64层螺旋CT血管成像对低龄儿童川崎病冠状动脉病变的随访诊断价值

目的 评价64层螺旋CT(MSCT)对低龄儿童川崎病冠状动脉瘤的随访诊断价值和应用可行性.方法 对12例随访中的川崎病冠状动脉瘤患儿(平均年龄5.2岁,随访时间1.1～5.1 年)进行64层MSCT冠状动脉成像,观察冠状动脉病变的程度和冠状动脉瘤的数目、位置、形态和大小,并和同期超声心动图(ECHO)进行比较分析.结果 MSCT共观察到30个冠状动脉瘤,左、右冠状动脉各15个,肿瘤最宽径为20.6 mm,平均(7.5±3.8)mm;最长径为38.0 mm,平均(124±9.1)mm;10个小冠状动脉瘤,7个中等冠状动脉瘤,13个为巨大瘤;14个圆形,16个梭形.累及左冠状动脉主干7个,前降支近段9个,前降支中段4个,回旋支2个;右冠状动脉近段6个,右冠状动脉中.段9个,右冠状动脉远段4个;其中9个肿瘤累及2个节段,1个累及3个节段.发现6处狭窄,5个瘤壁钙化,3个合并血栓.8个较小或位于中远段的冠状动脉瘤ECHO未能发现.结论 64层MSCT能清晰显示冠状动脉瘤和冠状动脉病变程度,可成为低龄川崎病冠状动脉瘤患儿随访和诊断的重要评估方法.     

Application of prospective ECG-triggered dual-source CT coronary angiography for infants and children with coronary artery aneurysms due to Kawasaki disease

Objectives

The aim of this study was to prospectively evaluate the initial application and value of prospective electrocardiogram (ECG)-triggered dual-source CT coronary angiography (DSCTCA) in the diagnosis of infants and children with coronary artery aneurysms due to Kawasaki disease.

Methods

19 children [12 males; mean age 13.47 months, range 3 months to 5 years; mean heart rate 112 beats per minute (bpm), range 83–141 bpm] underwent prospective ECG-triggered DSCTCA with free breathing. Subjective image quality was assessed on a five-point scale (1, excellent; 5, non-diagnostic) by two blinded observers. The location, number and size of each aneurysm were observed and compared with those of transthoracic echocardiography (TTE) performed within 1 week. Interobserver agreement concerning the subjective image quality was evaluated with Cohen''s κ-test. Bland–Altman analysis was used to evaluate the agreement on measurements (diameter and length of aneurysms) between DSCTCA and TTE. The average effective dose required for DSCTCA was calculated for all children.

Results

All interobserver agreement for subjective image quality assessment was excellent (κ=0.87). The mean±standard deviation (SD) aneurysm diameter with DSCTCA was 0.76±0.36 cm and with TTE was 0.76±0.39 cm. The mean±SD aneurysm length with DSCTCA was 2.06±1.35 cm and with TTE was 2.00±1.22 cm. The Bland–Altman plot for agreement between DSCTCA and TTE measurements showed good agreement. The mean effective dose was 0.36±0.06 mSv.

Conclusion

As an alternative diagnostic modality, prospective ECG-triggered DSCTCA with excellent image quality and low radiation exposure has been proved useful for diagnosing infants and children with coronary artery aneurysms due to Kawasaki disease.

Advances in knowledge

Prospective ECG–triggered DSCTCA for infants and children allows rapid, accurate assessment of coronary aneurysms due to Kawasaki diseases, compared with TTE.Kawasaki disease (KD), also known as mucocutaneous lymph node syndrome, is an autoimmune vasculitis in which the small and medium vessels throughout the body become inflamed [1,2]. It predominantly occurs in infants and children (younger than 5 years old). It affects many organ systems; injury, such as aneurysm, dilation, ectasia, stenosis and embolism, to the heart is rare but serious, and fatal myocardial infarction can be induced in untreated cases [3-6]. It is crucial to detect coronary artery lesions at an early stage [7]. Diagnosis of KD is based on clinical signs, symptoms and laboratory findings, but no specific laboratory test exists and it is hard to establish the diagnosis, especially in the early course [8].Recently, multidetector CT, especially the advent of dual-source CT, has provided improved spatial and temporal resolution; moreover, multiple techniques on dose reduction have been applied in children. Electrocardiogram (ECG)-gated scans, especially retrospective ECG-gated scans, have been used to evaluate coronary artery lesions in children with KD [2,9]. The high radiation dose required remains the main concern [10]; even though dose-saving methods including low tube potential, tube current modulation and body size-adapted CT protocols have been adopted, the effective radiation dose is still high at up to 2.17–3.14 mSv [11-13].Recently, prospective ECG-triggered scans were considered to be the most promising approach for dose reduction as they were used in the assessment of cardiovascular deformities in children with congenital heart disease [14-17]; however, no further studies have been reported on the application of prospective ECG-triggered CT angiography in children with KD.The aim of this study was to evaluate the initial application of prospective ECG-triggered dual-source CT coronary angiography (DSCTCA) in infants and children with coronary artery aneurysms due to KD.     

