心脏多层螺旋CT增强扫描对电极穿孔的诊断价值

发布时间：2018-11-10 12:45

【摘要】：【目的】探讨心脏起搏器或植入型心律转复除颤器导线穿孔患者心脏多层螺旋CT增强扫描的影像学表现和诊断价值。【方法】分析经临床、多种影像学检查及手术探查等证实的10例导线穿孔患者的心脏CT表现,判断导线穿孔与否、穿孔位置、有否合并心包积液、有无对比剂漏出至心包腔内、导线及其头端伪影。【结果】10例患者中仅1例胸部X线可明确诊断,6例超声心动图结合新发心包积液及起搏器程控参数诊断导线穿孔。心脏CT检查含常规CT增强扫描5例,序贯式心电门控CT增强扫描及随后的延迟增强扫描5例,CT诊断明确导线穿孔5例,可疑导线穿孔5例。穿孔位于右心尖7例,右室膈面2例,右心房后上壁1例。少至大量心包积液8例,无心包积液2例。5例行延迟增强扫描,均未发现对比剂延迟外漏至心包腔。10例行常规CT增强扫描患者(含5例心电门控扫描后的延迟增强扫描),所有患者导线及导线头端均产生运动伪影;9例患者导线产生中、重度金属伪影,1例患者导线未产生金属伪影;8例患者导线头端产生中、重度金属伪影,2例患者导线头端产生轻度金属伪影。5例行心电门控CT增强扫描患者,导线及导线头端均未产生运动伪影;2例患者导线产生轻度金属伪影,3例患者导线未产生金属伪影;4例患者导线头端产生轻度金属伪影,1例患者导线头端产生中度金属伪影。【结论】多层螺旋CT增强扫描有助于明确导线穿孔,尤其是心电门控增强扫描因减轻导线及其头端的运动伪影和金属伪影,可提高诊断准确率。
[Abstract]:[objective] to investigate the imaging features and diagnostic value of multilayer spiral CT in patients with cardiac pacemaker or implantable cardioverter defibrillator traverse perforation. The cardiac CT findings of 10 patients with perforation confirmed by various imaging examinations and surgical explorations were used to determine the perforation or not, the location of the perforation, the presence of pericardial effusion, and the leakage of contrast agents into the pericardial cavity. [results] only 1 case of 10 patients could be diagnosed by chest X-ray, 6 cases by echocardiography combined with new pericardial effusion and programmed parameters of pacemaker to diagnose wire perforation. Cardiac CT included conventional CT enhanced scan in 5 cases, sequential gated CT enhanced scan in 5 cases and delayed enhancement scan in 5 cases. CT diagnosis confirmed traverse perforation in 5 cases and suspicious traverse perforation in 5 cases. The perforations were located at the apical of the right heart in 7 cases, on the phrenic surface of the right ventricle in 2 cases and on the posterior superior wall of the right atrium in 1 case. As few as 8 cases of pericardial effusion, 2 cases of no pericardial effusion, 5 cases of delayed contrast enhanced scan, no delayed leakage of contrast agent into pericardial cavity. 10 cases of routine CT enhanced scanning (including 5 cases of delayed enhanced scan after ECG gated scan). Motion artifacts were produced in all patients with traverse and the head of the wire. In 9 cases, the metal artifacts were found in severe cases, while in 1 case, metal artifacts were not produced in the leads of the patients. In 8 cases, severe metal artifact was produced in the head end of the lead, and light metal artifact was produced in the head end of the lead in 2 cases. 5 cases were examined by ECG gated CT enhanced scan, and no motion artifacts were found in the lead and the head end of the lead. Light metal artifacts were produced in 2 patients' wires, and no metal artifacts were produced in 3 patients' wires. Light metal artifacts were produced at the head end of the lead in 4 cases and moderate metal artifacts at the head end of the lead in 1 case. [conclusion] Multi-layer spiral CT enhanced scanning is helpful to identify the perforation of the wire. Especially, ECG gated enhanced scan can improve the diagnostic accuracy by reducing the moving artifacts and metal artifacts of the wire and its head.
【作者单位】：中山大学孙逸仙纪念医院放射科;中山大学孙逸仙纪念医院心内科//广东省心电生理和心律失常重点实验室;
【基金】：广东省科技计划项目(2015020210043)
【分类号】：R541;R816.2

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