雙源CT前瞻性心電門控制劑量技術(shù)在小兒先天性心臟病中的臨床應(yīng)用
發(fā)布時(shí)間：2019-07-09 06:37
【摘要】：先天性心臟病(簡(jiǎn)稱先心病)是小兒常見的心臟病,術(shù)前準(zhǔn)確診斷和評(píng)估對(duì)患兒預(yù)后有重要意義。心血管造影(CAG)雖是先心病診斷的金標(biāo)準(zhǔn),但它有創(chuàng)、操作復(fù)雜、危險(xiǎn)性高且輻射劑量亦較高。經(jīng)胸超聲心動(dòng)圖(TTE)是先心病的首選診斷和隨訪方法,但其對(duì)大血管畸形的顯示欠佳,且受操作者經(jīng)驗(yàn)的影響較大。 多層螺旋CT (MSCT)和雙源CT (DSCT)對(duì)先心病患兒的異常解剖結(jié)構(gòu)顯示良好,但多采用回顧性心電門控技術(shù),輻射劑量較大。前瞻性心電門控(前門控)技術(shù)已應(yīng)用于成人冠狀動(dòng)脈檢查,成像質(zhì)量滿足診斷要求,而以輻射劑量低為突出優(yōu)點(diǎn),如能在小兒先心病中應(yīng)用,會(huì)有很大的臨床價(jià)值。 目的探討DSCT前門控低劑量技術(shù)在小兒先心病中的臨床應(yīng)用價(jià)值。 方法收集37例經(jīng)TTE擬診為先心病的患兒,行DSCT前門控低劑量技術(shù)掃描,采用固定觸發(fā)掃描技術(shù)。以四腔心同時(shí)顯影為標(biāo)志,手動(dòng)觸發(fā)延遲2s后開始掃描；參數(shù)設(shè)置：管電壓均為80kV,管電流根據(jù)患兒體重進(jìn)行調(diào)節(jié)。預(yù)設(shè)以40%為中心的32%～48%R-R間期為曝光時(shí)間窗。采用碘海醇350mg I/ml非離子型對(duì)比劑,注射量2.0ml/kg,接著以相同注射速率追加對(duì)比劑用量一半的生理鹽水。記錄其容積CT劑量指數(shù)(CTDIvol)和劑量長(zhǎng)度乘積(DLP),計(jì)算出有效輻射劑量(ED)。將最佳重建時(shí)相圖像數(shù)據(jù)傳送至后處理工作站(Leonardo),運(yùn)用用多平面重組(MPR)、最大密度投影(MIP)和容積再現(xiàn)(VR)等重組技術(shù)完成圖像處理。由2名放射科醫(yī)師獨(dú)立診斷并用5分法對(duì)圖像進(jìn)行質(zhì)量評(píng)估,對(duì)圖像質(zhì)量的評(píng)價(jià)符合程度采用Kappa檢驗(yàn)。以手術(shù)或CAG結(jié)果為標(biāo)準(zhǔn),分別計(jì)算DSCT前門控和TTE的診斷準(zhǔn)確率,通過χ2檢驗(yàn)比較DSCT前門控與TTE診斷結(jié)果的符合率,P0.05認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果37例患兒的平均有效輻射劑量是(0.39±0.14)mSv,最低0.195mSv,最高0.594mSv。圖像質(zhì)量評(píng)分為4.3±0.6,圖像均符合診斷要求；2名醫(yī)師的圖像質(zhì)量評(píng)價(jià)一致性好(Kw=0.832,P0.05)。37例患兒的手術(shù)或CAG共診斷血管異常與畸形91處：房間隔缺損14例,室間隔缺損16例,單心室1例,三尖瓣閉鎖2例,右室流出道狹窄5例,右室雙出口2例,房室連接異常1例,肺動(dòng)脈瓣狹窄1例,肺動(dòng)脈閉鎖3例,肺動(dòng)脈狹窄8例,動(dòng)脈導(dǎo)管未閉9例,肺動(dòng)脈擴(kuò)張8例,主動(dòng)脈騎跨6例,主動(dòng)脈縮窄7例,大動(dòng)脈轉(zhuǎn)位2例,迷走右鎖骨下動(dòng)脈1例,永存左上腔靜脈2例,冠狀動(dòng)脈異常起源3例,共診斷血管異常與畸形91處。DSCT前門控漏診房間隔缺損2例、室間隔缺損1例、房室連接異常1例,誤診房間隔缺損1例；TTE漏診肺動(dòng)脈狹窄2例、迷走右鎖骨下動(dòng)脈1例、冠狀動(dòng)脈異常起源3例,誤診主動(dòng)脈縮窄1例。DSCT前門控與TTE的診斷準(zhǔn)確率分別為99.2%、98.9%,差異無統(tǒng)計(jì)學(xué)意義(x2=0.335,P0.05)。 結(jié)論DSCT前瞻性心電門控低劑量技術(shù)不僅使先心病患兒的圖像滿足診斷要求,而且大幅度降低了輻射劑量,臨床應(yīng)用前景廣闊。
[Abstract]:Congenital heart disease (congenital heart disease) is a common heart disease in children. Accurate diagnosis and evaluation before operation is of great significance to the prognosis of children. Cardiovascular angiography (CAG) is the gold standard for the diagnosis of congenital heart disease, but it is invasive, complex operation, high risk and high radiation dose. Transthoracic echocardiography (TTE) is the first choice for the diagnosis and follow-up of congenital heart disease, but its display of macrovascular malformation is not good and is greatly affected by the operator's experience. Multi-slice spiral CT (MSCT) and double-source CT (DSCT) showed good abnormal anatomical structure in children with congenital heart disease, but most of them used retrospective ECG gating technique, and the radiation dose was large. Prospective ECG gating (Qianmen control) technique has been used in adult coronary artery examination, and the imaging quality meets the diagnostic requirements. Low radiation dose is the outstanding advantage, if it can be used in children with congenital heart disease, it will have great clinical value. Objective to evaluate the clinical value of DSCT Qianmen controlled low dose technique in children with congenital heart disease. Methods 37 children with congenital heart disease diagnosed by TTE were examined by DSCT Qianmen controlled low dose technique and fixed trigger scanning technique. Marked by the simultaneous development of the four-chamber center, the scanning began after the manual trigger delay of 2 s. The parameter setting: the tube voltage is 80 kV, and the tube current is adjusted according to the child's body weight. The default 32%~48%R-R interval centered on 40% is the exposure time window. 