儿童冠状动脉起源异常的多模态影像学诊断  

Multimodal imaging diagnosis of coronary artery origin abnormalities in children

作　　者：薛丽 曹永丽[2] 杨娇 徐丽媛 李姗姗 刘国文 张红菊 马宁 XUE Li;CAO Yongli;YANG Jiao;XU Liyuan;LI Shanshan;LIU Guowen;ZHANG Hongju;MA Ning(Department of Echocardiography,Cardiac center,Beijing Children's Hospital of Capital Medical University,National Center for Children's Health,Beijing,100045,China;Department of Radiology,Beijing Children's Hospital of Capital Medical University,National Center for Children's Health)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院心脏中心心脏超声科,北京100045 [2]国家儿童医学中心首都医科大学附属北京儿童医院影像中心

出　　处：《临床心血管病杂志》2023年第12期901-907,共7页Journal of Clinical Cardiology

基　　金：首都卫生发展科研专项项目(No:首发2022-1G-4262)。

摘　　要：目的:分析多模态影像学技术在儿童冠状动脉(冠脉)起源异常中的诊断价值。方法:回顾分析我院近5年确诊为冠脉起源异常患儿的经胸超声心动图(TTE)、冠脉CTA、心脏增强磁共振(MRI)、冠脉造影(CA)等检查结果、图像及病历资料。结果:冠脉起源异常患儿63例,其中冠脉异常起源于肺动脉(ACAPA)26例,年龄1个月~10岁,中位年龄6个月;冠脉异常主动脉起源(AAOCA)37例,年龄2个月~15岁,中位年龄7岁。TTE对ACAPA首诊检出率100%,确诊率77%(20/26);对AAOCA首诊检出率65%(24/37),确诊率46%(17/37),漏诊率35%(13/37)。TTE对心腔内瓣膜等结构、血流动力学和心功能评估有优势。CTA可明确显示冠脉起源位置,缺陷在于对心腔内结构的显示及血流动力学的评估方面,并有放射性。MRI的优势在于评估心肌缺血及是否发生纤维化。CA的优势在于明确冠脉起源位置以及血流充盈情况,缺点是有创和放射性。结论:在儿童冠脉起源异常的诊断中,各项影像学技术各有优势。TTE可作为筛查和首诊的首选技术。Objective To analyze the diagnostic value of multimodal imaging technology in children with abnormal coronary artery origin.Methods The results, images of transthoracic echocardiography(TTE), coronary CTA, cardiac contrast magnetic resonance imaging(MRI), coronary angiography(CA) and medical records of children diagnosed with coronary artery abnormalities in our hospital in the past 5 years were retrospectively analyzed.Results There were 63 children with abnormal coronary artery origin, including 26 cases with abnormal coronary artery origin of pulmonary artery(ACAPA), aged 1 month-10 years old, and median age was 6 months;37 cases of anomalous aortic origin of coronary artery(AAOCA), aged 2 months to 15 years, and median age was 7 years. The initial detection rate of ACAPA by TTE was 100% and the diagnosis rate was 77%(20/26). The initial detection rate of AAOCA was 65%(24/37), the diagnosis rate was 46%(17/37), and the missed diagnosis rate was 35%(13/37). TTE has advantages for assessing structures such as valves in the heart chamber, hemodynamics, and cardiac function. CTA can clearly show the location of coronary origin, but it is defective in the visualization of intra-chamber structures and hemodynamic assessment, and has radioactivity. MRI has the advantage of assessing myocardial ischemia and the presence of fibrosis. AC has the advantage of the location of the origin of the coronary artery and the filling of blood flow, but the disadvantage is invasive and radioactive.Conclusion In the diagnosis of abnormal origin of coronary arteries in children, various imaging techniques have their own advantages. TTE is the preferred examination method for screening and initial diagnosis.

关 键 词：儿童 冠脉起源异常 多模态影像学 超声心动图 

分 类 号：R541.3[医药卫生—心血管疾病]