64层计算机断层扫描检测儿童左侧冠状动脉异常起源于肺动脉  

Detection of anomalous origin of left coronary artery from pulmonary artery in children with 64-slice computed tomography

作　　者：张大江[1] 胡喜红[1] 沈全力[1] 姚琼[1] 乔中伟[1] 黄国英[2] 

机构地区：[1]复旦大学附属儿科医院放射科,上海201102 [2]复旦大学附属儿科医院心血管中心,上海201102

出　　处：《上海医学》2017年第5期270-274,共5页Shanghai Medical Journal

基　　金：上海市卫生和计划生育委员会面上项目(201640070);上海市卫生和计划生育委员会青年项目(20164Y0224)资助

摘　　要：目的探讨64层CT冠状动脉成像检查对儿童左侧冠状动脉异常起源于肺动脉(ALCAPA)的诊断价值。方法回顾性分析经手术证实的12例ALCAPA患儿的64层CT冠状动脉成像资料,其中男4例,女8例;年龄1个月~9岁,中位年龄为7个月;体重5~28kg,中位体重为7kg。检查前所有患儿均未控制心率,于药物镇静状态下应用多层螺旋CT(MSCT)进行冠状动脉扫描,扫描范围自主动脉弓顶至心尖。扫描参数:采用回顾性心电门控,管电压80kV,管电流100~130mA,层厚0.625mm,球管旋转速度0.35s/转,螺距0.24。所有MSCT图像均由复旦大学附属儿科医院2名具有5年以上心血管影像阅片经验的放射科医师在AW 4.3工作站进行阅读和评估。结果 12例患儿均经64层CT冠状动脉成像检查诊断为ALCAPA。检查时患儿接受的射线剂量为1.62~2.15mSv,心率为100~150次/min,最佳重组时相窗在R-R间期的35%~50%。左侧冠状动脉开口位于肺动脉左侧壁、肺动脉右侧壁、肺动脉左后窦、肺动脉后壁各3例,右侧冠状动脉开口均位于主动脉右冠窦;所有患儿均见左心室扩大。经手术证实为左侧冠状动脉主干起源于肺动脉,其中开口位于肺动脉左后窦3例,开口位于肺动脉窦远侧的左侧壁和右侧壁各3例,开口位于肺动脉后壁3例;均见左心室扩大。结论 64层CT冠状动脉成像检查可在低辐射剂量条件下显示冠状动脉的病理解剖信息,结合超声心动图检查可提高对ALCAPA的诊断准确率。Objective To explore the value of 64-slice computed tomography （CT） coronary artery angiography in detecting anomalous origin of left coronary artery from the pulmonary artery （ALOAPA） in children. Methods Twelve children who were confirmed with ALCAPA in surgical treatment and underwent electrocardiograph （EOG）-gated 64-slice CT coronary artery angiography were enrolled in this retrospective analysis. They were 4 boys and 8 girls with a median age of 7 months （ranging from 1 month to 9 years） and a median weight of 7 kg （ranging from 5 to 28 kg）. The children were give sedatives forscanning. The scanning were performed with 80 kV tube voltage, 100- 130 mA tube current, 0. 625 mm slice thickness, 0.35 s rotation time and 0.24 pitch, without controlling the heart rate. The examination ranged from the aortic arch to cardiac apex. Two pediatric radiologists with more than 5 years of experience in cardiac image independently assessed the multi-slice spiral CT （MSCT） image at AW 4. 3 workstation. Results ALCAPA was detected by MSCT in all the children. During the MSCT, the effective radiation dose was 1.62-2.15 mSv and heart rate was 100- 150 per minute. The best reconstructed phase was between 35% and 50% of the R-R interval. The left coronary artery originated from the left wall of the pulmonary artery in 3 patients, from the right wall of the pulmonary artery in 3, from the posterior-left sinuses of the pulmonary artery in 3 and from the posterior wall of the pulmonary artery in 3. The right coronary artery originated from the right coronary sinus in all patients. CT coronary angiography also showed enlargement of the left heart in all patients. The diagnosis of ALCAPA was confirmed by surgery in all patients. Conclusion The 64-slice CT coronary artery angiography can reveal the location of the ectopic ostium and the course of left coronary artery in children with ALCAPA.

关 键 词：冠状动脉异常 肺动脉 儿童 体层摄影术 X线计算机 

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