350mg I/ml Nonionic contrast agent was injected with 2.0 ml 路kg ~ (- 1), and then half of the dosage of normal saline was added at the same injection rate. The effective radiation dose (ED). Was calculated by recording the volume CT dose index (CTDIvol) and the dose length product (DLP),. The optimal reconstruction phase image data is transmitted to the post-processing workstation (Leonardo), by using multi-planar reconstruction (MPR), maximum density projection (MIP) and volume reproduction (VR) to complete the image processing. Two radiologists were diagnosed independently and the image quality was evaluated by 5-point method. Kappa test was used to evaluate the coincidence of the image quality. According to the results of operation or CAG, the diagnostic accuracy of DSCT front gate control and TTE were calculated respectively. the coincidence rate between DSCT front door control and TTE was compared by 蠂 2 test, and the difference was statistically significant (P 0.05). Results the average effective radiation dose of 37 children was (0.39 鹵0.14) mSv, the lowest was 0.195 mSvv, and the highest was 0.594 mSv. The image quality score was 4.3 鹵0.6, and the images all met the diagnostic requirements. The image quality evaluation of 2 doctors was consistent (Kw=0.832,P0.05). 91 vascular abnormalities and malformations were diagnosed by operation or CAG in 37 children: atrial septum defect (14 cases), ventricular septum defect (16 cases), single ventricle (1 case), tricuspid atresia (2 cases), right ventricular outflow tract stenosis (5 cases), right ventricular double outlet (2 cases), abnormal atrioventricular connection (1 case), pulmonary valve stenosis (1 case), pulmonary atresia (3 cases), pulmonary artery stenosis (8 cases). There were 9 cases of patent ductus arteriosus, 8 cases of pulmonary artery dilatation, 6 cases of aortic crossing, 7 cases of aortic coarctation, 2 cases of transposition of great artery, 1 case of vagus right subclavian artery, 2 cases of persistent left superior vena cava, 3 cases of abnormal origin of coronary artery, 91 cases of vascular abnormalities and malformations. There were 2 cases of atrial septum defect, 1 case of ventricular septum defect, 1 case of abnormal atrioventricular connection and 1 case of misdiagnosed atrial septum defect. There were 2 cases of pulmonary artery stenosis missed by TTE, 1 case of right subclavian artery vagus, 3 cases of abnormal origin of coronary artery and 1 case of misdiagnosed coarctation of aortic. The diagnostic accuracy of TTE was 99.2% and 98.9% respectively, the difference was not statistically significant (x2 鈮，
本文編號(hào)：2511937
[Abstract]:Congenital heart disease (congenital heart disease) is a common heart disease in children. Accurate diagnosis and evaluation before operation is of great significance to the prognosis of children. Cardiovascular angiography (CAG) is the gold standard for the diagnosis of congenital heart disease, but it is invasive, complex operation, high risk and high radiation dose. Transthoracic echocardiography (TTE) is the first choice for the diagnosis and follow-up of congenital heart disease, but its display of macrovascular malformation is not good and is greatly affected by the operator's experience. Multi-slice spiral CT (MSCT) and double-source CT (DSCT) showed good abnormal anatomical structure in children with congenital heart disease, but most of them used retrospective ECG gating technique, and the radiation dose was large. Prospective