多层螺旋CT在小儿川崎病冠状动脉损害中的应用价值

目的评价多层螺旋CT（MSCT）在小儿川崎病冠状动脉损害中应用的可行性及价值。方法34例川崎病患儿进行16层或64层CT冠状动脉增强扫描，其中18例有同期二维超声心动图检查对照。计算各支冠状动脉的显示情况。观察病变形态，测量左、右冠状动脉主干的直径，计算2种方法的相关系数。结果除4例左旋支及8例右冠状动脉中段显示不清外，其余冠状动脉均可清楚显示。MSCT发现34例患者中，14例有冠状动脉损害，共22支冠状动脉受累。冠状动脉主干扩张6例，主干扩张伴动脉瘤形成3例，主干未扩张而中远段有动脉瘤形成2例，冠状动脉狭窄1例，钙化2例，串珠状改变3例。MSCT及二维超声在冠状动脉主干测量值上差异无统计学意义（P〉0．05），左、右冠状动脉主干测量值的相关系数分别为0．85、0．91（P〈0．05）。3例右冠状动脉中远段的动脉瘤及1例冠状动脉狭窄超声未发现。2例轻至中度二尖瓣反流及5例血管壁增厚MSCT未发现。结论MSCT用于探查小儿川崎病冠状动脉损害是可行的，可以作为心脏超声的补充和替代方法用于川崎病冠状动脉损害的诊断及随访。

Noninvasive detection of coronary abnormalities in pediatric patients with Kawasaki disease using multi-slice spiral CT

Objective To evaluate the feasibility and value of detecting coronary artery lesions in Kawasaki disease using multi-slice computed tomography(MSCT).Methods Thirty-four pediatric patients underwent 16-slice or 64-slice CT coronary angiography.18 patients were also examined with 2 dimension echocardiography(2DE).In all cases,visibility of coronary artery segment was recorded.The diameter of the LCA,RCA were measured in MSCTA and compared with 2DE.Correlation coefficient of dimension and coincidence rate of two methods were calculated.Results Coronary artery lesions were found in 14 patients (22 branches)of the 34 cases with KD on MSCT.Six cases were dialated,3 cases were dialated with aneurysms,2 cases had aneurysms without dialation.Coronary artery stenosis in 1 cases,calcification in 2 cases.Three cases had multiple aneurysms with the presence of alternate stenosis that made the artery a bead-like appearance.CC of LM and RCA were 0.85,0.91,respectively(P>0.05).Three coronary artery aneurysm in the distal RCA was missed by 2DE.MSCT could not detect slight or moderate mitral regurgitation in 2 patients and artery wall thickening in 5 patients.Conclusion MSCT would be an effective complementary or alternative method for CDEC to evaluate coronary artery lesions non-invasively in pediatric patients with Kawasaki disease.