双源CT前瞻性心电门控低剂量技术在小儿先天性心脏病中的应用  

Application of lowdose prospective ECGtriggering dualsource CT angiography in children with congenital heart disease

作　　者：纪晓鹏[1] 王锡明[2] 程召平[2] 聂佩[1] 杨世锋[1] 乔红艳[1] 张海洲[3] 赵宏磊[4] 

机构地区：[1]山东大学医学院,山东济南250012 [2]山东省医学影像学研究所CT室 [3]山东省立医院心外科 [4]山东大学齐鲁医院心外科

出　　处：《实用放射学杂志》2012年第3期424-428,共5页Journal of Practical Radiology

摘　　要：目的 探讨双源CT（DSCT）前瞻性心电门控（简称前门控）低剂量技术在小儿先天性心脏病（简称先心病）中的临床应用价值.方法 收集行DSCT前门控低剂量技术扫描的22例先心病患儿,记录其容积CT剂量指数（CTDIvol）和剂量长度乘积（DLP）,计算出有效辐射剂量（ED）.由2名放射科医师独立诊断并用5分法对图像进行质量评估,对图像质量的评价符合程度采用Kappa检验.以手术或DSA结果为标准,比较DSCT前门控与经胸超声心动图（TTE）结果的符合率,采用χ2检验,以P〈0.05为差异有统计学意义.结果 22例患儿DSCT前门控低剂量技术扫描的平均有效辐射剂量是（0.37±0.10）mSv,最低0.195 mSv,最高0.594 mSv.图像质量评分为4.4±0.6,图像均符合诊断要求;2名放射科医师的图像质量评价一致性极强（Kw=0.838,P〈0.05）.DSCT前门控与TTE的诊断准确率分别为98.7%、98.2%,差异无统计学意义（χ2=0.338,P〉0.05 ）.结论 DSCT前门控低剂量技术在保证图像满足诊断要求的前提下,大大降低了受检患儿的辐射剂量,减少了辐射危害,具有重要的临床应用价值.Objective To explorc the clinical value of low-dose prospective ECG triggering dual-source CT（DSCT）angiography in children with congenital heart disease（CHD）.Methnds Twenty two patients（mean age：0.85 years,range：22 days to 3 years and 5 months;male 15, female 7;mean weight：7.74 kg）underwent low-dose prospective ECG -triggering DSCT angiography. The CT dose index volume（CTDIvol）and dose length product（DLP）were recorded in order to calculate effective dose（ED）. Diagnosis and overall image quality were assessed by two experienced radiologists by using a five point scale independently, the degree of agreement between two radiologists was determined by Kappa statistics. All patients underwent transthoracic echocardiography（TTE）. Operation was performed in 18 patients, and conventional cardiac angiography（CCA）was performed in 5 patients. The accuracy of DSCT angi ography and TTE was calculated based on the surgical and/or CCA findings. The degree of correspondence between DSCT angiogra phy and TTE was delermined by Chi-square statistics. Results The mean ED was （0.37＋-0.10）mSv with a range of 0. 195 mSv to 0. 594 mSv. The average subjective image quality score was .1.4 ＋- 0.6. All images were diagnosahle. The proximal segments of coronary arteries in all cases were detectable . The accurate rates of DSCT angiography and TTE were 98.7% and 98.2 % , respectively. Overall test parameters for DSCT angiography and TTE were similar（sensitivity,94.2% vs 91.3% ;specificity,99.7% vs 99.7% ）. Conclusion Low-dose prospective ECG --triggering DS（TT angiography can effectively decrease radiation dose and obtain satisfactory imagc qualhy for diagnosis of anomalies in children with CHD.

关 键 词：心脏 辐射剂量 体层摄影术 X线计算机 先天性心脏病 超声心动描记术 

分 类 号：R541.1[医药卫生—心血管疾病] R814.42[医药卫生—内科学]