ECG gating (Qianmen control) technique has been used in adult coronary artery examination, and the imaging quality meets the diagnostic requirements. Low radiation dose is the outstanding advantage, if it can be used in children with congenital heart disease, it will have great clinical value. Objective to evaluate the clinical value of DSCT Qianmen controlled low dose technique in children with congenital heart disease. Methods 37 children with congenital heart disease diagnosed by TTE were examined by DSCT Qianmen controlled low dose technique and fixed trigger scanning technique. Marked by the simultaneous development of the four-chamber center, the scanning began after the manual trigger delay of 2 s. The parameter setting: the tube voltage is 80 kV, and the tube current is adjusted according to the child's body weight. The default 32%~48%R-R interval centered on 40% is the exposure time window. 350mg I/ml Nonionic contrast agent was injected with 2.0 ml 路kg ~ (- 1), and then half of the dosage of normal saline was added at the same injection rate. The effective radiation dose (ED). Was calculated by recording the volume CT dose index (CTDIvol) and the dose length product (DLP),. The optimal reconstruction phase image data is transmitted to the post-processing workstation (Leonardo), by using multi-planar reconstruction (MPR), maximum density projection (MIP) and volume reproduction (VR) to complete the image processing. Two radiologists were diagnosed independently and the image quality was evaluated by 5-point method. Kappa test was used to evaluate the coincidence of the image quality. According to the results of operation or CAG, the diagnostic accuracy of DSCT front gate control and TTE were calculated respectively. the coincidence rate between DSCT front door control and TTE was compared by 蠂 2 test, and the difference was statistically significant (P 0.05). Results the average effective radiation dose of 37 children was (0.39 鹵0.14) mSv, the lowest was 0.195 mSvv, and the highest was 0.594 mSv. The image quality score was 4.3 鹵0.6, and the images all met the diagnostic requirements. The image quality evaluation of 2 doctors was consistent (Kw=0.832,P0.05). 91 vascular abnormalities and malformations were diagnosed by operation or CAG in 37 children: atrial septum defect (14 cases), ventricular septum defect (16 cases), single ventricle (1 case), tricuspid atresia (2 cases), right ventricular outflow tract stenosis (5 cases), right ventricular double outlet (2 cases), abnormal atrioventricular connection (1 case), pulmonary valve stenosis (1 case), pulmonary atresia (3 cases), pulmonary artery stenosis (8 cases). There were 9 cases of patent ductus arteriosus, 8 cases of pulmonary artery dilatation, 6 cases of aortic crossing, 7 cases of aortic coarctation, 2 cases of transposition of great artery, 1 case of vagus right subclavian artery, 2 cases of persistent left superior vena cava, 3 cases of abnormal origin of coronary artery, 91 cases of vascular abnormalities and malformations. There were 2 cases of atrial septum defect, 1 case of ventricular septum defect, 1 case of abnormal atrioventricular connection and 1 case of misdiagnosed atrial septum defect. There were 2 cases of pulmonary artery stenosis missed by TTE, 1 case of right subclavian artery vagus, 3 cases of abnormal origin of coronary artery and 1 case of misdiagnosed coarctation of aortic. The diagnostic accuracy of TTE was 99.2% and 98.9% respectively, the difference was not statistically significant (x2 鈮，
本文編號(hào)：2511937
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