Coronary artery calcification detected with ultrafast CT as an indication of coronary artery disease.

To assess the relationship of coronary artery calcification to angiographically detectable disease, the authors evaluated 100 patients less than 60 years of age who underwent clinically indicated coronary angiography and ultrafast computed tomography (CT). The ultrafast CT technique consisted of 3-mm-thick contiguous sections and a 100-msec acquisition time. All patients with clinically significant disease at angiography (defined as at least one stenosis with a diameter narrowing of at least 50%) had some coronary artery calcification present at ultrafast CT (100% sensitivity in this population). The absence of calcification at ultrafast CT had a 100% negative predictive value for clinically significant coronary artery disease. Specificity and positive predictive value were 47% and 62%, respectively. Sensitivity and specificity of ultrafast CT in the detection of patients with angiographically detectable disease were 94% and 72%, respectively. Ultrafast CT of the heart is an anatomically based, noninvasive test with high sensitivity for the detection of coronary artery calcification. Ultrafast CT may be beneficial in the screening of selected populations for the presence of atherosclerotic coronary disease.     

Comparison of coronary artery measurements between echocardiograms and cardiac CT in Kawasaki disease patients with aneurysms

BackgroundAmerican Heart Association (AHA) guidelines for management of Kawasaki disease (KD) rely on coronary artery (CA) z-scores from echocardiograms. Compared with echocardiography, cardiac CT (CCT) offers better visualization of distal segments and evaluation for thrombosis and stenosis. Despite increasing use of CCT in KD, CA z-scores for CCT are not available and measurement concordance between imaging modalities is a critical knowledge gap.MethodsWe retrospectively reviewed KD patients with CA aneurysms who had concurrent echocardiography and CCT between 2016 and 2020. Patients were included if they had history of CA z-scores of ≥3 on echocardiography during their clinical course. Agreement between CCT and echocardiography was assessed using Bland-Altman analysis.ResultsPaired CCT and echocardiography studies were available in 18 patients (21 studies). The largest CA aneurysms were large/giant (z-score ≥10) in 14 studies, medium (z-score ≥5, <10) in 3 studies, and small (z score ≥2.5, <5) in 2 studies. Intra- and inter-observer reliability for CCT measurements were high for all CA segments (ICC 99.7% and 98.6%). For the LMCA, proximal LAD and proximal and distal RCA there was high correlation between echocardiogram and CCT absolute measurements with wider variation between modalities for the distal LAD and circumflex. Overall, CCT measurements tended to be smaller than echocardiogram measurements, and led to a lower AHA z-score risk classification in 24% of studies.ConclusionCCT and echocardiography have high agreement for absolute measurements of proximal CA segments, but more measurement discrepancy exists for distal CA segments with bias toward lower dimensions on CCT.     

Coronary artery to pulmonary artery fistulae with multiple aneurysms: radiological features on dual-source 64-slice CT angiography

Coronary artery fistula is a rare vascular anomaly in which there is abnormal communication between the coronary artery and the great vessels or cardiac chambers. We report the case of a 66-year-old man with two separate coronary artery to pulmonary artery fistulas (one of which demonstrated multiple aneurysms), which were diagnosed on dual-source 64-slice coronary CT and reconfirmed by coronary catheter angiography.     

Coronary artery noninvasive imaging in adult Kawasaki disease

Coronary artery aneurysms, stenoses, and thromboses are significant complications of Kawasaki disease (KD). While appearing in childhood, coronary complications are often left unrecognized until early and mid-adulthood. Along with the increasing capacity of noninvasive coronary artery imaging modalities, especially computed tomography and magnetic resonance, radiologists are more likely to face the diagnosis of KD in adults. This article will review the clinical aspects of KD for radiologists and will compare coronary imaging modalities in the diagnosis of KD.     

Obstructive sleep apnea: diagnosis with ultrafast CT

Patients with sleep-disordered breathing often have physiologic and anatomic abnormalities of the upper airway that are demonstrable while awake. An ultrafast computed tomographic (CT) scanner was used to measure the oropharyngeal and nasopharyngeal cross-sectional areas of 11 patients with obstructive sleep apnea. Twenty-four healthy volunteers served as control subjects. The percentage of change in cross-sectional area during quiet tidal breathing was used as a measure of airway compliance. Compared with weight-matched control subjects, patients with obstructive sleep apnea had smaller oropharyngeal airways (40.4 vs 177.8 mm2) (P less than .001) and smaller nasopharyngeal airways (31.3 vs 134.2 mm2) (P less than .001). In addition, their oropharyngeal airways were significantly more compliant (75% vs 27%) (P less than .001). Patients with obstructive sleep apnea are characterized by a small, collapsible oropharyngeal airway and by nasopharyngeal airway narrowing. These abnormalities can cause sleep-disordered breathing. Ultrafast CT scanning allows rapid, noninvasive assessment of airway variables.     

