64层螺旋CT对低龄儿童川崎病冠状动脉成像质量的探讨

The Evaluation of Coronary Angiography with 64 MDCT for Young Children with Coronary Artery Aneurysm Due to Kawasaki Disease

目的探讨64层螺旋CT对随访中低年龄儿童川崎病冠状动脉瘤的冠状动脉成像质量技术，并对图像进行评估分析。资料与方法应用64层螺旋CT对12例随访中川崎病冠状动脉瘤的男性儿童（平均年龄5．1岁，随访时间1．1～5．1年）进行回顾性心电门控技术冠状动脉成像，在无屏气状态下进行扫描，扫描时平均心率（74±12）次／min；采用“去条带状伪影”的心脏重组算法进行血管分析处理。由两名影像科医师独立对成像重组时相、每例患者的冠状动脉13个节段进行直径测量和图像质量评估，并观察冠状动脉瘤的数目、位置、形态和大小。结果共有114／156个节段能满足图像评价并进行直径测量，符合诊断要求率达到73％；两侧冠状动脉最佳显示相位窗集中在45％和75％-85％两个相位区间。MSCT共观察到30个冠状动脉瘤，其中8个较小或位于中远段的冠状动脉瘤超声心动图未能发现。结论在较高心率、无屏气扫描模式下，选择适当的对比剂剂量和流率、准确的扫描时间、合适的重组相位和有效心脏重组算法的64层螺旋CT冠状动脉成像技术，可以成为低年龄川崎病冠状动脉瘤患儿随访和诊断的重要评估方法。

Objective To discuss the techniques and assess the image quality of 64 muhidetector computed tomography in the follow up of young children with coronary artery aneurysm due to Kawasaki disease. Materials and Methods 12 boys （ mean age 5.1 years, range 1.8 to 7.8 years） for follow up （ time range from 1.1 to 5.1 years） of known Kawasaki disease and coronary artery aneurysm received 64 MDCT ECG gated coronary angiography. All data were acquired without breath holding. Heart rates were （74 ± 12） min （ range 53 -98/min） during scanning and reconstructed by using snapshot segment plus method. Two experienced pediatric radiologists independently assessed image quality and the diameter of all coronary segments for each patient. The number, position, shape and size of each coronary artery aneurysm were observed. Results A total of 114/156 segments permitted ＇visualization with diagnostic image quality, 73% successful visualization of the coronary artery with diagnostic image quality. 45% and 75% - 85% was the best heart circle in LCA and RCA. 30 coronary artery aneurysms were identified in this group. ECHO failed to detect 8 small aneurysms far end of of the coronary. Conclusion 64 slice VCT angiography scan technique With retrospective electrocardiogram gating without breath holding, best heart circle, as well as the heart image reconstruction with eliminating respiratory band motion artifacts technique is a diagnostic modality in the follow up of young children with coronary artery aneurysm due to Kawasaki disease.