摘要
目的用受试者工作特征(ROC)曲线分析法评价复杂型先天性心脏病(先心病)影像诊断方法的应用价值。方法由三位医师双盲对28例复杂型先心病的二维超声心动图(2DE)、实时三维超声心动图(RT-3DE)、数字减影心血管造影(DSA)、磁共振成像(MRI)或多层螺旋CT资料进行观察后,对有无心内、大血管根部畸形及心外畸形等作出各自诊断,并以手术诊断为金标准,按"完全正确"至"完全不正确"5个诊断精度进行ROC分析法评价。结果对复杂型先心病心内及大血管根部畸形诊断,RT-3DE的ROC曲线最偏左上角,曲线下面积为RT-3DE(0.96)>2DE(0.92)>MRI/CT(0.91)>DSA(0.89)。Z检验示RT-3DE优于2DE(Z=2.30,双侧P=0.0215)、MRI/CT(Z=2.80,双侧P=0.0050)、DSA(Z=3.18,双侧P=0.0015)。而对心外畸形的诊断,DSA的ROC曲线最偏左上角,曲线下面积为DSA(0.99)>MRI/CT(0.98)>2DE(0.92)。Z检验示DSA优于2DE(Z=2.67,双侧P=0.0075),但与MRI/CT诊断结果相似(Z=1.52,双侧P=0.1292),差异无统计学意义(P>0.05)。结论ROC评价提示对复杂型先心病心内及大血管根部畸形诊断首选超声,当要进一步明确畸形空间位置、立体形态时可加做RT-3DE;而对心外血管畸形诊断MRI、多层螺旋CT准确性高,在某种程度上可替代心血管造影。
Objective To evaluate the value of cardiovascular imaging in diagnosis of complex congenital heart disease （CHD） in children with receiver operating characteristic （ROC） analysis. Methods Twenty-eight patients with complex CHD were examined by three cardiologists with two-dimensional eehocardiography （2DE）, real-time three-dimensional echocardiography （RT-3DE） , magnetic resonance imaging （MRI） , multi-slice spiral computed tomography （CT）, and digital subtraction angiography （DSA）. All the cardiologists involved in the study were blinded to the clinical data. The results of the pathologic morphology of complex CHD showed in the imaging examination were divided at three levels： atria, ventricles and great arteries, atrial-ventricular and ventricular-arterial continuity, and extracardiac vascular malformations. The results were compared with surgical findings which were used as ＂gold standard＂, and diagnostic value of imaging technology was evaluated by ROC analysis using a five-point categorical scale that ranged from definitely abnormal to definitely normal. Results The diagnostic assessments of the imaging technology were grouped and further analyzed by ROC curves. In examination of intracardiac malformations, atrial-ventricular and ventricular-arterial continuities, ROC curve for RT-3DE was located left-superior to that for 2DE, MRI/CT, DSA. And the area under ROC curve for RT-3DE （0.96） was higher than that for 2DE （0.92）, MRI/CT （0.91）, DSA （0.89）. There were significant differences between RT-3DE and 2DE （P = 0.021 5）, RT-3DE and MRI/CT （P = 0.005 0）, RT-3DE and DSA （P = 0.001 5）. Thus, left-superior ROC curve for RT-3DE and the larger area under ROC curve for RT-3DE were closer to the ideal discrimination function than that for 2DE, MRI/CT, DSA （P 〈 0.05）. While in the examination of extracardiac vascular malformations, ROC curve for DSA was located left-superior to that for MRI/CT, 2DE, and the area under ROC curve for DSA （0.99） was
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2009年第3期284-288,共5页
Journal of Clinical Pediatrics
基金
"十五"国家科技攻关计划资助(No.2004BA714B02)
