双源CT在小儿冠状动脉瘘诊断中的价值  

Clinical application of dual-source CT in diagnosis of coronary artery fistulas in children

作　　者：程召平[1] 王锡明[1] 赵斌[1] 王涛[1] 段艳华[1] 乌大尉[1] 聂佩[1] 纪晓鹏[1] 晁宝婷[1] 

机构地区：[1]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,济南250021

出　　处：《中华放射学杂志》2014年第3期232-235,共4页Chinese Journal of Radiology

基　　金：山东省优秀中青年科学家科研奖励基金计划（BS2013YY060）;山东省医药卫生科技发展计划（2013WS0180）

摘　　要：目的 探讨低剂量双源CT（DSCT）血管成像在小儿冠状动脉瘘（CAF）诊断中的应用价值.方法 回顾性分析22例临床诊断CAF患儿的临床和影像资料,年龄1.2 ～6.0岁,平均（3.2±1.5）岁；男12例,女10例.其中9例患儿行手术治疗,13例患儿行介入治疗.所有患儿行低剂量前瞻性心电门控下DSCT血管成像,由2名放射科医师独立对CT图像质量进行主观评价,以手术或传统心血管造影（CCA）结果为标准计算CT诊断CAF的准确性,同时记录辐射剂量.2名观察者之间图像质量主观评分的一致性采用Kappa检验进行评估.结果 所有患儿的CT图像均为可诊断图像,主观评分为（2.6±0.7）分,2名医师的评价一致性好（Kappa值为0.75,P＜0.05）.DSCT血管成像共诊断25处CAF,诊断准确率为100％,包括右冠状动脉瘘13例（59.1％）,左冠状动脉瘘8例（36.4％）,左、右冠状动脉瘘1例（4.5％）.4例患儿合并冠状动脉瘤形成.平均剂量长度乘积及有效辐射剂量分别为（25 ±4）mGy·cm和（0.25±0.07） mSv.结论 低剂量DSCT血管成像可作为一种准确可靠的诊断小儿CAF的无创影像学方法.Objective To explore the clinical application of low-dose dual-source CT （DSCT） angiography in diagnosis of coronary artery fistulas （CAF） in children. Methods A total of 22 patients [mean age （3.2 ± 1.5） yrs,age range 1.2-6.0 yrs; male 12,female 10] with CAF who underwent DSCT angiography under free breathing were retrospectively reviewed.Surgery was performed in 9 patients,and transcatheter closure in 13 patients.The diagnostic accuracy of DSCT was evaluated based on the surgical or conventional cardiac angiography （CCA） findings.The subjective image quality was evaluated on a fourpoint scale by two radiologists.Radiation dose values were recorded.Interobserver agreement of subjective image quality grading was assessed by using Kappa statistics.Results All images were diagnosable.The average subjective image quality score was 2.6 ± 0.7.Two radiologists made good agreement （K =0.75,P 〈 0.05）.Twenty-five coronary artery fistulas in all patients were clearly displayed on DSCT images with accuracy of 100%.CAF arose from right coronary artery in 13（59.1%） cases,from left coronary artery in 8（36.4%） cases and from dual coronary arteries in 1 （4.5%） case.There were 4 patients associated with coronary artery aneurysms.The mean dose-length product （DLP） was （25 ± 4） mGy · cm resulting in an estimated mean effective radiation dose of （0.25 ± 0.07）mSv.Conclusion Low-dose DSCT angiography provides accurate and reliable diagnosis for coronary artery fistulas in children.

关 键 词：冠状血管 血管瘘 体层摄影术 X线计算机 辐射剂量 儿童 

分 类 号：R816.92[医药卫生—放射医学] R725.4[医药卫生—临床医学]