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.

Value of 64-slice spiral CT angiography for follow-up of young children with coronary artery aneurysms due to Kawasaki disease

Objective To assess the value and feasibility of 64-slice spiral CT in diagnosis of coronary artery aneurysm in the follow-up of young children with previous Kawasaki disease. Methods Twelve boys (mean age 5.1 years) for follow-up (ranged 1.1 to 5.1 years) with known Kawasaki disease and coronary artery aneurysms underwent coronary CT angiography using 64-slice spiral CT.The number,location,shape and size of each coronary artery aneurysm were recorded and compared with those of echocardiography performed simutaneously. Results A total of 30 coronary artery aneurysms were identified with mean diameter of(7.5±3.8) mm,and mean maximum length of (12.4±9.1) mm.10 aneurysms were small in size,7 aneurysms were medium in size and 13 were giant aneurysms.Fourteen aneurysms were saccular,and the remaining 16 were fusiform. Among the aneurysms in left coronary artery,7 of them were located in the main branch,9 were located in the proximal segment of the anterior descending branch,4 were located at the middle segment of the anterior descending branch,and 2 were located in the circumflex branch.Among the aneurysms in right coronary artery,6 of them were located in the proximal segment,9 were located in the middle segment,and 4 were located at the distal segment.Nine of the aneurysms involved 2 segments of the coronary arteries,and one involved 3 segments.Six stenotic segments were found. Calcification was found in 5 aneurysms and 3 of them had thrombosis. Echocardiography failed to detect 8 aneurysms of small size and located in the middle or distal segments of the coronary arterys.Conclusion The 64-slice CT angiography proved valuable for monitoring young children with Kawasakidisease.