Lee Edward Y, Siegel Marilyn J, Hildebolt Charles F, Gutierrez Fernando R, Bhalla Sanjeev, Fallah Juliet H
Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd., St. Louis, MO 63110, USA.
AJR Am J Roentgenol. 2004 Mar;182(3):777-84. doi: 10.2214/ajr.182.3.1820777.
The objective of our study was to compare accuracies of axial, multiplanar, and 3D volume-rendered images in the diagnosis of thoracic aortic anomalies in pediatric patients and young adults.
Fourteen patients, 17 days to 20 years old, with thoracic aortic anomalies underwent MDCT using axial, multiplanar, and 3D volume-rendering imaging. All images were reviewed by three radiologists for position of the aortic arch, coarctation, vascular compression of the airway, collateral vessel formation, and aortopulmonary shunts (patent ductus arteriosus). Final diagnosis was determined by echocardiography, conventional angiography, bronchoscopy, or surgery. Diagnostic accuracy, sensitivity, and interobserver agreement were evaluated.
Average accuracies (average of the three observers for a correct diagnosis) were greater than or equal to 96% for diagnoses of aortic position and airway narrowing on all image types. For the diagnosis of coarctation, average sensitivities (average of the three observers for a true diagnosis) were 73% for axial, 100% for multiplanar, and 100% for 3D volume-rendered images. For the diagnosis of patent ductus arteriosus, average sensitivities were 78% for axial, 94% for multiplanar, and 89% for 3D volume-rendered images. No patients in this study had collateral vessel formation. For the diagnosis of absence of collateral vessel formation, average sensitivities were 100% for axial, 100% for multiplanar, and 100% for 3D volume-rendered images. There were no significant statistical differences in diagnostic performances, agreement with truth, or confidence scores among observers or imaging formats (p > 0.05).
Axial, multiplanar, and 3D volume-rendered images serve equally well as methods for assessing the side of the aorta to diagnose anomalies. For evaluation of coarctation and patent ductus arteriosus, multiplanar and 3D volume-rendered images perform slightly better than axial images.
本研究的目的是比较轴向、多平面和三维容积再现图像在诊断儿科患者和年轻成人胸主动脉异常中的准确性。
14例年龄在17天至20岁之间的胸主动脉异常患者接受了使用轴向、多平面和三维容积再现成像的MDCT检查。三位放射科医生对所有图像进行了评估，以观察主动脉弓的位置、缩窄、气道的血管压迫、侧支血管形成以及主肺动脉分流（动脉导管未闭）情况。最终诊断由超声心动图、传统血管造影、支气管镜检查或手术确定。评估了诊断准确性、敏感性和观察者间一致性。
对于所有图像类型，主动脉位置和气道狭窄诊断的平均准确性（三位观察者正确诊断的平均值）均大于或等于96%。对于缩窄的诊断，轴向图像的平均敏感性（三位观察者真实诊断的平均值）为73%，多平面图像为100%，三维容积再现图像为100%。对于动脉导管未闭的诊断，轴向图像的平均敏感性为78%，多平面图像为94%，三维容积再现图像为89%。本研究中没有患者出现侧支血管形成。对于侧支血管形成缺失的诊断，轴向图像、多平面图像和三维容积再现图像的平均敏感性均为100%。观察者或成像方式之间在诊断性能、与真实情况的一致性或信心评分方面没有显著统计学差异（p>0.05）。
轴向、多平面和三维容积再现图像作为评估主动脉侧方以诊断异常的方法同样有效。对于缩窄和动脉导管未闭的评估，多平面和三维容积再现图像的表现略优于轴向图像。
