智能期相选择重组在高心率儿童冠状动脉CTA中的应用

The application of smart phase selective reconstruction in coronary CTA examinations for high heart rate children

目的评估智能期相(SP)选择重组技术用于高心率儿童冠状动脉CT血管成像(CCTA)的可行性及影像质量。方法收集2018年1月—4月拟诊为川崎病冠状动脉瘤或冠状动脉起源发育异常要求行CCTA检查的患儿28例(冠状动脉血管及其分支共420支),其中男13例,女15例,平均年龄(4.4±3.0)岁,平均心率(99.2±18.0)次/min。采用GE Revolution 256层宽体CT行CCTA检查,对扫描原始数据分别采用SP选择技术(SP组)和手动期相选择技术(MP组)对影像重组。重组影像由2位放射医师采用美国心脏协会推荐的冠状动脉15分段法进行评分,评分采用4分制。采用配对t检验比较MP组和SP组重组影像中冠状动脉及其分支的主观评分。2位评分者之间的一致性采用Kappa检验分析。结果 CCTA共显示386支冠状动脉血管及其分支,其中S10节段有15例患儿显示,S14节段有24例显示,S15节段有11例显示,其余血管节段在28例中全部显示。2位医师影像评分一致性中等(κ=0.62)。重组影像主观评分均满足诊断要求,其中MP组对S3、S9、S14段的评分高于SP组(P<0.05),其余各段评分差异无统计学意义(P>0.05)。28例患儿中SP与MP的重组期相诊断一致率为85.7%(24/28)。结论使用SP选择重组技术对高心率儿童行CCTA检查可以获得满足诊断的影像质量,同时可以节省时间提高工作效率。

Objective To evaluate the feasibility and image quality of smart phase（SP） selective reconstruction technique in high heart rate children coronary CTA（CCTA）. Methods Twenty-eight children（13 males and 15 females,mean age 4.4 ±3.0 years） who underwent CCTA and were diagnosed as Kawasaki disease coronary aneurysm or abnormal development of coronary origin from January to April 2018 were selected. A total of 420 coronary arteries and their branches were evaluated. The average heart rate was 99.2 ±18.0 bpm. All the CCTA examinations were performed on the GE-Revolution 256-detector row CT scanner. The original data were acquired using smart phase selection techniques（SP group）and manual phase selection（MP group） to reconstruct images. The image quality was scored into 4 categories by two physicians for each segmentation according to the American Heart Association recommended coronary artery 15 segmentation method. The subjective scores of the coronary arteries and their branches in the MP and SP groups were compared using the paired-sample t-test. Inter-observer agreement in subjective image quality assessment was evaluated by kappa statistics.Results A total of 386 coronary vessels and their branches were decipherable on CCTA. The S10 segment was decipherable in 15 patients, the S14 segment in 24 patients, and the S15 segment in 11 patients. The remaining vascular segments were all decipherable in 28 patients. The consistency of the image scores of the two radiologists was moderate（κ=0.62）. Subjective scores of both groups were satisfied the diagnostic requirement. The scores of the S3, S9, and S14 segments were higher in the MP group than in the SP group（P〈0.05）. The scores of the remaining segmentations were not statistically significant between the two groups（P〉0.05）. The diagnosis based on optimal cardiac phase in the SP group agreed with the diagnosis based on MP was same in in 24 of 28（85.7%） patients. Conclusion In high-rate children, SP selective reconstruction CCTA can be used to efficiently obtain the images that meets the diagnosis requirements.