双源CT前瞻性心电门控制剂量技术在小儿先天性心脏病中的临床应用
发布时间：2019-07-09 06:37
【摘要】：先天性心脏病(简称先心病)是小儿常见的心脏病,术前准确诊断和评估对患儿预后有重要意义。心血管造影(CAG)虽是先心病诊断的金标准,但它有创、操作复杂、危险性高且辐射剂量亦较高。经胸超声心动图(TTE)是先心病的首选诊断和随访方法,但其对大血管畸形的显示欠佳,且受操作者经验的影响较大。 多层螺旋CT (MSCT)和双源CT (DSCT)对先心病患儿的异常解剖结构显示良好,但多采用回顾性心电门控技术,辐射剂量较大。前瞻性心电门控(前门控)技术已应用于成人冠状动脉检查,成像质量满足诊断要求,而以辐射剂量低为突出优点,如能在小儿先心病中应用,会有很大的临床价值。 目的探讨DSCT前门控低剂量技术在小儿先心病中的临床应用价值。 方法收集37例经TTE拟诊为先心病的患儿,行DSCT前门控低剂量技术扫描,采用固定触发扫描技术。以四腔心同时显影为标志,手动触发延迟2s后开始扫描；参数设置：管电压均为80kV,管电流根据患儿体重进行调节。预设以40%为中心的32%～48%R-R间期为曝光时间窗。采用碘海醇350mg I/ml非离子型对比剂,注射量2.0ml/kg,接着以相同注射速率追加对比剂用量一半的生理盐水。记录其容积CT剂量指数(CTDIvol)和剂量长度乘积(DLP),计算出有效辐射剂量(ED)。将最佳重建时相图像数据传送至后处理工作站(Leonardo),运用用多平面重组(MPR)、最大密度投影(MIP)和容积再现(VR)等重组技术完成图像处理。由2名放射科医师独立诊断并用5分法对图像进行质量评估,对图像质量的评价符合程度采用Kappa检验。以手术或CAG结果为标准,分别计算DSCT前门控和TTE的诊断准确率,通过χ2检验比较DSCT前门控与TTE诊断结果的符合率,P0.05认为差异有统计学意义。 结果37例患儿的平均有效辐射剂量是(0.39±0.14)mSv,最低0.195mSv,最高0.594mSv。图像质量评分为4.3±0.6,图像均符合诊断要求；2名医师的图像质量评价一致性好(Kw=0.832,P0.05)。37例患儿的手术或CAG共诊断血管异常与畸形91处：房间隔缺损14例,室间隔缺损16例,单心室1例,三尖瓣闭锁2例,右室流出道狭窄5例,右室双出口2例,房室连接异常1例,肺动脉瓣狭窄1例,肺动脉闭锁3例,肺动脉狭窄8例,动脉导管未闭9例,肺动脉扩张8例,主动脉骑跨6例,主动脉缩窄7例,大动脉转位2例,迷走右锁骨下动脉1例,永存左上腔静脉2例,冠状动脉异常起源3例,共诊断血管异常与畸形91处。DSCT前门控漏诊房间隔缺损2例、室间隔缺损1例、房室连接异常1例,误诊房间隔缺损1例；TTE漏诊肺动脉狭窄2例、迷走右锁骨下动脉1例、冠状动脉异常起源3例,误诊主动脉缩窄1例。DSCT前门控与TTE的诊断准确率分别为99.2%、98.9%,差异无统计学意义(x2=0.335,P0.05)。 结论DSCT前瞻性心电门控低剂量技术不仅使先心病患儿的图像满足诊断要求,而且大幅度降低了辐射剂量,临床应用前景广阔。
[Abstract]:Congenital heart disease (congenital heart disease) is a common heart disease in children. Accurate diagnosis and evaluation before operation is of great significance to the prognosis of children. Cardiovascular angiography (CAG) is the gold standard for the diagnosis of congenital heart disease, but it is invasive, complex operation, high risk and high radiation dose. Transthoracic echocardiography (TTE) is the first choice for the diagnosis and follow-up of congenital heart disease, but its display of macrovascular malformation is not good and is greatly affected by the operator's experience. Multi-slice spiral CT (MSCT) and double-source CT (DSCT) showed good abnormal anatomical structure in children with congenital heart disease, but most of them used retrospective ECG gating technique, and the radiation dose was large. Prospective ECG gating (Qianmen control) technique has been used in adult coronary artery examination, and the imaging quality meets the diagnostic requirements. Low radiation dose is the outstanding advantage, if it can be used in children with congenital heart disease, it will have great clinical value. Objective to evaluate the clinical value of DSCT Qianmen controlled low dose technique in children with congenital heart disease. Methods 37 children with congenital heart disease diagnosed by TTE were examined by DSCT Qianmen controlled low dose technique and fixed trigger scanning technique. Marked by the simultaneous development of the four-chamber center, the scanning began after the manual trigger delay of 2 s. The parameter setting: the tube voltage is 80 kV, and the tube current is adjusted according to the child's body weight. The default 32%~48%R-R interval centered on 40% is the exposure time window. 