Helen M. Stanley MD, Danish Vaiyani MD, Meryl S. Cohen MD, MSEd, Shobha S. Natarajan MD, Brian R. White MD, PhD
{"title":"多模态成像在术前评估完全异常肺静脉连接:单中心实践变异性和诊断错误的系统回顾。","authors":"Helen M. Stanley MD, Danish Vaiyani MD, Meryl S. Cohen MD, MSEd, Shobha S. Natarajan MD, Brian R. White MD, PhD","doi":"10.1016/j.echo.2025.05.020","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary vein anatomy varies widely in total anomalous pulmonary venous connection (TAPVC), with diagnostic accuracy affecting surgical planning and prognosis. Echocardiography is the preferred screening modality. Cross-sectional imaging (cardiac computed tomography [CT] or magnetic resonance [MR]) may offer added value.</div></div><div><h3>Methods</h3><div>As the first step in a quality improvement initiative, we sought to describe practice patterns in presurgical imaging in TAPVC with attention to diagnostic error. We also evaluated the available literature on diagnostic accuracy of imaging in TAPVC. Patients with TAPVC who underwent repair at our center (January 1, 2006, to September 15, 2022) were included.</div></div><div><h3>Results</h3><div>Thirty-three of 167 patients (20%) underwent presurgical CT or MR. Initial echocardiogram incorrectly diagnosed the subtype of TAPVC in 9% (15/167). Patients with birth weight under 3 kg, born preterm, or with an initial diagnosis of mixed-type TAPVC were more likely to have misdiagnosis by initial echocardiogram. Computed tomography or MR miscategorized 3/33 patients. A systematic literature review revealed 10 studies that evaluated CT imaging diagnostic accuracy in TAPVC, one of which also included MR studies. Among 171 total patients, there were no patients with inaccurate anatomic diagnosis by CT or MR.</div></div><div><h3>Conclusions</h3><div>Cross-sectional angiography is used increasingly in this population and with diagnostic excellence, although it is not infallible. Efforts to improve echocardiographic quality as well as multimodality imaging in high-risk patients may improve diagnostic accuracy and surgical planning.</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"38 10","pages":"Pages 924-931"},"PeriodicalIF":6.0000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Multimodality Imaging in Presurgical Evaluation of Total Anomalous Pulmonary Venous Connection: Single-Center Practice Variability and a Systematic Review of Diagnostic Error\",\"authors\":\"Helen M. Stanley MD, Danish Vaiyani MD, Meryl S. Cohen MD, MSEd, Shobha S. Natarajan MD, Brian R. White MD, PhD\",\"doi\":\"10.1016/j.echo.2025.05.020\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Pulmonary vein anatomy varies widely in total anomalous pulmonary venous connection (TAPVC), with diagnostic accuracy affecting surgical planning and prognosis. Echocardiography is the preferred screening modality. Cross-sectional imaging (cardiac computed tomography [CT] or magnetic resonance [MR]) may offer added value.</div></div><div><h3>Methods</h3><div>As the first step in a quality improvement initiative, we sought to describe practice patterns in presurgical imaging in TAPVC with attention to diagnostic error. We also evaluated the available literature on diagnostic accuracy of imaging in TAPVC. Patients with TAPVC who underwent repair at our center (January 1, 2006, to September 15, 2022) were included.</div></div><div><h3>Results</h3><div>Thirty-three of 167 patients (20%) underwent presurgical CT or MR. Initial echocardiogram incorrectly diagnosed the subtype of TAPVC in 9% (15/167). Patients with birth weight under 3 kg, born preterm, or with an initial diagnosis of mixed-type TAPVC were more likely to have misdiagnosis by initial echocardiogram. Computed tomography or MR miscategorized 3/33 patients. A systematic literature review revealed 10 studies that evaluated CT imaging diagnostic accuracy in TAPVC, one of which also included MR studies. Among 171 total patients, there were no patients with inaccurate anatomic diagnosis by CT or MR.</div></div><div><h3>Conclusions</h3><div>Cross-sectional angiography is used increasingly in this population and with diagnostic excellence, although it is not infallible. Efforts to improve echocardiographic quality as well as multimodality imaging in high-risk patients may improve diagnostic accuracy and surgical planning.</div></div>\",\"PeriodicalId\":50011,\"journal\":{\"name\":\"Journal of the American Society of Echocardiography\",\"volume\":\"38 10\",\"pages\":\"Pages 924-931\"},\"PeriodicalIF\":6.0000,\"publicationDate\":\"2025-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American Society of Echocardiography\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0894731725002913\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Society of Echocardiography","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0894731725002913","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Multimodality Imaging in Presurgical Evaluation of Total Anomalous Pulmonary Venous Connection: Single-Center Practice Variability and a Systematic Review of Diagnostic Error
Background
Pulmonary vein anatomy varies widely in total anomalous pulmonary venous connection (TAPVC), with diagnostic accuracy affecting surgical planning and prognosis. Echocardiography is the preferred screening modality. Cross-sectional imaging (cardiac computed tomography [CT] or magnetic resonance [MR]) may offer added value.
Methods
As the first step in a quality improvement initiative, we sought to describe practice patterns in presurgical imaging in TAPVC with attention to diagnostic error. We also evaluated the available literature on diagnostic accuracy of imaging in TAPVC. Patients with TAPVC who underwent repair at our center (January 1, 2006, to September 15, 2022) were included.
Results
Thirty-three of 167 patients (20%) underwent presurgical CT or MR. Initial echocardiogram incorrectly diagnosed the subtype of TAPVC in 9% (15/167). Patients with birth weight under 3 kg, born preterm, or with an initial diagnosis of mixed-type TAPVC were more likely to have misdiagnosis by initial echocardiogram. Computed tomography or MR miscategorized 3/33 patients. A systematic literature review revealed 10 studies that evaluated CT imaging diagnostic accuracy in TAPVC, one of which also included MR studies. Among 171 total patients, there were no patients with inaccurate anatomic diagnosis by CT or MR.
Conclusions
Cross-sectional angiography is used increasingly in this population and with diagnostic excellence, although it is not infallible. Efforts to improve echocardiographic quality as well as multimodality imaging in high-risk patients may improve diagnostic accuracy and surgical planning.
期刊介绍:
The Journal of the American Society of Echocardiography(JASE) brings physicians and sonographers peer-reviewed original investigations and state-of-the-art review articles that cover conventional clinical applications of cardiovascular ultrasound, as well as newer techniques with emerging clinical applications. These include three-dimensional echocardiography, strain and strain rate methods for evaluating cardiac mechanics and interventional applications.