CAJ | 학술논문

目的与经胸多普勒超声比较,评价双源CT前瞻性心电门控心胸联合扫描在小儿复杂先心病诊断中的临床应用价值.方法回顾分析2008年12月至2010年9月山东大学医学院临床疑诊或确诊为先天性心脏病的87例患儿资料,男46例、女41例；年龄3个月～6岁,平均年龄28个月；平均体重15 kg,临床疑诊先心病(CHD),同时于本单位行经胸多普勒超声(TTE)和双源CT(DSCT)前瞻性心电门控心胸联合扫描.其中,54例患儿行手术治疗.由2名经验丰富的放射科医师以4分法评价整体图像质量,kappa检验评价两种检查方法的一致性.与手术结果对照分析,比较DSCT前瞻性心电门控心胸联合扫描与TTE对复杂先心病的诊断准确率；计算所有患儿的有效辐射剂量(ED).结果 87例患儿均成功完成DSCT心胸联合扫描.DSCT共发现心内外结构畸形267处,CDFI共发现畸形231处.2名影像科医师对所有患儿的图像质量评分一致性好(kappa值0.78)；54例行手术治疗的患者共发现畸形173处,DSCT诊断正确169处,诊断准确率为97.69％；CDFI诊断正确142处,诊断准确率为82.08％.87例患儿的平均有效剂量为(0.40±0.08) mSv.结论与经胸超声对比,DSCT前瞻性心电门控心胸联合扫描能清晰显示复杂性先天性心脏病患儿的心内外结构畸形,对先心病的术前评估有重要的价值.
목적 여경흉다보륵초성비교,평개쌍원CT전첨성심전문공심흉연합소묘재소인복잡선심병진단중적림상응용개치.방법 회고분석2008년12월지2010년9월산동대학의학원림상의진혹학진위선천성심장병적87례환인자료,남46례、녀41례；년령3개월～6세,평균년령28개월；평균체중15 kg,림상의진선심병(CHD),동시우본단위행경흉다보륵초성(TTE)화쌍원CT(DSCT)전첨성심전문공심흉연합소묘.기중,54례환인행수술치료.유2명경험봉부적방사과의사이4분법평개정체도상질량,kappa검험평개량충검사방법적일치성.여수술결과대조분석,비교DSCT전첨성심전문공심흉연합소묘여TTE대복잡선심병적진단준학솔；계산소유환인적유효복사제량(ED).결과 87례환인균성공완성DSCT심흉연합소묘.DSCT공발현심내외결구기형267처,CDFI공발현기형231처.2명영상과의사대소유환인적도상질량평분일치성호(kappa치0.78)；54례행수술치료적환자공발현기형173처,DSCT진단정학169처,진단준학솔위97.69％；CDFI진단정학142처,진단준학솔위82.08％.87례환인적평균유효제량위(0.40±0.08) mSv.결론 여경흉초성대비,DSCT전첨성심전문공심흉연합소묘능청석현시복잡성선천성심장병환인적심내외결구기형,대선심병적술전평고유중요적개치.
Objective To explore the application of prospective ECG-triggering dual-source CT (DSCT) angiography in infants and children with complex congenital heart disease (CHD) compared with transthoracic echocardiography ( TTE ).Methods Eighty-seven patients ( mean age: 28 months,range 3 months to 6 years; male 46; mean weight:1S kg) underwent prospective ECG-triggering DSCT angiography and TTE.Surgery was performed in 54 patients.The overall imaging quality was evaluated on a four-point scale.Inter-observer agreement in subjective image quality grading was assessed by kappa statistics.The accuracy of DSCT angiography and TTE was calculated based on the surgery findings in the 54 patients who were performed with surgery.Results A total of 267 cardiovascular deformities were diagnosed by DSCT angiography,and 231 deformities were diagnosed by TTE.There was a good agreement on overall image quality (kappa =0.78).A total of 173 cardiovascular deformities were confirmed by surgery findings in 54 patients.The accuracy of DSCT angiography and TTE was 97.69％ ( 169/173 ) and 82.08％ ( 142/173 ).The mean effective dose was ( 0.40±0.08 ) mSv.Conclusions Prospective ECG-triggering DSCT angiography with a very low effective radiation dose allows the accurate diagnosis of anomalies in infants and children with complex CHD compared with TTE.It has great value for preoperative assessment of CHD.