350mg I/ml Nonionic contrast agent was injected with 2.0 ml 路kg ~ (- 1), and then half of the dosage of normal saline was added at the same injection rate. The effective radiation dose (ED). Was calculated by recording the volume CT dose index (CTDIvol) and the dose length product (DLP),. The optimal reconstruction phase image data is transmitted to the post-processing workstation (Leonardo), by using multi-planar reconstruction (MPR), maximum density projection (MIP) and volume reproduction (VR) to complete the image processing. Two radiologists were diagnosed independently and the image quality was evaluated by 5-point method. Kappa test was used to evaluate the coincidence of the image quality. According to the results of operation or CAG, the diagnostic accuracy of DSCT front gate control and TTE were calculated respectively. the coincidence rate between DSCT front door control and TTE was compared by 蠂 2 test, and the difference was statistically significant (P 0.05). Results the average effective radiation dose of 37 children was (0.39 卤0.14) mSv, the lowest was 0.195 mSvv, and the highest was 0.594 mSv. The image quality score was 4.3 卤0.6, and the images all met the diagnostic requirements. The image quality evaluation of 2 doctors was consistent (Kw=0.832,P0.05). 91 vascular abnormalities and malformations were diagnosed by operation or CAG in 37 children: atrial septum defect (14 cases), ventricular septum defect (16 cases), single ventricle (1 case), tricuspid atresia (2 cases), right ventricular outflow tract stenosis (5 cases), right ventricular double outlet (2 cases), abnormal atrioventricular connection (1 case), pulmonary valve stenosis (1 case), pulmonary atresia (3 cases), pulmonary artery stenosis (8 cases). There were 9 cases of patent ductus arteriosus, 8 cases of pulmonary artery dilatation, 6 cases of aortic crossing, 7 cases of aortic coarctation, 2 cases of transposition of great artery, 1 case of vagus right subclavian artery, 2 cases of persistent left superior vena cava, 3 cases of abnormal origin of coronary artery, 91 cases of vascular abnormalities and malformations. There were 2 cases of atrial septum defect, 1 case of ventricular septum defect, 1 case of abnormal atrioventricular connection and 1 case of misdiagnosed atrial septum defect. There were 2 cases of pulmonary artery stenosis missed by TTE, 1 case of right subclavian artery vagus, 3 cases of abnormal origin of coronary artery and 1 case of misdiagnosed coarctation of aortic. The diagnostic accuracy of TTE was 99.2% and 98.9% respectively, the difference was not statistically significant (x2 鈮，
本文编号：2511937
[Abstract]:Congenital heart disease (congenital heart disease) is a common heart disease in children. Accurate diagnosis and evaluation before operation is of great significance to the prognosis of children. Cardiovascular angiography (CAG) is the gold standard for the diagnosis of congenital heart disease, but it is invasive, complex operation, high risk and high radiation dose. Transthoracic echocardiography (TTE) is the first choice for the diagnosis and follow-up of congenital heart disease, but its display of macrovascular malformation is not good and is greatly affected by the operator's experience. Multi-slice spiral CT (MSCT) and double-source CT (DSCT) showed good abnormal anatomical structure in children with congenital heart disease, but most of them used retrospective ECG gating technique, and the radiation dose was large. Prospective ECG gating (Qianmen control) technique has been used in adult coronary artery examination, and the imaging quality meets the diagnostic requirements. Low radiation dose is the outstanding advantage, if it