【摘要】 目的用受试者工作特征(ROC)分析法评价经胸三维超声心动图诊断先天性圆锥动脉干畸形(conotruncaldefects,CTD)的应用价值。方法由3位心内科医师双盲对48例CTD心脏的二维超声、三维超声及心血管造影资料进行观察,并以心室大动脉连接水平为中心对CTD的室间隔缺损位置、大动脉根部位置、心室大动脉连接、房室连接等作出各自的3种影像方法诊断,然后以手术诊断为金标准,按完全正确、正确、部分正确、不正确、完全不正确5个诊断精度,分别作出3种影像方法诊断CTD的ROC分析评价。结果ROC评价显示三维超声的ROC曲线比其他两条曲线更偏左上角,其曲线下面积为三维超声(0.96)>二维超声(0.92)>心血管造影(0.86)。经Z检验,三维超声与二维超声对CTD心内及大动脉根部结构的诊断较心血管造影准确(P<0.05),且三维超声优于二维超声(P<0.05),提示三维超声对CTD心脏有较高的诊断敏感性,可进一步完善CTD的超声诊断。结论三维超声能基本满足CTD等小儿复杂型先天性心脏病的三维诊断要求,尤在心内结构上比二维超声及心血管造影提供更丰富直观的空间诊断信息。更多还原

【Abstract】 Objective To evaluate the diagnostic value of transthoracic three-dimensional echocardiography (3DE) in the pathologic morphology of conotruncal defects (CTD) in children using receiver operating characteristic (ROC) analysis.Methods Forty-eight patients with CTD were respectively diagnosed by three experienced clinical cardiologists with 3DE,2DE and angiocardiography blinded to their clinical diagnoses.The diagnostic results of the three imaging methods in the major spatial information of inner cardiac structures including ventricular configuration identification,atrial-ventricular and ventricular-arterial continuity,location and shape of ventricular septal defect,and spatial appreciation of the defects related with great arteries,etc,were compared with surgical findings as "Gold Standard",and evaluated by ROC analysis using a five-point categorical scale that ranged from definitely abnormal to definitely normal.Results It was shown that the ROC curve for 3DE at the inner cardiac structures of CTD was closer to the ideal discrimination function than those for 2DE and for angiocardiography.The area under ROC curve for 3DE ( 0.96) was significantly (P< 0.05) larger than that for 2DE ( 0.92) and for angiocardiography ( 0.86) by the Z-test,which demonstrated the higher sensitivity and specificity of CTD pathologic morphological cardiac structures detected by 3DE than by 2DE and by angiocardiography.Conclusions Compared to 2DE and angiocardiography,3DE could provide more complete spatial portrayal of inner cardiac structure in children with complex congenital heart malformations.更多还原