【摘要】：目的探討64層CT冠狀動(dòng)脈成像檢查對(duì)兒童左側(cè)冠狀動(dòng)脈異常起源于肺動(dòng)脈(ALCAPA)的診斷價(jià)值。方法回顧性分析經(jīng)手術(shù)證實(shí)的12例ALCAPA患兒的64層CT冠狀動(dòng)脈成像資料,其中男4例,女8例;年齡1個(gè)月~9歲,中位年齡為7個(gè)月;體重5~28kg,中位體重為7kg。檢查前所有患兒均未控制心率,于藥物鎮(zhèn)靜狀態(tài)下應(yīng)用多層螺旋CT(MSCT)進(jìn)行冠狀動(dòng)脈掃描,掃描范圍自主動(dòng)脈弓頂至心尖。掃描參數(shù):采用回顧性心電門控,管電壓80kV,管電流100~130mA,層厚0.625mm,球管旋轉(zhuǎn)速度0.35s/轉(zhuǎn),螺距0.24。所有MSCT圖像均由復(fù)旦大學(xué)附屬兒科醫(yī)院2名具有5年以上心血管影像閱片經(jīng)驗(yàn)的放射科醫(yī)師在AW 4.3工作站進(jìn)行閱讀和評(píng)估。結(jié)果 12例患兒均經(jīng)64層CT冠狀動(dòng)脈成像檢查診斷為ALCAPA。檢查時(shí)患兒接受的射線劑量為1.62~2.15mSv,心率為100~150次/min,最佳重組時(shí)相窗在R-R間期的35%~50%。左側(cè)冠狀動(dòng)脈開(kāi)口位于肺動(dòng)脈左側(cè)壁、肺動(dòng)脈右側(cè)壁、肺動(dòng)脈左后竇、肺動(dòng)脈后壁各3例,右側(cè)冠狀動(dòng)脈開(kāi)口均位于主動(dòng)脈右冠竇;所有患兒均見(jiàn)左心室擴(kuò)大。經(jīng)手術(shù)證實(shí)為左側(cè)冠狀動(dòng)脈主干起源于肺動(dòng)脈,其中開(kāi)口位于肺動(dòng)脈左后竇3例,開(kāi)口位于肺動(dòng)脈竇遠(yuǎn)側(cè)的左側(cè)壁和右側(cè)壁各3例,開(kāi)口位于肺動(dòng)脈后壁3例;均見(jiàn)左心室擴(kuò)大。結(jié)論 64層CT冠狀動(dòng)脈成像檢查可在低輻射劑量條件下顯示冠狀動(dòng)脈的病理解剖信息,結(jié)合超聲心動(dòng)圖檢查可提高對(duì)ALCAPA的診斷準(zhǔn)確率。
[Abstract]:Objective to investigate the diagnostic value of 64-slice CT coronary angiography in children with anomalous origin of left coronary artery originated from pulmonary artery (ALCAPA). Methods the data of 64-slice CT coronary angiography in 12 children with ALCAPA confirmed by operation were retrospectively analyzed, including 4 males and 8 females, aged from 1 month to 9 years, with a median age of 7 months, and a mean weight of 7 kg with a body weight of 5 ~ 28 kg. Heart rate was not controlled in all the children before examination. Coronary artery was scanned by multislice spiral CT (MSCT) under drug sedation from the top of aortic arch to the apex of heart. Scanning parameters: retrospective ECG gating, tube voltage 80kV, tube current 100m 130mA, layer thickness 0.625mm, ball rotating speed 0.35s/ rotation, pitch 0.24. All MSCT images were read and evaluated at AW 4.3 workstation by two radiologists with more than 5 years experience in cardiovascular imaging reading in the Pediatrics Hospital affiliated to Fudan University. Results all 12 children were diagnosed as ALCAPA by 64-slice CT coronary angiography. The dose of radiation was 1.62V 2.15mSv, the heart rate was 100m / min, and the optimal time window was 35g / min at R-R interval. The left coronary artery was located in the left wall of the pulmonary artery, the right wall of the pulmonary artery, the left posterior sinus of the pulmonary artery, the posterior wall of the pulmonary artery in 3 cases, and the right coronary artery opening in the right coronary sinus of the aorta. It was proved that the main coronary artery originated from the pulmonary artery, in which the orifice was located in the left posterior sinus of the pulmonary artery in 3 cases, the opening in the left wall and the right wall in the distal side of the pulmonary artery in 3 cases, and the opening in the posterior wall of the pulmonary artery in 3 cases. Left ventricular dilatation was seen in all patients. Conclusion 64-slice CT coronary angiography can display the pathological and anatomical information of coronary artery at low radiation dose. Combined with echocardiography, the diagnostic accuracy of ALCAPA can be improved.
【作者單位】： 復(fù)旦大學(xué)附屬兒科醫(yī)院放射科;復(fù)旦大學(xué)附屬兒科醫(yī)院心血管中心;
【基金】：上海市衛(wèi)生和計(jì)劃生育委員會(huì)面上項(xiàng)目(201640070);上海市衛(wèi)生和計(jì)劃生育委員會(huì)青年項(xiàng)目(20164Y0224)資助
【分類號(hào)】：R725.4;R816.92

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