CAJ | 학술논문

目的评价双源CT(DSCT)前瞻性心电门控低剂量扫描在小儿川崎病(KD)冠状动脉损害诊断中的临床应用价值.方法回顾性分析19例临床诊断为KD冠状动脉损害,同时行经胸多普勒超声(TTE)和DSCT前瞻性心电门控低剂量扫描的患儿资料；由2名放射科医师采用盲法独立阅片,以5分法评价整体图像质量,Kappa检验评价诊断的一致性；记录所有患儿冠状动脉瘤样扩张及动脉瘤的位置、数量并测量其大小；Pearson相关分析比较DSCT成像和TTE两种检查方法诊断结果的一致性；计算所有患儿的平均有效辐射剂量(ED).结果 19例患儿均成功完成DSCT前瞻性心电门控低剂量冠状动脉成像,可评价冠状动脉节段比率为91.5％(226/247),其中,15例患儿被诊断为川崎病冠状动脉瘤样扩张或动脉瘤形成,DSCT成像上共发现28个动脉瘤、15支血管瘤样扩张.其中,9个动脉瘤(2个位于右冠状动脉远段、2个位于左心室后支、1个位于前降支中段、1个位于回旋支中段、2个位于回旋支远段、1个位于钝缘支)及2支瘤样扩张(1支对角支、1支钝缘支)TTE未显示.DSCT成像与TTE对比显示冠状动脉瘤及瘤样扩张最大直径的平均测量值分别为(0.63 ±0.20)和(0.58 ±0.20) cm,相关性较好(r=0.989,P＜0.05)；对瘤体及瘤样扩张最大长径的平均测量值分别为(1.49±0.83)和(1.22±0.66)cm,相关性较好(r=0.965,P＜0.05).2名影像科医师对所有患儿的CTA图像质量评分一致性好(Kappa=0.87).19例患儿的ED为(0.24±0.08) mSv.结论相比TTE,DSCT前瞻性心电门控低剂量冠状动脉成像对小儿川崎病患儿冠状动脉远段的动脉瘤及瘤样扩张的显示较好.
목적 평개쌍원CT(DSCT)전첨성심전문공저제량소묘재소인천기병(KD)관상동맥손해진단중적림상응용개치.방법 회고성분석19례림상진단위KD관상동맥손해,동시행경흉다보륵초성(TTE)화DSCT전첨성심전문공저제량소묘적환인자료；유2명방사과의사채용맹법독립열편,이5분법평개정체도상질량,Kappa검험평개진단적일치성；기록소유환인관상동맥류양확장급동맥류적위치、수량병측량기대소；Pearson상관분석비교DSCT성상화TTE량충검사방법진단결과적일치성；계산소유환인적평균유효복사제량(ED).결과 19례환인균성공완성DSCT전첨성심전문공저제량관상동맥성상,가평개관상동맥절단비솔위91.5％(226/247),기중,15례환인피진단위천기병관상동맥류양확장혹동맥류형성,DSCT성상상공발현28개동맥류、15지혈관류양확장.기중,9개동맥류(2개위우우관상동맥원단、2개위우좌심실후지、1개위우전강지중단、1개위우회선지중단、2개위우회선지원단、1개위우둔연지)급2지류양확장(1지대각지、1지둔연지)TTE미현시.DSCT성상여TTE대비현시관상동맥류급류양확장최대직경적평균측량치분별위(0.63 ±0.20)화(0.58 ±0.20) cm,상관성교호(r=0.989,P＜0.05)；대류체급류양확장최대장경적평균측량치분별위(1.49±0.83)화(1.22±0.66)cm,상관성교호(r=0.965,P＜0.05).2명영상과의사대소유환인적CTA도상질량평분일치성호(Kappa=0.87).19례환인적ED위(0.24±0.08) mSv.결론 상비TTE,DSCT전첨성심전문공저제량관상동맥성상대소인천기병환인관상동맥원단적동맥류급류양확장적현시교호.
Objective To explore the application of low-dose prospective ECG-triggering dualsource CT (DSCT) angiography in infants and children with Kawasaki disease (KD).Methods Nineteen children diagnosed of Kawasaki disease underwent low-dose prospective ECG- triggering DSCT angiography (DSCTA) with free breathing and transthoracic echocardiogram (TTE).The overall imaging quality was graded on a five-point scale. Interobserver agreement in subjective image quality grading was assessed by Kappa statistics.The location,number and size of the aneurysms and dilations were recorded and compared with those of TTE.Pearson correlation analysis was used to evaluate the agreement on measurements between DSCTA and TTE.The average effective dose of DSCTA in all 19 children was calculated.Results DSCTA was performed successfully in all 19 children.A total of 91.5 ％ (226/247) segments permitted visualization with diagnostic image quality. Fifteen patients were diagnosed with coronary artery lesions. A total of 28 aneurysms and 15 arterial aneurysmal dilations were detected by DSCTA,while 19 aneurysms and 13 arterial aneurysmal dilations were found by TTE.TTE failed to detect 9 aneurysms (2 in the distal right coronary artery,2 in the posterior descending artery,1 in the middle of left anterior descending artery,1 in the middle of left circumflex artery,2 in the distal of LCX and 1 in the obtuse marginal branch)and 2 arterial aneurysmal dilations (1 at the diagonal branch and 1 at obtuse marginal branch). The concordance of DSCTA and TTE in measurement of diameter and length of these aneurysms and aneurysmal dilatations are good (0.63 ± 0.20) and (0.58 ± 0.20) cm vs ( 1.49 ± 0.83 ) and ( 1.22 ± 0.66) cm ( r =0.989 and 0.965,P ＜ 0.05 ).There was a good agreement on overall image quality ( Kappa =0.87 ). The mean effective dose was(0.24 ± 0.08) mSv.Conclusion Prospective ECG-triggering DSCTA with very low effective radiation dose is safe,reliable and more sensitive than TTE on diagnosing of coronary artery lesions,especially in the distal lesions,in infants and children with KD.