Giant coronary artery aneurysm secondary to Kawasaki disease: diagnosis in an adult by multi-detector row CT coronary angiography

We present the case of an adult female patient with a giant coronary artery aneurysm secondary to Kawasaki disease diagnosed for the first time, as far as the authors are aware, on multi-detector row computed tomography (MDCT). The long-term complications relate to the persistence of these aneurysms with giant coronary aneurysms having the lowest regression rate, the highest risk of stenosis and strongest association with myocardial infarction. MDCT coronary angiography represents an ideal, alternative non-invasive imaging modality for the diagnosis and follow-up of the coronary arterial complications of Kawasaki disease, thereby avoiding invasive coronary imaging, and its use in the management algorithm should be considered. We also aim to contribute to the expanding clinical role of MDCT coronary imaging.     

Evaluation of Kawasaki’s disease-associated coronary artery aneurysms with 3D CT cinematic rendering

Kawasaki’s disease (KD) is a vasculitis that predominantly affects children and can lead to the development of coronary artery aneurysms. These aneurysms can subsequently thrombose and occlude, which may lead to chest pain and other signs and symptoms of acute coronary syndrome in young patients. Coronary CT angiography, including 3D visualization techniques, is a common modality used in the follow-up of KD patients. In this series of three patients, we present the typical coronary artery imaging findings that can appear in these patients, with an emphasis on the use of the novel 3D technique of cinematic rendering (CR). CR utilizes a different lighting model than other 3D methods and is able to produce highly-detailed, photorealistic images. The potential advantages of CR images in understanding the complex mediastinal vascular anatomy and the relationships of coronary artery aneurysms to other anatomic structures are emphasized.     

Coronary artery disease and electron-beam CT.

Because its precision allows early detection of atherosclerotic processes in patients exhibiting no or few symptoms, electron-beam computed tomography (EBCT) will play an increasingly important role in the assessment of coronary artery disease (CAD). This article provides an introduction to CAD, traditional imaging approaches for its assessment, and the rationale and methods used in CAD-related EBCT imaging. The article also discusses the promise and limitations of using EBCT to detect, assess and monitor CAD, particularly in asymptomatic patients.     

Subdural hematomas due to ruptured cerebral aneurysms: angiographic diagnosis and potential pitfall for CT.

Two patients with subdural hematoma secondary to rupture of intracranial aneurysms are described. Computed tomography and plain skull films are generally the examination of choice for the patient with significant head trauma. In selected patients, however, cerebral angiography in place of, or along with, computed tomography may be necessary to demonstrate an underlying cause for the subdural hematoma.     

Non-invasive assessment of bleeding pulmonary artery aneurysms due to Behçet disease

Because of its ability to depict intravascular, intramural, and extramural pathology, non-invasive imaging is well suited to assessing life-threatening hemoptysis that may complicate Beh?et disease. We made exclusive use of CT angiography supplemented by MR to identify pulmonary thromboembolism, mediastinal lymphadenopathy, and bilateral pulmonary artery aneurysms with signs of previous unilateral rupture. Two-dimensional reformatted CT images provided surgeons with a road map of upstream and downstream vascular relationships prior to aneurysm resection. Imaging findings were confirmed by surgery and pathology. Non-invasive imaging proved to be a useful alternative to standard catheter arteriography in the preoperative assessment of hemoptysis in this patient with Beh?et disease. Received 2 April 1997; Revision received 20 June 1997; Accepted 1 September 1997     

冠状动脉瘘与巨大冠状动脉瘤的影像学诊断

小儿及青少年时期冠状动脉病变多表现为动脉瘤或动脉瘘．两者均有冠状动脉的异常扩张．但其血液动力学改变、临床表现及治疗措施明显不同。我们近年来收治冠状动脉瘘和巨大冠状动脉瘤患者共11例．现作一对比分析。     

双源CT冠状动脉成像的初步研究

目的初步探讨无需口服控制心率药物准备的双源CT冠状动脉成像的扫描技术和图像质量。方法对215例临床怀疑冠心病或冠状动脉早期病变患者进行无需口服控制心率药物准备的双源CT冠状动脉成像。扫描步骤包括平扫和增强扫描。用平扫图像行冠状动脉钙化积分，用增强扫描图像行多平面重组（MPR）、最大密度投影（MIP）及容积再现技术（VRT）重组。总结双源CT冠状动脉成像的扫描技术和后处理方法。将图像质量分为3级，按冠状动脉分段标准评价各个节段的图像质量。结果215例患者钙化积分值中位数为82．2（2．3～1827．9）。增强扫描平均心率为（80．6±15．3）（57～139）次／min，尽可能使冠状动脉良好显示的后处理方法有：（1）多个时相筛选法；（2）2个或多个时相补充法；（3）早搏去除法和心律不齐移位法。共评价3026个冠状动脉节段，其中图像质量为1级者占97．5％（2951／3026），2级者占2．0％（62／3026），为3级者占0．5％（13／3026）；图像质量为2级和3级的节段多由于呼吸伪影所致。215例患者共91例冠状动脉各节段均未见斑块或狭窄，共诊断〈50％冠状动脉狭窄节段112个，≥50％冠状动脉狭窄节段213个。结论双源CT冠状动脉成像在无需口服控制心率药物准备的情况下可获得非常好的冠状动脉各节段图像，心率不再是影响图像质量的关键因素，通过单时相或多时相重组可良好显示冠状动脉主干及分支。