多层螺旋CT成像技术在川崎病冠状动脉病变诊断中的应用价值

目的 探讨多层螺旋CT冠状动脉成像技术在观察川崎病冠状动脉病变中的应用价值。方法 采用多层螺旋CT冠状动脉成像技术（MSCT）和二维超声心动图方法（TDE）检查34例川崎病患儿的冠状动脉,分析对比两种检查方法的价值。结果 MSCT显示冠状动脉损伤12例,累及冠状动脉16支,其中左冠状动脉扩张9支（26％）,狭窄、钙化和狭窄合并钙化各1支,右冠状动脉扩张4支（12％）。TDE显示冠状动脉扩张10例,其中左冠状动脉7支（21％）,右冠状动脉6支（18％）。MSCT显示3例狭窄和钙化,2例左前降支扩张的病变,TDE显示阴性结果。两种方法探察冠状动脉扩张的阳性率比较,差异无统计学意义;探察冠状动脉狭窄和钙化,差异有统计学意义,χ^2=24．3（P〈0．01）。两种方法测量左右冠状动脉内径有很好的相关性,相关系数分别为r=0．90,r=0．82（均P〈0．01）。结论 利用MSCT能观察冠状动脉的全貌,特别是冠状动脉的中远段,在诊断钙化和狭窄方面具有独到之处,弥补了二维超声的不足,可部分取代传统的冠状动脉造影,是一种有价值的川崎病追踪随访的检查手段。

Value of multislice spiral computed tomography in finding coronary artery lesion in children with Kawasaki disease

OBJECTIVE: Kawasaki disease is an acute systemic vasculitis syndrome primarily affecting small and medium-sized arteries, with development of severe coronary artery lesion (CAL). CAL may induce myocardial infarction and sudden death. So it is very important to find CAL early. In this study the value of multislice spirral computed tomography (MSCT) was investigated to find CAL in patients with Kawasaki disease. METHODS: Thirty-four patients with Kawasaki disease were examined respectively by using MSCT and two dimensional echocardiography (TDE), then the findings were analyzed. RESULTS: MSCT showed CAL in 12 of 34 patients involving 16 coronary arteries, including 9 (26%) dilated left coronary arteries (LCA), 1 constricted, 1 calcified and 1 LCA which had both stenosis and 4 (12%) dilated right coronary artery. TDE showed that 10 patients had 13 dilated coronary arteries, including 7 (21%) left coronary arteries and 6 (18%) right coronary arteries. TDE failed to show the abnormalities in 3 patients with coronary artery stenosis or calcification and in 2 patients with left descending artery dilation demonstrated by MSCT. However, no significant difference was found between the two methods (P > 0.05) in the rates of positive findings. The correlation between TDE and MSCT, in left as well as right coronary artery, was significantly positive (r = 0.90, r = 0.82, respectively, P < 0.01). However, compared with TDE, MSCT was significantly better in finding coronary artery stenosis and calcification (chi(2) = 24.3, P < 0.01). CONCLUSIONS: Use of MSCT may help better find the lesions of coronary artery, especially those in middle and distant sections as compared to TDE. MSCT is better than TDE in exploring coronary wall calcification and coronary artery stenosis. MSCT could be a helpful new addition to the current CAL monitoring method in long-term follow-up of patients with Kawasaki disease.