CAJ | 학술논문

目的：探讨128层螺旋 CT 冠脉成像技术（128MSCT）在诊断川崎病患儿冠状动脉损害及随访中的应用价值。方法回顾性分析30例川崎病患儿128MSCT 及超声心动图（ECHO）检查结果。128MSCT 在无屏气状态下进行扫描，扫描时心率为80～130次·min-1，平均（99±18）次·min-1。主要观察冠状动脉瘤的数目、部位、大小及形状。冠状动脉病变按左冠状动脉（LCA）主干、冠状动脉左前降支（LAD）、回旋支（LCX）和右冠状动脉（RCA）主干进行分析。结果急性期：30例川崎病患者中17例行128MSCT 和 ECHO 冠状动脉检查均未见异常。128MSCT 显示冠状动脉损害患者13例[病变累及冠状动脉起始处或近端6例，累及冠状动脉中段和（或）远端7例]；ECHO 只显示冠状动脉起始处和近端的损害6例，ECHO 诊断完全符合率为76．67％（23/30）。ECHO 评估中远端冠脉病变有限；漏诊7例（LCA、RCA 近、中、远端多处瘤样扩张3例，双侧远端冠状动脉增粗迂曲2例，LCA中端中度或 LAD 轻度狭窄2例）。恢复期：13例冠状动脉损害患者以128MSCT 结果为对照，ECHO 诊断完全符合率为61．54％（8/13），8例同期随访（1～6个月）128 MSCT 及 ECHO 均提示冠状动脉病变消失。漏诊5例（128MSCT 提示 RCA 中、远端节段性瘤样扩张2例，LCA、RCA 多发巨大瘤合并双侧冠脉瘤壁钙化1例，LCA 中端或 LAD 狭窄各1例）。结论在较高心率、无屏气模式下，128MSCT 有助于评价川崎病患儿冠状动脉病变全貌，能为川崎病合并冠状动脉损害患儿随访和诊断策略的制定提供更多信息。
목적：탐토128층라선 CT 관맥성상기술（128MSCT）재진단천기병환인관상동맥손해급수방중적응용개치。방법회고성분석30례천기병환인128MSCT 급초성심동도（ECHO）검사결과。128MSCT 재무병기상태하진행소묘，소묘시심솔위80～130차·min-1，평균（99±18）차·min-1。주요관찰관상동맥류적수목、부위、대소급형상。관상동맥병변안좌관상동맥（LCA）주간、관상동맥좌전강지（LAD）、회선지（LCX）화우관상동맥（RCA）주간진행분석。결과급성기：30례천기병환자중17례행128MSCT 화 ECHO 관상동맥검사균미견이상。128MSCT 현시관상동맥손해환자13례[병변루급관상동맥기시처혹근단6례，루급관상동맥중단화（혹）원단7례]；ECHO 지현시관상동맥기시처화근단적손해6례，ECHO 진단완전부합솔위76．67％（23/30）。ECHO 평고중원단관맥병변유한；루진7례（LCA、RCA 근、중、원단다처류양확장3례，쌍측원단관상동맥증조우곡2례，LCA중단중도혹 LAD 경도협착2례）。회복기：13례관상동맥손해환자이128MSCT 결과위대조，ECHO 진단완전부합솔위61．54％（8/13），8례동기수방（1～6개월）128 MSCT 급 ECHO 균제시관상동맥병변소실。루진5례（128MSCT 제시 RCA 중、원단절단성류양확장2례，LCA、RCA 다발거대류합병쌍측관맥류벽개화1례，LCA 중단혹 LAD 협착각1례）。결론재교고심솔、무병기모식하，128MSCT 유조우평개천기병환인관상동맥병변전모，능위천기병합병관상동맥손해환인수방화진단책략적제정제공경다신식。
Objective To investigate the value of 128-slice CT coronary angiography in the di-agnosis of coronary artery injury and follow-up in children with Kawasaki disease.Methods The findings on 128-slice CT coronary angiography and echocardiography of 30 children with Kawasa-ki disease were retrospectively analyzed.The 128-slice CT coronary angiography was performed without breath-holding.During scanning,the average heart rate was(99± 18)/minute(range 80/minute to 130/minute ).The number,location,size and shape of coronary artery aneurysms were measured by echocardiography.Lesions of main left coronary artery(LCA),left anterior descend-ing coronary artery(LAD),left circumflex(LCX)and right coronary artery(RCA)were analyzed in all patients.Results Among the 30 children with Kawasaki disease,no coronary artery anoma-lies were found in acute phase in 17.The 128-slice CT coronary angiography showed coronary ar-tery injury in 13 children(lesions involving the initial or proximal portion of the coronary artery in 6,and involving the middle and/or distal portions of the coronary artery in 7).Echocardiography was limited in the evaluation of lesions of middle and distal portions of the coronary artery.It only showed lesions of the initial and proximal portions of the coronary artery in 6 children.The diag-nostic coincidence rate of echocardiography was 76.67%(23/30).The diagnosis was missed in 7 children,including aneurysmal dilatation of proximal,middle and distal LCA and RCA in 3,thick-ening and circumflex of bilateral distal coronary arteries in 2,and moderate LCA stenosis or mild LAD stenosis in 2.In the recovery phase,echocardiography showed coronary artery injury in 8 of the 13 children with coronary artery lesions diagnosed by 128-slice CT coronary angiography.The diagnostic coincidence rate was 61.54%.Both 128-slice CT coronary angiography and echocardio-graphy showed the disappearance of coronary artery lesions during following-up.Missed diagnosis occurred in 5 children,including segmental aneurysmal dilatation of middle and distal RCA in 2, multiple huge tumors complicated by bilateral aneurysm wall calcification in 1,middle LCA steno-sis in 1,and LAD stenosis in 1.Conclusion The 128-slice CT coronary angiography performed at higher heart rates without breath-holding helps to evaluate the panorama of coronary artery le-sions in children with Kawasaki disease,and provides information for the development of follow-up and diagnostic strategies in children with Kawasaki disease complicated by coronary artery in-jury.