先天性主动脉弓畸形1ppt课件

Congenital aortic arch anomalies:MRA diagnosis Radiology Department of Shanghai Childrens Medical Center Zhu Ming Congenital Aortic Arch Anomalies in Broad Definition Obstructive congenital aortic arch abnormalities , COA, IAA Non-obstructive congenital aortic arch abnormalities such as double aortic arch and right aortic arch with aberrant left subclavian artery and so on Congenital aortic arch shunt abnormality , PDA 343 cases Congenital Aortic Arch Anomalies MRA diagnosis All examinations were performed between April 1999 and December 2003. 216 male and 127 female, with an age range of 5 days to 11 years ( mean 2.4 years) All examinations were performed with GE Signa 1.5T MR unit MR Examination Technique ECG gated T1-weighted spin-echo sequence was performed in every case Gradient-echo cine sequence was performed in every case Phase-contrast cine sequence was performed in some cases CE-MRA was performed in every case. CE-MRA is the most helpful sequence Total examination time is less than 30 min. 343 cases Congenital Aortic Arch Anomalies MRA diagnosis PDA （patent ductus arteriosus) 139 COA（coarctation） 135, IAA （interruption of aortic arch） 27 Non-obstructive congenital aortic arch abnormalities 42 Diagnostic accuracy : CE-MRA 96.8% (302/312) echocardiography 87.2% (272/312) Obstructive Congenital Aortic Arch Abnormalities 135 COA , 83 were without PDA and 52 were with PDA 27 IAA , 18 were type A IAA and 9 were type B IAA. Obstructive Congenital Aortic Arch Abnormalities In some very severe COA and IAA, CE- MRA even can give more information than X -ray angiocardiography. CE-MRA did not make accurate diagnoses for 2 COA, 1 IAA Non-obstructive congenital aortic arch abnormalities double aortic arch 2, right aortic arch with aberrant left subclavian artery 12, right aortic arch with isolated left subclavian artery 2, left aortic arch with aberrant right subclavian artery 13, fifth aortic arch 3, cervical aortic arch 2, right aortic arch with left descending aorta 4, left aortic arch with right descending aorta 1, right aortic arch with aberrant left innominate artery 1, left aortic arch with isolated right subclavian artery 1 , right aortic arch with isolated left innominate artery 1. Non-obstructive congenital aortic arch abnormalities Edwards scheme is very helpful for understanding and diagnoses of non- obstructive congenital aortic arch anomalies. Regression in an abnormal site in the fourth aortic arch system is the reason of most non- obstructive congenital aortic arch anomalies. Fifth aortic arch Cervical aortic arch Congenital aortic arch shunt abnormalities 139 PDA cases , 3 were window type PDA and 21 were vertical type PDA. CE-MRA lost 5 small PDA diagnoses Discussion CE-MRA is a reliable diagnostic method for congenital aortic arch anomalies. Our data was a big group data from one medical center. The patients age was very young . The result shows that the diagnostic accuracy of CE-MRA was superior to echocardiography (P0.01). Discussion Although T1-weighted spin-echo sequence and gradient-echo cine sequence have been proven helpfully for evaluation of congenital heart diseases, they are not as good as contrast enhancement magnetic resonance angiography for diagnoses of congenital aortic arch anomalies. Doctors can get enough time to consider and to do reconstraction at workstation after CE-MRA scan. Discussion Conventional X-ray angiocardiography is the gold standar