The Research On Diagnostic Value Of Echocardiography Combined With Flash CT For Conotruncal Defects And Anomalous Pulmonary Venous Connection

PartⅠ: Research the diagnostic value of echocardiography combinedwith Flash CT for conotruncal defectsBackground and PurposeConotruncal defects(CTD) are a category of complex congenital cardiacabnormalities which are combined with peripheral vascular malformations.Echocardiography has always been considered to be the first choice for the diagnosisof this disease with its noninvasive, economic, simple and repeatable examination,comprehensive technique advantages and so on. But the rapid development of spiralCT technique is superior to echocardiography in the diagnosis of peripheral vascularmalformations accuracy aspects, which are favored by clinicians. Thus makingechocardiographic be challenged in terms of diagnostic accuracy CTD. When theFlash dual-source CT appeared in2010, cardiac imaging has have a new generation.Flash CT significantly reducing scanning time and decreasing radiation dose withunique Flash scan mode and using high pitch ultrafast scanning, completelyregardless of the influence of heart rate, in addition scanning time only0.25s, realizessub-mSv ultrafast cardiac scanning and is considered as green CT, not only ensuringdiagnostic accuracy but also noticing the safe issues involving low radiation dose.The aim of this study is to contrastively research the diagnostic value ofechocardiography combined with Flash CT for conotruncal defects. Provide areasonable choice screening method for the future to improve ultrasound diagnosticaccuracy of such deformities and patients before surgery. Materials and methods:We enrolled96patients to do control study with echocardiography and FlashCT.96cases including persistent truncus arteriosus17cases, pulmonary atresia22cases, aortopulmonary septal defect5cases, double outlet ventricle18cases,tertralogy of Fallot18cases, transposition of great arteries16cases. Intracardiacanatomy, great vessels connecting structure, extracardiac malformation, thepulmonary arterial pressure, valvular function and cardiac function were oberved andmeasured with echocardiography. The Flash scanning mode was applied toprospective ECG-gated dual-source CT. After the scanning, all raw data werereconstructed on workstation, including maximum intensity projection, multipleplanar reformation, curve planar reformation, volume rendering, virtual endoscope etc.This study would not be as classification on the basis of other cardiac malformationswere classified as merger deformity. valvular insufficiency and pulmonary arterialhypertension are not defined as combined malformations. After examination,according to the CT quality standard guidelines of European, the CT dose index, doselength and effective radiation dose were recorded and calculated in all CTD cases.Results1. All96cases of patients with conotruncal defects were determined by clinicaldiagnosis. The results of ultrasonic diagnosis: accurate diagnosis of82lesions,misdiagnosis of13lesion, missed diagnosis of1lesions. The results of Flash CT:accurate diagnosis of92lesions, misdiagnosis of4lesion, missed diagnosis of0lesions. The accuracy of echocardiography and Flash CT were85.42%（82/96）and95.83%(92/96) respectively. The difference was statistically significant(P<0.05).2. The classificatory diagnosis of96CTD patients: accurate diagnosis of64cases, misdiagnosis of15cases, no classificatory diagnosis of17cases withechocardiography; accurate diagnosis of86cases, misdiagnosis of4cases, noclassificatory diagnosis of6cases with Flash CT. The accuracy rate of classificatorydiagnosis with echocardiography and Flash CT was66.67%(64/96) and89.58%(86/96) respectively. The difference was statistically significant(P<0.01).3. There were249lesions of combined malformations in96CTD patients. The results of ultrasonic diagnosis: accurate diagnosis of232lesions, misdiagnosis of1lesion, missed diagnosis of16lesions. The results of Flash CT: accurate diagnosis of238lesions, misdiagnosis of0lesion, missed diagnosis of11lesions.The accuracyrate of diagnosis with echocardiography and Flash CT was93.17%（232/249）and95.58%(238/249) respectively. There was no statistically significant difference(P>0.05).4.Statistics of radiation dose in96patients with conotruncal defects: the averageDLP was7.0±1.50mGy*cm(range:5-10mGy*cm), the average ED was0.212±0.039mSv(range:0.144-0.273mSv).Conclusions:1．Echocardiogram has a high diagnostic accuracy about CTD and may be thepreferred or even the unique method to check TOF, TGA, DORV and APSD.2．Echocardiogram has difficulty in the classified diagnosis and differentialdiagnosis of parts of PTA and PA; it also has definite error in judging aorticoverriding rate for tiny minority TOF and DORV. When the above-mentionedcircumstances emerge, we can combine Flash CT with echocardiography.3．