前瞻性心电门控大螺距CT检查对小儿先天性心脏病诊断的价值  

Clinical value of prospective ECG⁃gated high⁃pitch CT scanning in the diagnosis of pediatric congenital heart disease

作　　者：孙明华 潘玉坤 温茹 张继良 谢瑞刚 葛英辉 Sun Minghua;Pan Yukun;Wen Ru;Zhang Jiliang;Xie Ruigang;Ge Yinghui(Department of Radiology,Fuwai Central China Cardiovascular Hospital,Key Laboratory of Cardiology Radiology of Henan Province,Zhengzhou 451464,China)

机构地区：[1]阜外华中心血管病医院放射科,河南省心脏病影像医学重点实验室,郑州451464

出　　处：《中华放射医学与防护杂志》2024年第3期228-232,共5页Chinese Journal of Radiological Medicine and Protection

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20220123)。

摘　　要：目的探讨第三代双源CT(DSCT)低剂量前瞻性心电门控大螺距扫描对小儿先天性心脏病(CHD)诊断的价值。方法前瞻性收集临床确诊CHD、拟行手术治疗的患儿,采用随机数法分为3组,每组81例。第一组采用第三代DSCT前瞻性心电门控大螺距扫描(Flash_(3rd)组),第二组采用第二代DSCT前瞻性心电门控大螺距扫描(Flash_(2nd)组),第三组采用第三代DSCT前瞻性心电门控序列扫描(Sequence_(3rd)组)。图像质量客观评价包括主动脉根部及肺动脉噪声值(SD)和信噪比(SNR),主观评分采用5分制。以手术结果为标准,分析3组患儿心内外畸形的诊断准确率。结果Flash_(3rd)组、Flash_(2nd)组及Sequence_(3rd)组患儿E分别为0.24(0.19,0.27)mSv、0.11(0.10,0.14)mSv及0.44(0.39,0.48)mSv(H=207.04,P<0.05)。Flash_(3rd)组、Sequence_(3rd)组的主观评分显著高于Flash_(2nd)组[4(4,4)、4(3,4)及3(3,3),H=124.05,P<0.05],前两组间差异无统计学意义(P>0.05);Flash_(3rd)组、Sequence_(3rd)组的主动脉SD及肺动脉SD均低于Flash_(2nd)组(H=-40.27~33.38,P<0.05);Flash_(3rd)组主动脉SNR及肺动脉SNR均高于Flash_(2nd)组和Sequence_(3rd)组(H=-0.90~51.42,P<0.05)。Flash_(2nd)组诊断心内结构畸形的准确率显著低于Flash_(3rd)组及Sequence_(3rd)组(77.7%、90.9%及88.9%,K=9.36,P<0.05),后两组间差异无统计学意义(P>0.05)。3组间诊断心外结构畸形准确率差异无统计学意义(P>0.05)。结论第三代双源CT前瞻性心电门控触发的大螺距扫描能够兼顾辐射剂量及图像质量,对小儿先天性心脏病诊断具有重要的临床价值。Objective To investigate the clinical value of prospective ECG⁃gated high⁃pitch protocol scanning of third generation DSCT in the diagnosis of pediatric congenital heart disease(CHD).Methods A total of 243 children with confirmed CHD who were expected to undergo surgical treatment were prospectively collected and randomly divided evenly into 3 groups,with first group for prospective ECG⁃gated high⁃pitch scanning in third generation DSCT(Flash_(3rd)),second group for prospective ECG⁃gated high⁃pitch scanning in second generation DSCT(Flash_(2nd))and third group for prospective sequential scanning in third generation DSCT(Sequence_(3rd)).The SD value and SNR of aortic root and pulmonary artery of each child were recorded.The 5⁃point system is adopted with subjective scoring.Based on the result of operation,the diagnosis accuracy in 3 groups was analyzed.Results The E values in Flash_(3rd),Flash_(2nd)and Sequence_(3rd)group were 0.24(0.19,0.27),0.11(0.10,0.14)and 0.44(0.39,0.48)mSv(H=207.04,P<0.05),respectively.Subjective scores of group Flash_(3rd)and Sequence_(3rd)were significantly higher than that of group Flash_(2nd)[4(4,4)vs.4(3,4)vs.3(3,3),H=124.05,P<0.05]and no difference between these two groups.SD value of aortic root and pulmonary artery of group Flash_(3rd)and Sequence_(3rd)were significantly lower than that of group Flash_(2nd)(H=-40.27-33.38,P<0.05).SNR of aortic root and pulmonary artery of group Flash_(3rd)was significantly higher than that of group Flash_(2nd)and Sequence_(3rd)(H=-0.90-51.42,P<0.05).Diagnosis accuracy of intracardiac malformation for group Flash_(2nd)was significantly lower than that of Flash_(3rd)and Sequence_(3rd)(77.7%,90.9%,88.9%,K=9.36,P<0.05),and there was no significant difference between the latter two groups.There was no difference in diagnosis accuracy of extracardiac malformation among 3 groups(88.6%,94.8%,92.2%,K=3.11,P=0.21).Conclusions The prospective ECG⁃gated high⁃pitch scanning in third generation DSCT can take into account radiation dose and image

关 键 词：先天性心脏缺损 计算机体层成像 双源CT 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]