64层计算机断层扫描检测儿童左侧冠状动脉异常起源于肺动脉

发布时间：2018-07-27 16:11

【摘要】：目的探讨64层CT冠状动脉成像检查对儿童左侧冠状动脉异常起源于肺动脉(ALCAPA)的诊断价值。方法回顾性分析经手术证实的12例ALCAPA患儿的64层CT冠状动脉成像资料,其中男4例,女8例;年龄1个月~9岁,中位年龄为7个月;体重5~28kg,中位体重为7kg。检查前所有患儿均未控制心率,于药物镇静状态下应用多层螺旋CT(MSCT)进行冠状动脉扫描,扫描范围自主动脉弓顶至心尖。扫描参数:采用回顾性心电门控,管电压80kV,管电流100~130mA,层厚0.625mm,球管旋转速度0.35s/转,螺距0.24。所有MSCT图像均由复旦大学附属儿科医院2名具有5年以上心血管影像阅片经验的放射科医师在AW 4.3工作站进行阅读和评估。结果 12例患儿均经64层CT冠状动脉成像检查诊断为ALCAPA。检查时患儿接受的射线剂量为1.62~2.15mSv,心率为100~150次/min,最佳重组时相窗在R-R间期的35%~50%。左侧冠状动脉开口位于肺动脉左侧壁、肺动脉右侧壁、肺动脉左后窦、肺动脉后壁各3例,右侧冠状动脉开口均位于主动脉右冠窦;所有患儿均见左心室扩大。经手术证实为左侧冠状动脉主干起源于肺动脉,其中开口位于肺动脉左后窦3例,开口位于肺动脉窦远侧的左侧壁和右侧壁各3例,开口位于肺动脉后壁3例;均见左心室扩大。结论 64层CT冠状动脉成像检查可在低辐射剂量条件下显示冠状动脉的病理解剖信息,结合超声心动图检查可提高对ALCAPA的诊断准确率。
[Abstract]:Objective to investigate the diagnostic value of 64-slice CT coronary angiography in children with anomalous origin of left coronary artery originated from pulmonary artery (ALCAPA). Methods the data of 64-slice CT coronary angiography in 12 children with ALCAPA confirmed by operation were retrospectively analyzed, including 4 males and 8 females, aged from 1 month to 9 years, with a median age of 7 months, and a mean weight of 7 kg with a body weight of 5 ~ 28 kg. Heart rate was not controlled in all the children before examination. Coronary artery was scanned by multislice spiral CT (MSCT) under drug sedation from the top of aortic arch to the apex of heart. Scanning parameters: retrospective ECG gating, tube voltage 80kV, tube current 100m 130mA, layer thickness 0.625mm, ball rotating speed 0.35s/ rotation, pitch 0.24. All MSCT images were read and evaluated at AW 4.3 workstation by two radiologists with more than 5 years experience in cardiovascular imaging reading in the Pediatrics Hospital affiliated to Fudan University. Results all 12 children were diagnosed as ALCAPA by 64-slice CT coronary angiography. The dose of radiation was 1.62V 2.15mSv, the heart rate was 100m / min, and the optimal time window was 35g / min at R-R interval. The left coronary artery was located in the left wall of the pulmonary artery, the right wall of the pulmonary artery, the left posterior sinus of the pulmonary artery, the posterior wall of the pulmonary artery in 3 cases, and the right coronary artery opening in the right coronary sinus of the aorta. It was proved that the main coronary artery originated from the pulmonary artery, in which the orifice was located in the left posterior sinus of the pulmonary artery in 3 cases, the opening in the left wall and the right wall in the distal side of the pulmonary artery in 3 cases, and the opening in the posterior wall of the pulmonary artery in 3 cases. Left ventricular dilatation was seen in all patients. Conclusion 64-slice CT coronary angiography can display the pathological and anatomical information of coronary artery at low radiation dose. Combined with echocardiography, the diagnostic accuracy of ALCAPA can be improved.
【作者单位】：复旦大学附属儿科医院放射科;复旦大学附属儿科医院心血管中心;
【基金】：上海市卫生和计划生育委员会面上项目(201640070);上海市卫生和计划生育委员会青年项目(20164Y0224)资助
【分类号】：R725.4;R816.92

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