低剂量CT心血管造影对成人先心病诊断的价值

The clinical utility of Low-Dose and wide range restrospective ECG-gated cardiac CTA in adults with congenital heart disease

目的通过图像质量评价和诊断评价,探讨低剂量CT心脏大血管造影(CCTA)对成人先天性心脏病(CCHD)诊断的价值。方法 143位CCHD阳性患者和7位CCHD阴性患者采用MSCT进行低剂量CCTA检查。计算有效辐射剂量。对成像质量进行主、客观评价;以经胸超声(TTE)为对照,进行诊断评价。结果平均有效剂量为(5.95±0.28)mSv。图像信噪比(SNR)为11.31±2.92。CTA和TTE诊断心内畸形的准确度分别为90.4%,96.8%(P=0.152);诊断心外大血管连接畸形的准确度分别为94.1%,80.4%(P=0.022);诊断心外大血畸形的准确度分别为100%,68.7%(P=0.000)。结论低剂量心脏大血管造影的图像质量能够满足CCHD诊断的要求。

Objective To evaluate the feasibility and clinical utility of low-dose and wide range restrospective ECG-gated cardiac CTA in adults with congenital heart disease. Methods This prospective study included 150 adult patients who un- derwent low-dose and wide range restrospective ECG-gated cardiac CTA and transthoracic echocardiography （TTE）. The effective radiation dose was calculated and the imaging quality was assessed by quantitative measurements and subjective e- valuation. The diagnostic accuracy was calculated and compared based on surgery, thoracoscopic surgery,cardiac interven- tional procedure and/or conventional cardiac angiography. Results The calculated effective radiation dose was （5. 95± 0.28） mSv. The attenuation of pulmonary artery was （243.18±48.25） HU （≥200 HU in 84% of patients）. The attenu- ation of aortic artery was （263.93±71.51） HU （≥200HU in 89% of patients）. The calculated SNR （signal to noise ratio） and CNR （contrast to noise ratio） of cardiac cavity were 11.31±2.92, 8.26±2.68 respectively. The imaging quality of cardiac cavity was subjectively evaluated as excellent in 80.7% of patients. The diagnosable rate of each segment of coronary arteries was greater than or equal to 81%. The diagnostic accuracy of cardiac CTA and TTE in intra cardiac anomalies was 90.4% and 96.8%0 （ P =0. 152） respectively and in cardiac-arterial connection anomalies was 94.1% and 80.4% （ P = 0. 022） respectively and in extra cardiac anomalies was 100 % and 68.7 % （ P 〈 0. 000） respectively. Conclusion Wide range retrospective ECG--gated cardiac CTA can be performed using a low-dose protocol. The image quality has the ability to meet the requirements of morphological diagnosis in adult patients with congenital heart disease. Compared with TTE, the Cardiac CTA has unique advantages.