| 姚莉萍,张丽,丁茗,虞崚崴,孙锟,李惠民.前瞻性心电门控心血管CTA在小儿先天性心脏病冠状动脉评估中的应用价值[J].中华放射医学与防护杂志,2016,36(7):534-539 |
| 前瞻性心电门控心血管CTA在小儿先天性心脏病冠状动脉评估中的应用价值 |
| Assessment of coronary artery by prospective ECG-triggered 256 multi-slice CT on children with congenital heart diseases |
| 投稿时间：2015-11-11 |
| DOI：10.3760/cma.j.issn.0254-5098.2016.07.012 |
| 中文关键词: 冠状动脉 先天性心脏病 前瞻性心电门控256-MSCT 辐射剂量 |
| 英文关键词:Coronary artery Congenital heart disease Prospective ECG-triggered 256-MSCT angiography Radiation dosage |
| 基金项目:上海市科委基础研究重点项目（12JC1406600） |
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| 中文摘要: |
| 目的 研究先天性心脏病（congenital heart disease，CHD）患儿进行前瞻性心电门控256-MSCT血管造影时冠状动脉的显示质量和辐射剂量。方法 93例CHD患儿纳入研究，按年龄分为A组 （<4个月）、B组（4个月≤年龄<3岁）、C组（3≤年龄<8岁）以及D组（8~15岁）。分析容积剂量指数（volumetric CT dose index，CTDIvol）， 剂量长度乘积（dose-length product，DLP） 和有效剂量（effective dose，E）与年龄之间的相关性。对74例同时记录心率变化的患儿进行冠脉分析，运用4点评分法研究冠状动脉的检出率。记录信号值（signal）、噪声（noise）和对比噪声比（contrast-to-noise ratio，CNR）评价图像质量与年龄的关系以及不同年龄组间冠状动脉图像质量。结果 按11个节段分析法，冠状动脉总检出率为91%，左右冠状动脉起始、冠状动脉的近段、中段和远段检出率分别为100%、97%、92%和78%，不同年龄组间差异无统计学意义（P > 0.05）。A、B、C和D组的E值分别为1.8、1.3、0.8和 0.7 mSv，E与年龄间呈负相关性（r=-0.803， P < 0.01）。虽然DLP与年龄间无相关性（r=0.124， P > 0.05），但是D组的数值高于其他年龄组。噪声与年龄间无相关性（r=0.041， P > 0.05）。信号、CNR和E值，（A+B）组均高于（C+D）组（t=3.386、2.073、3.825，P < 0.05）。结论 新一代256-MSCT对CHD儿童冠状动脉检测有优异的显示效果。虽然远段检出率较其他节段低，但是比以往有更好的检出，为小儿冠状动脉疾病的诊断提供一种高效选择。同时从辐射剂量的角度，大年龄儿童可尝试使用更低的管电压完成检查，3岁以下小儿童仍应慎重选择CT检查。 |
| 英文摘要: |
| Objective To investigate the image quality and radiation dosage of the prospective ECG-triggered 256 multi-slice computer tomography (MSCT) angiography in accessing coronary artery (CA) on children. Methods Coronary arteries of ninety-three children were evaluated using prospective ECG-triggered 256-MSCT with the same system setting. Seventy-four patients had the heart rate records and a four-point scoring system was applied to study the capability of MSCT in detecting CA. The signal, noise and contrast-to-noise ratio (CNR) were analyzed to investigate the association of image quality with age (n=74). Then volumetric CT dose index (CTDIvol), dose-length product (DLP) and effective dose (E) were utilized to study the association of radiation dosage with age (n=93). Results On 74 patients with heart records, the detection rate for original, proximal, middle, distal and all 11 segments of CA was 100%, 97%, 92%, 78% and 91%, respectively. No influence of age was found on their detection (all P > 0.05). E of group A,B,C and D were 1.8, 1.3, 0.8 and 0.7 mSv, respectively. A strong negative correlation was found between E and age (r=-0.803, P < 0.01). Higher DLP was found on elder patients, though no correlation was found between ages vs. DLP(r=0.124, P > 0.05). No correlation was found between noise vs. age (r=0.041, P > 0.05). Significantly larger signals,CNR and E(t=3.386, 2.073, 3.825, P < 0.05)were found on younger patients (age < 3 years). Conclusions Prospective ECG-triggered 256-MSCT has considerable performance for the evaluation of coronary arteries on children. However, children under the age of 3 are not recommended for this examinary, but for examination on children ≥ 8-year old, the tube current could be further needed. |
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