双源CT前瞻性心电门控低剂量扫描在小儿川崎病冠状动脉损害诊断中的应用  

Application of low-dose prospective electrocardiography-triggering dual-source CT angiography in infants and children with congenital heart disease

作　　者：段艳华[1] 武乐斌[2] 程召平[2] 乌大尉[2] 聂佩[1] 纪晓鹏[1] 王锡明[2] 

机构地区：[1]山东大学医学院山东省医学影像学研究所CT室, 济南250021 [2]山东省医学影像学研究所山东省心脑血管疾病诊治重点实验室

出　　处：《中华放射学杂志》2012年第4期312-316,共5页Chinese Journal of Radiology

基　　金：基金项目：山东省科学技术发展计划资助项目（2008GG30002049,2010GG0020217）

摘　　要：目的评价双源CT（DSCT）前瞻性心电门控低剂量扫描在小儿川崎病（KD）冠状动脉损害诊断中的临床应用价值。方法回顾性分析19例临床诊断为KD冠状动脉损害，同时行经胸多普勒超声（TTE）和DSCT前瞻性心电门控低剂量扫描的患儿资料；由2名放射科医师采用肓法独立阅片，以5分法评价整体图像质量，Kappa检验评价诊断的一致性；记录所有患儿冠状动脉瘤样扩张及动脉瘤的位置、数量并测量其大小；Pearson相关分析比较DSCT成像和TTE两种检查方法诊断结果的一致性；计算所有患儿的平均有效辐射剂量（ED）。结果19例患儿均成功完成DSCT前瞻性心电门控低剂量冠状动脉成像，可评价冠状动脉节段比率为91．5％（226／247），其中，15例患儿被诊断为川崎病冠状动脉瘤样扩张或动脉瘤形成，DSCT成像上共发现28个动脉瘤、15支血管瘤样扩张。其中，9个动脉瘤（2个位于右冠状动脉远段、2个位于左心室后支、1个位于前降支中段、1个位于回旋支中段、2个位于回旋支远段、1个位于钝缘支）及2支瘤样扩张（1支对角支、1支钝缘支）TTE未显示。DSCT成像与TTE对比显示冠状动脉瘤及瘤样扩张最大直径的平均测量值分别为（0．63±0．20）和（0．58±0．20）cm，相关性较好（r=0．989，p〈0．05）；对瘤体及瘤样扩张最大长径的平均测量值分别为（1．49±0．83）和（1．22±0．66）cm，相关性较好（r=0．965，P〈0．05）。2名影像科医师对所有患儿的CTA图像质量评分一致性好（Kappa=0．87）。19例患儿的ED为（0．24±0．08）mSv。结论相比TTE，DSCT前瞻性心电门控低剂量冠状动脉成像对小儿川崎病患儿冠状动脉远段的动脉瘤及瘤样扩张的显示较好。Objective To explore the application of low-dose prospective ECG-triggering dualsource CT （DSCT） angiography in infants and children with Kawasaki disease （KD）. Methods Nineteen children diagnosed of Kawasaki disease underwent low-dose prospective ECG- triggering DSCT angiography （DSCTA） with free breathing and transthoracic eehocardiogram （TTE）. The overall imaging quality was graded on a five-point scale. Interobserver agreement in subjective image quality grading was assessed by Kappa statistics. The location, number and size of the aneurysms and dilations were recorded and compared with those of TTE. Pearson correlation analysis was used to evaluate the agreement on measurements between DSCTA and TrE. The average effective dose of DSCTA in all 19 children was calculated. Results DSCTA was performed successfully in all 19 children. A total of 91.5% （226/247） segments permitted visualization with diagnostic image quality. Fifteen patients were diagnosed with coronary artery lesions. A total of 28 aneurysms and 15 arterial aneurysmal dilations were detected by DSCTA, while 19 aneurysms and 13 arterial aneurysmal dilations were found by TTE. TTE failed to detect 9 aneurysms （2 in the distal right coronary artery, 2 in the posterior descending artery, 1 in the middle of left anterior descending artery, 1 in the middle of left circumflex artery, 2 in the distal of LCX and 1 in the obtuse marginal branch） and 2 arterial aneurysmal dilations （1 at the diagonal branch and 1 at obtuse marginal branch）. The concordance of DSCTA and TIE in measurement of diameter and length of these aneurysms and aneurysmal dilatations are good （0. 63 ± 0. 20） and （0. 58 ± 0. 20） cm vs （ 1.49 ± 0. 83） and （ 1.22 ± 0. 66） cm （ r = 0. 989 and 0. 965, P 〈 0. 05 ）. There was a good agreement on overall image quality （Kappa = 0. 87）. The mean effective dose was（0. 24 ± 0.08） mSv. Conclusion Prospective ECG-triggefing DSCTA with very low effective radiation dose is safe, reliable a

关 键 词：黏膜皮肤淋巴结综合征 冠状动脉疾病 体层摄影术 X线计算机 超声心动 描记术 辐射剂量 

分 类 号：R72[医药卫生—儿科] R816[医药卫生—临床医学]