3.0 T无对比剂冠状动脉MR血管成像在川崎病儿童的应用价值  

Application of 3.0 T non-contrast coronary MR angiography in children with Kawasaki disease

作　　者：文凌仪 周忠琴 伏川 阿折十干莫 郭应坤[1] Wen Lingyi;Zhou Zhongqin;Fu Chuan;Azheshiganmo;Guo Yingkun(Department of Radiology,Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education,West China Second Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西第二医院放射科出生缺陷与相关妇儿疾病教育部重点实验室,成都610041

出　　处：《中华放射学杂志》2022年第10期1058-1063,共6页Chinese Journal of Radiology

基　　金：国家自然科学基金(81971586,82120108015,82102020)。

摘　　要：目的探讨3.0 T无对比剂冠状动脉MR血管成像(CMRA)技术评估川崎病(KD)患儿冠状动脉瘤(CAA)的诊断准确度和应用价值。方法收集2019年5月2日至2022年1月19日在四川大学华西第二医院诊断为KD的75例患儿,所有患儿在1周内均同时进行无对比剂CMRA和经胸超声心动图(TTE)检查,其中26例患儿在两周内同时进行了冠状动脉CT血管成像(CCTA)或冠状动脉造影(ICA)检查。以CCTA或ICA为金标准,分别统计MRCA和TTE在每例患儿、每支冠状动脉、冠状动脉近段和中远段显示CAA的灵敏度和特异度,并采用配对卡方检验进行对比。比较MRCA和TTE对KD患儿冠状动脉病变检出的差异。结果本研究所有患儿成功完成CMRA。其中同时做了CCTA或ICA的26例患儿中,按每支冠状动脉为单位,MRCA显示CAA的灵敏度高于TTE[MRCA组97.7%(43/44)、TTE组84.1%(37/44);χ^(2)=4.17,P<0.05],且CMRA在近段[MRCA组96.2%(50/52)、TTE组71.2%(37/52);χ^(2)=10.08,P<0.05]和中远段[MRCA组100%(21/21)、TTE组52.4%(11/21);χ^(2)=7.11,P<0.05]显示CAA的灵敏度均高于TTE。在75例患儿中,总共有115个CAA被CMRA发现,但其中只有75.7%(87/115)的CAA被TTE观察到。TTE未观察到的CAA中,在右冠状动脉(RCA)、左冠状动脉主干(LMCA)、左冠状脉前降支(LAD)和左冠状动脉回旋支(LCX)占比分别为57.1%(16/28)、7.1%(2/28)、25.0%(7/28)和10.7%(3/28);与CMRA对比,TTE在LMCA、RCA、LAD和LCX近段未观察到的CAA占比39.3%(11/28),在LAD、RCA和LCX中远段未观察到的CAA占比60.7%(17/28)。在75例KD患儿中,CMRA总共发现8例患儿有血栓形成,但其中62.5%(5/8)未被TTE观察到。结论3.0 T无对比剂CMRA无创、无辐射,对CAA诊断性能高,适用于KD患儿的冠状动脉血管成像,尤其是对KD患儿RCA和冠状动脉中远段的病灶有良好的诊断价值。Objective To explore the diagnostic accuracy and application value of 3.0 T non-contrast coronary magnetic resonance angiography(CMRA)in evaluating coronary artery in children with Kawasaki disease(KD).Methods From May 2019 to January 2022,75 children diagnosed with KD in our hospital were enrolled.All the patients underwent CMRA and transthoracic echocardiography(TTE)in one week,twenty-six of whom underwent coronary CT angiography(CCTA)or invasive coronary angiography(ICA)within two weeks.The diagnostic performance of CMRA and TTE was evaluated with CCTA/ICA as reference standard by per-patient basis,per-vessel basis,per-segment basis.Sensitivity and specificity of CMRA and TTE was compared by paired chi square test.The distribution of coronary artery aneurysm(CAA),thrombosis and other pathological changes of coronary artery were recorded and compared between two methods.The patients′height and weight were collected to calculate the Z value.Z value>2.5 was defined as CAA.Results All patients successfully completed CMRA examinations.Among the 26 patients,the sensitivity of CMRA was significantly higher than that of TTE by per coronary artery[97.7%(43/44)vs.84.1%(37/44),χ^(2)=4.17,P<0.05].CMRA showed a higher sensitivity than that of TTE both by proximal segments and middle/distal segments[97.7%(43/44)vs.84.1%(37/44),100%(21/21)vs.52.4%(11/21),χ^(2)=10.08,7.11,both P<0.05).A total of 115 CAAs was found by CMRA,while only 87(75.7%)CAAs were observed by TTE.Of the 28(24.3%)CAAs missed by TTE,16(57.1%)were located in right coronary artery(RCA),2(7.1%)in left main coronary artery,7(25.0%)in left anterior ascending coronary artery(LAD)and 3(10.7%)in left circumflex coronary artery(LCX).Eleven(39.3%)missed CAAs by TTE were located in the proximal segment of RCA,LMCA,LAD and LCX,and 17(60.7%)missed CAAs were located in the middle and distal segments.TTE missed coronary thrombosis in 5 patients compared with CMRA.Conclusions 3.0 T non-contrast CMRA is non-invasive and non-radiation,and the image quality can meet the n

关 键 词：磁共振成像 冠状动脉 川崎病 经胸超声心动图 

分 类 号：R725.4[医药卫生—儿科] R445.2[医药卫生—临床医学]