular DiseasesPulmonary VeinsEchocardiographyComputed Tomography Angiography
《中国临床医学影像杂志》 2024 (003)
182-185 / 4
2022年度湖南省自然科学基金(2022JJ30320).
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