回顾性心电门控CT在儿童川崎病冠状动脉损伤评估中的应用

目的探讨回顾性心电门控冠状动脉CT血管造影(CCTA)评估川崎病(KD)患儿冠状动脉病变的可行性及成像技术,并与经胸超声心动图(TTE)对比研究。方法回顾性分析2014年1月—2018年7月经临床确诊的32例KD患儿资料男19例,女13例,年龄2个月～10岁,平均(3.89±3.19)岁],所有患儿均行回顾性心电门控CT及TTE检查,由2名影像科医师独立对CT成像质量、重组时相,冠状动脉病变的数目、位置、大小及危险性分级进行测量和观察,并与TTE结果对比研究;计算所有患儿接受的有效辐射剂量。对两种方法测得的数据进行配对t检验及χ~2检验,一致性分析采用Kappa检验。结果CCTA可评价冠状动脉节段比为93.8%(120/128),共观察到46个冠状动脉瘤、33支瘤样扩张及1支动脉壁钙化,其中7个动脉瘤、5支瘤样扩张及1支动脉壁钙化TTE检查时未发现。两种方法对左右冠状动脉主干直径的测量值及对各节段冠状动脉损伤检出的阳性率的差异均无统计学意义(P0.05)。冠状动脉最优化重组相位位于45%及75%～85%两个相位间。2名放射科医师对所有CCTA影像质量主观评分一致性好(κ=0.87),对KD危险度分级完全一致。32例患儿的有效辐射剂量为(3.22±1.57)mSv。结论回顾性心电门控CCTA检查可以在降低辐射剂量的基础上取得良好的成像效果,能够精确地观察冠状动脉的全程各段及病变程度,对儿童KD的评价及其危险分级具有重要的临床价值。

Application of retrospective ECG-gated CT angiography in evaluation of coronary artery lesions in children with Kawasaki disease

Objective To evaluate the feasibility and imaging techniques of the retrospective electrocardiogram gated coronary CT angiography (REG-CCTA) for assessing the coronary artery of children with Kawasaki disease (KD), and to compare this technique with the transthoracic echocardiography (TTE). Methods A retrospective analysis was performed on 32 cases with clinically diagnosed KD during January 2014 to July 2018 (19 males, 13 females, age range 2 months -10 years, mean age 3.89±3.19 years). All patients underwent a retrospective electrocardiographic CT scan and a transthoracic echocardiography (TTE). Two radiologists independently evaluated CT imaging quality, the recombination phase, and the number of coronary artery lesions, location, size and risk classification, and compared with TTE results. Effective radiation dose received by each child was calculated. The measurements obtained from the two methods were compared with paired t-test or χ2 test. Kappa test was used to test the consistency between the two raters. Results The ratio of coronary artery segment was 93.8% (120/128) on CCTA. Forty-six aneurysms and 33 tumor like dilatation were observed on CCTA, of which 7 aneurysms, 5 tumor like dilation and 1 artery wall calcified were not found on TTE. There was no significant difference in the left and right coronary artery diameters and the positive rate of coronary artery injury between the measures from REG-CCTA and TTE (P>0.05). The optimal phases of coronary artery reconstruction were at 45% and between 75% to 85%. The two radiologists had good consistency in all CCTA subjective image quality scores (κ=0.87), and the risk classification of KD was completely consistent. The effective radiation dose of 32 cases was 3.22±1.57 mSv. Conclusion REG-CCTA can achieve good imaging quality on the basis of reducing radiation dose, and can accurately observe the whole course?of coronary artery and lesion severity. REG-CCTA has important clinical value for the evaluation and risk classification of children’s KD.