70kV结合低对比剂用量CT扫描在小儿冠状动脉疾病诊断中的临床价值  

Clinical value of 70 kV combined with low contrast agent CT scan in the diagnosis of pediatric coronary artery disease

作　　者：段艳华[1] 陈力 卢光明[3] 乌大尉[1] 程召平[1] 王锡明[1] Duan Yanhua;Chen Li;Lu Guangming;Wu Dawei;Cheng Zhaoping;Wang Ximing(Department of Radiology,Shandong Medical Imaging Research Institute,Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardiocerebral Vascular Disease,Shandong University,Jinan 250021,ChinaS（Present address： Department of Medical Imaging,Nanjing General Hospital,Nanfing 210002,China)

机构地区：[1]山东省医学影像学研究所影像科、山东省心脑血管疾病诊治重点实验室,济南250021 [2]山东大学附属省立医院超声诊疗科 [3]南京军区南京总医院医学影像科

出　　处：《中华放射学杂志》2018年第7期507-512,共6页Chinese Journal of Radiology

基　　金：中国博士后基金(2015M582898);山东省重点研发计划项目(2015GGH318005);山东省医药卫生发展计划项目(2014WS0117)

摘　　要：目的以DSA或手术对照，评价70 kV结合低对比剂用量与80 kV双源CT小儿冠状动脉成像的图像质量、辐射剂量及诊断效能。 方法前瞻性连续收集2012年4月至2017年4月临床疑诊或确诊小儿冠状动脉病变，并行冠状动脉CTA的150例患儿资料，男90例、女60例，年龄（14.7±1.9）个月，按照随机数字表法将患者随机分为3组，每组50例：A组采用80 kV管电压，对比剂用量1.5 ml/kg，B组采用70 kV管电压，对比剂用量1.5 ml/kg，C组70 kv管电压，对比剂用量1.0 ml/kg；采用方差分析比较3组冠状动脉主观图像质量的差异；t检验比较70 kV组与80 kV组有效辐射剂量的差异；以手术和（或）造影结果为金标准，评估3组的诊断效能。 结果所有患儿均顺利完成双源CT冠状动脉成像并获得满意的可诊断图像。3组的主观图像质量评分分别为3.5±0.7、3.4±0.6、3.7±0.8，组间差异无统计学意义（F=2.042，P=0.133）。以手术和（或）造影结果为金标准，3组对冠状动脉病变的诊断准确率均为100%。80 kV组（A组）与70 kV组（B＋C组）的有效辐射剂量分别为（0.49±0.04）、（0.30±0.03）mSv，差异有统计学意义（t=4.037，P=0.001）。 结论70 kV管电压结合低对比剂用量双源CT冠状动脉血管成像能较好地显示和诊断小儿冠状动脉病变，诊断准确率高，是诊断小儿冠状动脉病变的可靠检查手段。ObjectiveDSA and/or surgery was used as a control to evaluate the image quality, radiation dose and diagnostic efficacy of 70 kV combined with low contrast agent dose and 80 kV dual-source CT scanning of coronary artery. MethodsBetween Apr, 2012 and Apr, 2017, a total of 150 consecutive pediatrics with suspected or confirmed coronary arterial diseases underwent DSCTCA, and the patients were randomly divided into 3 groups by different scanning protocols. Group A （n=50）： 80 kV with 1.5 ml/kg contrast agent; Group B （n=50）： 70 kV with 1.5 ml/kg contrast agent;Group C （n=50）： 70 kV with 1.0 ml/kg contrast agent. ANOVA was used to compare the differences of subjective coronary arteries image quality between the three groups;The t-test was used to compare the difference in effective radiation dose between the 70 kV group and the 80 kV group; The surgery and/or angiography results were used as gold standard to evaluate the diagnostic efficacy of the three groups. ResultsAll patients underwent DSCTCA successfully and satisfactory diagnostic images were gained. The mean scores of subjective image quality of coronary artery were 3.5±0.7, 3.4±0.6, 3.7±0.8, respectively. There was no significant difference between the3 groups （F=2.042, P=0.133）. The diagnostic accuracy of the three groups for coronary artery disease was 100%, as the surgical and/or angiographic results were used as gold standard. The effective radiation doses in 80 kV group （A group） and the 70 kV group （B＋C group） were （0.49±0.04） and （0.30±0.03） mSv, respectively, with a statistically significant difference （t=4.037, P=0.001）. ConclusionsDSCTCA can better display and diagnose pediatric coronary artery lesions with 70 kV tube voltage combined with low contrast agent, and has a high diagnostic accuracy. It is a reliable method for diagnosing pediatric coronary artery disease.

关 键 词：儿童 冠状动脉疾病 体层摄影术 X线计算机 辐射剂量 

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