can be used in children with congenital heart disease, it will have great clinical value. Objective to evaluate the clinical value of DSCT Qianmen controlled low dose technique in children with congenital heart disease. Methods 37 children with congenital heart disease diagnosed by TTE were examined by DSCT Qianmen controlled low dose technique and fixed trigger scanning technique. Marked by the simultaneous development of the four-chamber center, the scanning began after the manual trigger delay of 2 s. The parameter setting: the tube voltage is 80 kV, and the tube current is adjusted according to the child's body weight. The default 32%~48%R-R interval centered on 40% is the exposure time window. 350mg I/ml Nonionic contrast agent was injected with 2.0 ml 路kg ~ (- 1), and then half of the dosage of normal saline was added at the same injection rate. The effective radiation dose (ED). Was calculated by recording the volume CT dose index (CTDIvol) and the dose length product (DLP),. The optimal reconstruction phase image data is transmitted to the post-processing workstation (Leonardo), by using multi-planar reconstruction (MPR), maximum density projection (MIP) and volume reproduction (VR) to complete the image processing. Two radiologists were diagnosed independently and the image quality was evaluated by 5-point method. Kappa test was used to evaluate the coincidence of the image quality. According to the results of operation or CAG, the diagnostic accuracy of DSCT front gate control and TTE were calculated respectively. the coincidence rate between DSCT front door control and TTE was compared by 蠂 2 test, and the difference was statistically significant (P 0.05). Results the average effective radiation dose of 37 children was (0.39 卤0.14) mSv, the lowest was 0.195 mSvv, and the highest was 0.594 mSv. The image quality score was 4.3 卤0.6, and the images all met the diagnostic requirements. The image quality evaluation of 2 doctors was consistent (Kw=0.832,P0.05). 91 vascular abnormalities and malformations were diagnosed by operation or CAG in 37 children: atrial septum defect (14 cases), ventricular septum defect (16 cases), single ventricle (1 case), tricuspid atresia (2 cases), right ventricular outflow tract stenosis (5 cases), right ventricular double outlet (2 cases), abnormal atrioventricular connection (1 case), pulmonary valve stenosis (1 case), pulmonary atresia (3 cases), pulmonary artery stenosis (8 cases). There were 9 cases of patent ductus arteriosus, 8 cases of pulmonary artery dilatation, 6 cases of aortic crossing, 7 cases of aortic coarctation, 2 cases of transposition of great artery, 1 case of vagus right subclavian artery, 2 cases of persistent left superior vena cava, 3 cases of abnormal origin of coronary artery, 91 cases of vascular abnormalities and malformations. There were 2 cases of atrial septum defect, 1 case of ventricular septum defect, 1 case of abnormal atrioventricular connection and 1 case of misdiagnosed atrial septum defect. There were 2 cases of pulmonary artery stenosis missed by TTE, 1 case of right subclavian artery vagus, 3 cases of abnormal origin of coronary artery and 1 case of misdiagnosed coarctation of aortic. The diagnostic accuracy of TTE was 99.2% and 98.9% respectively, the difference was not statistically significant (x2 鈮，
本文编号：2511937
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