宽体探测器低剂量CT在婴幼儿先天性心脏病中的应用价值  

Application value of a whole -heart CT scanner in infants with congenital heart disease

作　　者：范丽娟[1,2] 徐冬生[1] 张计旺[1] 刘军波[1] 付东海[1] 凌坚 于铁链[2] Fan Lijuan;Xu Dong-sheng;Zhang Jiwang;Liu Junbo;Fu Donghai;Ling Jian;Yu Tielian(Department of Radiology,TEDA International Cardiovascular Disease Hospital,Tianjin 300457,China（Fan LJ,Xu DS,Zhang JW,Liu JB,Fu DH,Ling J;Department of Radiology,General Hospital of Tianjin Medical University,Tianjin 300052,China（Fan L J,Yu TL)

机构地区：[1]泰达国际心血管病医院放射科,天津300457 [2]天津医科大学总医院放射科,300052

出　　处：《中华实用儿科临床杂志》2018年第13期1004-1007,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨宽体探测器低剂量CT在婴幼儿先天性心脏病检查中的诊断准确率、图像质量及有效辐射剂量（ED）。方法纳入连续先天性心脏病患儿86例，年龄〈2岁。根据扫描方案不同分为2组：宽体探测器低剂量组43例，男28例，女15例；年龄12 d～19个月；使用宽体探测器低剂量CT扫描。容积螺旋穿梭组43例，男23例，女20例；年龄19 d～16个月；使用多排CT容积螺旋穿梭技术扫描。以手术结果作为参考标准，计算2组对心血管畸形的诊断灵敏性、特异性、阳性预测值、阴性预测值及诊断准确率。测量2组升主动脉、主肺动脉及邻近肌肉组织的CT值和图像噪声，并计算信噪比（SNR）及对比噪声比（CNR）。采用双盲法评价心内结构、心外结构及冠状动脉的客观图像质量。记录每例患儿的容积CT剂量指数（CTDIvol）和剂量长度乘积（DLP），并计算ED。比较2组的诊断准确率、图像质量及ED。结果宽体探测器低剂量组和容积螺旋穿梭组分别发现124处和113处心血管畸形，二者诊断准确率分别为99.2%和98.8%，差异无统计学意义（χ2＝0.035，P＝0.852）。2组诊断的灵敏性、特异性、阳性预测值和阴性预测值分别为97.8%、99.7%、98.4%、99.6%和95.2%、99.3%、98.2%、98.7%。2组升主动脉和主肺动脉的CT值、图像噪声、SNR及CNR比较，差异均无统计学意义（均P〉0.05）。2组心内结构及心外结构的客观图像质量评分比较差异均无统计学意义（均P〉0.05）。宽体探测器低剂量组冠状动脉的图像质量显著高于容积螺旋穿梭组（4.02±0.91比2.79±0.74），差异有统计学意义（Z＝－5.562，P＝0.000）。宽体探测器低剂量组ED[（0.59±0.31） mSv]较容积螺旋穿梭组[（2.28±1.07） mSv]下降了74%，差异有统计学意义（t＝－11.285，P＝0.000）。结论宽体探测器低剂量CT检查婴幼儿先天性心脏病，在保证较高图像质量，尤�ObjectiveTo investigate the accuracy, image quality and effective dose （ED） of the whole-heart CT scanner in infants with congenital heart disease.MethodsTotally 86 consecutive pediatric patients younger than 2 years old with congenital heart disease were enrolled.They were divided into 2 groups： whole-heart CT scanner with low dose group, 43 patients（28 males, 15 females, aged 12 d-19 months） underwent CT acquisition by using the whole-heart CT, and the other 43 patients（23 males, 20 females, aged 19 d-16 months） examined with volume helical shuttle （VHS） of high definition CT were assigned as VHS group.With surgical results as the standard, the sensitivity, specificity, positive predictive value（PPV）, negative predictive value（NPV） and the diagnostic accuracy of the 2 groups for cardiovascular abnormalities were evaluated.Attenuation and noise of 2 groups of ascending aorta, main pulmonary artery, and muscle were measured, and the signal-to-noise ratio （SNR） and contrast-to-noise ratio （CNR） were calculated.The double blind method was used to evaluate the subjective image quality of the level of intra-cardiac, extra-cardiac and coronary artery.Both the volumetric CT dose index （CTDIvol） and dose-length product（DLP） of each child were recorded, and the ED was also estimated in both groups.ResultsBy using surgical findings as the reference standard, a total of 124 and 113 separate cardiovascular anomalies were confirmed by the whole-heart CT scanner in the low dose group and the VHS group.The diagnostic accuracy in 2 groups was 99.2% and 98.8%, respectively, without significant difference（χ2=0.035, P=0.852）. The sensitivity, specificity, PPV and NPV in 2 groups were 97.8%, 99.7%, 98.4%, 99.6% and 95.2%, 99.3%, 98.2%, 98.7%, respectively.No significant difference was found in the attenuation, image noise, SNR, and CNR between 2 groups in the same anatomic regions （all P〉0.05）. No significant difference was found in subjective image quality between 2 groups on th

关 键 词：计算机体层成像 先天性心脏病 辐射剂量 迭代重建 

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