Big pitch Flash CT scanning technology due to low radiation doses, which hasa high classification diagnostic accuracy about CTD, is the best supplementexamination method for the echocardiography.Part Ⅱ: Research the diagnostic value of echocardiography combinedwith Flash CT for anomalous pulmonary venous connectionBackground and Purpose:Anomalous pulmonary venous connection(APVC), which is also calledabnormal connection of pulmonary vein or abnormal circumfluence of pulmonaryvein, is a rare congenital cardiac malformation. With the rapid development of spiralCT technology, with its peripheral vascular malformations good display and areincreasingly being recognized by clinicians. When the Flash dual-source CT appearedin2010, Flash CT significantly shortening scanning time and decreasing radiation dose with unique Flash scan mode and using high pitch ultrafast scanning, completelyregardless of the influence of heart rate, in addition scanning time only0.25s, realizessub-mSv ultrafast cardiac scanning and is considered as Green CT, not only ensuringdiagnostic accuracy but also noticing the safe issues involving low radiation dose.Analysis and study the causes of misdiagnosis for echocardiography combined withFlash CT scanning technology for various types of anomalous pulmonary venousmissed. The purpose is to improve the accuracy of echocardiography in the diagnosisof anomalous pulmonary venous drainage, minimizing unnecessary CT, avoid harmrays. Of course, there are difficult cases for ultrasound diagnosis, can be combinedwith low radiation dose CT scan large pitch surface technology to provide referencefor the surgery.Materials and methods:71cases of anomalous pulmonary venous connection were divided into twogroups, total anomalous pulmonary venous connection(T group) and partialanomalous pulmonary venous connection (P group). Both groups then divided intosupra-cardiac、intracardiac、infra-cardiac and hybrid type. All71cases of patientsunderwent both echocardiography and high pitch Flash CT scanning examination,then the results of both were compared with results of surgery. In addition, to collect20normal infants and20infants with pure atrial septal defects respectively as controlgroup of group T with34cases, collect normal adults20cases and20adults withpure atrial septal defects respectively as control group of group P with19cases.Analysis indicators including the size of left atrium and right ventricle, pulmonaryartery pressure, age, etc. After examination, according to the CT quality standardguidelines of European, the CT dose index, dose length and effective radiation dosewere recorded and calculated in all CTD cases.Results:1.44cases of patients in T group(22supra-cardiac types,17intracardiac types,2infra-cardiac types and3hybrid types). There were38accurate diagnosis cases,4missed diagnosed cases,2misdiagnosed cases in echocardiography and43accurate diagnosis cases, no missed diagnosed case,1misdiagnosed case in Flash CT. Theaccuracy rate of diagnosis with echocardiography and Flash CT was86.36%（38/44）and97.72%(43/44) respectively. There was no statistically significant difference(P>0.05).2.62lesions of combined malformations in T group. There were accuratediagnosis in all lesions with echocardiography and59accurate diagnosis lesions, nomissed diagnosed lesion,3misdiagnosed lesions with Flash CT. The accuracy rate ofdiagnosis with echocardiography and Flash CT was100%（62/62）and95.16%(59/62)respectively. There was no statistically significant difference (P>0.05).3.27cases of patients in P group(7supra-cardiac types,10intracardiac types,1infra-cardiac type and9hybrid types). There were20accurate diagnosis cases,2missed diagnosed cases,5misdiagnosed cases in echocardiography and26accuratediagnosis cases, no missed diagnosed cases,1misdiagnosed case in Flash CT. Theaccuracy rate of diagnosis with echocardiography and Flash CT was74.1%（20/27）and96.3%(26/27) respectively. The difference was statistically significant(P<0.05).4.45lesions of combined malformations in P group. There were44accuratediagnosis lesions,1missed diagnosed lesion, no misdiagnosed lesion inechocardiography and34accurate diagnosis lesions,8missed diagnosed lesions,2misdiagnosed lesions in Flash CT. The accuracy rate of diagnosis withechocardiography and Flash CT was97.8%（44/45）and75.6%(34/45) respectively.The difference was statistically significant(P<0.01).5. Most of patients in T group were infants and young children. The sizes of LAwas less than the control groups significantly(P<0.05). The pressure of RV andpulmonary artery were significantly higher than the control groups(P<0.01). The sizesof ASD was significantly large than the control group(P<0.05).6. Most of patients in P group were adults. The inner diameter of LA was lessthan the control groups significantly(P<0.01). The pressure of RV and pulmonaryartery were significantly higher than the control groups(P<0.01). The sizes of ASDwas significantly less than the control group(P<0.01).7. Statistics of radiation dose in71patients with anomalous pulmonary venousconnection: the average DLP was13.5±3.9mGy*cm(range:8-30mGy*cm), the average ED was0.324±0.065mSv(range:0.182-0.540mSv).Conclusions:1．Echocardiographic diagnosis of APVC connection with high accuracy, canmake a comprehensive assessment of valvular disease, pulmonary arterial pressureand heart function, is a reliable means of checking.2．Most cases of partial anomalous pulmonary venous connection are infants,while total anomalous pulmonary venous connection are adults. Because of thehemodynamic differences, the inner diameter of left atrium and right ventricle,pulmonary artery pressure and age can maybe be a sensitive judging indicator forpatients with partial or complete pulmonary vein malformations drainage. Especiallyin patients with atrial septal defects.3. Flash CT scanning technology for large pitch around the heart vascularmalformations has unique advantages, without affecting the diagnostic accuracy ofthe premise, greatly reducing the radiation dose radiation on echocardiography andplayed a good role in complementary diagnosis.