128层螺旋CT冠状动脉成像在诊断川崎病冠脉损害及随访中的应用价值

Value of 128-slice CT Coronary Angiography in Diagnosis of Coronary Artery Injury and Follow-up in Children with Kawasaki Disease

目的：探讨128层螺旋CT冠脉成像技术（128MSCT）在诊断川崎病患儿冠状动脉损害及随访中的应用价值。方法回顾性分析30例川崎病患儿128MSCT及超声心动图（ECHO）检查结果。128MSCT在无屏气状态下进行扫描，扫描时心率为80-130次·min-1，平均（99±18）次·min-1。主要观察冠状动脉瘤的数目、部位、大小及形状。冠状动脉病变按左冠状动脉（LCA）主干、冠状动脉左前降支（LAD）、回旋支（LCX）和右冠状动脉（RCA）主干进行分析。结果急性期：30例川崎病患者中17例行128MSCT和ECHO冠状动脉检查均未见异常。128MSCT显示冠状动脉损害患者13例[病变累及冠状动脉起始处或近端6例，累及冠状动脉中段和（或）远端7例]；ECHO只显示冠状动脉起始处和近端的损害6例，ECHO诊断完全符合率为76．67％（23/30）。ECHO评估中远端冠脉病变有限；漏诊7例（LCA、RCA近、中、远端多处瘤样扩张3例，双侧远端冠状动脉增粗迂曲2例，LCA中端中度或LAD轻度狭窄2例）。恢复期：13例冠状动脉损害患者以128MSCT结果为对照，ECHO诊断完全符合率为61．54％（8/13），8例同期随访（1-6个月）128MSCT及ECHO均提示冠状动脉病变消失。漏诊5例（128MSCT提示RCA中、远端节段性瘤样扩张2例，LCA、RCA多发巨大瘤合并双侧冠脉瘤壁钙化1例，LCA中端或LAD狭窄各1例）。结论在较高心率、无屏气模式下，128MSCT有助于评价川崎病患儿冠状动脉病变全貌，能为川崎病合并冠状动脉损害患儿随访和诊断策略的制定提供更多信息。

Objective To investigate the value of 128-slice CT coronary angiography in the di-agnosis of coronary artery injury and follow-up in children with Kawasaki disease.Methods The findings on 128-slice CT coronary angiography and echocardiography of 30 children with Kawasa-ki disease were retrospectively analyzed.The 128-slice CT coronary angiography was performed without breath-holding.During scanning,the average heart rate was（99± 18）/minute（range 80/minute to 130/minute ）.The number,location,size and shape of coronary artery aneurysms were measured by echocardiography.Lesions of main left coronary artery（LCA）,left anterior descend-ing coronary artery（LAD）,left circumflex（LCX）and right coronary artery（RCA）were analyzed in all patients.Results Among the 30 children with Kawasaki disease,no coronary artery anoma-lies were found in acute phase in 17.The 128-slice CT coronary angiography showed coronary ar-tery injury in 13 children（lesions involving the initial or proximal portion of the coronary artery in 6,and involving the middle and/or distal portions of the coronary artery in 7）.Echocardiography was limited in the evaluation of lesions of middle and distal portions of the coronary artery.It only＆amp;nbsp;showed lesions of the initial and proximal portions of the coronary artery in 6 children.The diag-nostic coincidence rate of echocardiography was 76.67%（23/30）.The diagnosis was missed in 7 children,including aneurysmal dilatation of proximal,middle and distal LCA and RCA in 3,thick-ening and circumflex of bilateral distal coronary arteries in 2,and moderate LCA stenosis or mild LAD stenosis in 2.In the recovery phase,echocardiography showed coronary artery injury in 8 of the 13 children with coronary artery lesions diagnosed by 128-slice CT coronary angiography.The diagnostic coincidence rate was 61.54%.Both 128-slice CT coronary angiography and echocardio-graphy showed the disappearance of coronary artery lesions during following-up.Missed diagnosis occurred in 5 children,including segmental aneurysmal dilatation of middle and distal RCA in 2, multiple huge tumors complicated by bilateral aneurysm wall calcification in 1,middle LCA steno-sis in 1,and LAD stenosis in 1.Conclusion The 128-slice CT coronary angiography performed at higher heart rates without breath-holding helps to evaluate the panorama of coronary artery lesions in children with Kawasaki disease,and provides information for the development of follow-up and diagnostic strategies in children with Kawasaki disease complicated by coronary artery injury.