双源CT在先天性心脏病诊断中的价值
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摘要
先天性心脏(简称,先心病)是儿科的常见疾病,主要依靠手术治疗。先心病尤其是伴有多处心内、外结构畸形的复杂先心病,术前准确的的诊断对手术能成功至关重要。经胸壁超声心动图(transthoracic echocardiography,TTE)在显示心内畸形及瓣膜病变有较大优势,但其受声学窗的影像,对心外大血管的畸形显示欠佳。X线心血管造影(cardioangiography,CAG)是一种有创检查,操作复杂且受体位限制,由于心脏与大血管位置常常相互重叠,使得某些复杂心血管畸形难于明确诊断。多层螺旋CT(multi-slice spiral CT,MSCT)具有扫描速度快、扫描范围大、时间和空间分辨率高、方便快捷等优势,在心血管疾病的诊断中具有很大的价值和潜力。
双源CT(dual-source CT,DSCT)具有两套呈90°角X-ray球管和采集系统,时间分辨率达到83ms,可以满足任何心率的心脏成像,扫描时间更短、成像速度更快,必将给心血管疾病的诊断带来更广阔的前景。
目的本研究通过低剂量心电门控下使用双源CT对先心脏病患者进行心胸联合血管造影,探讨双源CT心胸联合血管成像在先心病诊断中的应用价值。
方法对51例经临床和TTE初诊为先心病,低剂量心电门控下行双源CT心胸联合血管成像。通过采用实时的心电图适应性剂量调控技术(ECG-Pulsing)、降低管电压和管电流来实现对患者的低剂量扫描。管电压、管电流采用个体化方案:＜1岁患儿:管电压80 kV,管电流50～60mAs;2～6岁的患儿:管电压100kV,管电流60～70mAs;7～12岁患儿:管电压120kV,管电流60～80mAs;13～18岁患儿:管电压120kV,管电流80～100mAs。对扫描参数、辐射剂量进行记录。所得原始图像全部传入后处理工作站,利用工作站进行多平面重组(MPR)、最大密度投影(MIP)以及容积再现(VR)等多种图像重组,所有图像由两位有经验的放射科医师共同进行分析并作出诊断。51例患者均行TTE检查,24例患者做X线心血管造影(CAG)检查,32例患者接受手术治疗。计算DSCT和TTE两种检查方法对心内、外畸形的诊断准确率,利用四格表资料的x~2检验比较二者差异是否具有统计学意义。
结果DSCT共发现心内外畸形结构177处,其中心脏内结构畸形共59处:房间隔缺损16处,室间隔缺损31处,单心房1处,三房心1处,单心室1处,右室双出口1处,右位心1处,瓣膜病变7处。
冠状动脉畸形12例:先天性冠状动脉瘘2例;左冠状动脉起源于主肺动脉2例;单一左冠状动脉1例;左冠状动脉主干闭塞,左冠前降支、回旋支与右冠状动脉形成侧枝循环2例;左冠回旋支与右冠状动脉主干共干起源于主动脉右窦的1例;左冠前降支与右冠共干起源于主动脉右窦的1例;左冠前降支与左冠回旋支各自起源于主动脉左窦的1例;单一右冠状动脉1例;右冠状动脉起源于主动脉左窦,而左冠状动脉起源于主动脉后窦1例;
肺血管畸形:肺动脉起源异常3处;肺动脉狭窄14处;肺动脉闭锁6处,伴有体肺大侧支血管12处;肺静脉异位引流7处。
心外大血管畸形:动脉导管未闭12处;主动脉骑跨15处;主动脉弓缩窄6处,主动脉弓离断6处,永存动脉干1处,大动脉转位1处,主—肺动脉间隔缺损1处,头臂血管起源变异4例,腔静脉异位引流3处,永存上腔静脉7处,右位主动脉弓7处。
经手术和/或CAG证实,51例患者共发现15种心脏畸形,共计182处畸形,其中心脏结构畸形分63处,心脏结构畸形119处。
DSCT诊断总的特异度、敏感度、准确度分别位100%、97.25%、97.25%。心内畸形共63处,DSCT和TTE对心内畸形的诊断准确率分别为93.65%、98.41%,二者的准确率差异无显著性意义(x~2=1.87,P＞0.10)。心外畸形共计119处,DSCT和TTE对心外畸形的诊断准确率分别为99.16%、67.23%,DSCT的诊断准确率明显高于TTE(x~2=43.40,P＜0.005)。DSCT和TTE联合诊断准确率可提高至99.45%。
辐射剂量统计结果:＜1岁患儿、平均CTDI_(vol)1.96±0.19mGy;2～6岁平均CTDI_(vol)5.01±0.71mGy;7～12岁平均CTDI_(vol)9.87±0.89mGy;13～18岁平均CTDI_(vol)12.11±1.56mGy。
结论低剂量心电门控下DSCT心胸联合血管成像对先天性心脏病有重要的诊断价值,尤其对冠状动脉、肺血管等心外血管畸形的诊断明显优于TTE,将DSCT和TTE相结合,可大大提高先心病的诊断准确率。采用个体化的扫描方案,能有效的降低患者所接受的辐射剂量。
BACKGROUND:
Congenital heart disease(CHD)is a common condition with a varying incidence of 4-6 cases per 1,000 live births for complex forms.Transthoracic echocardiography(TTE) remains a first-line imaging examination in patients with suspected CHD.This test has been considered the clinical gold standard,often eliminating the need for cardiac catheterization.However,it is limited by a small field of view,a variable acoustic window,inability to penetrate air and bone,and difficulty in delineating extracardiac vascular structures in their entirety.Angiography is an invasive modality that yields important hemodynamic data while clearly defining anatomy in vessels that are accessible to catheterization.However,angiography often gives only indirect information regarding venous connections and arterial anatomy distal to high-grade stenosis or atresia.It also uses high doses of ionizing radiation and is limited by the risks inherent to iodinated contrast material.Non-invasive coronary angiography using multi-slice computed tomography(CT)has recently emerged as an clinical tool for the accurate assessment of congental heart disease(CHD).
The recently introduced dual-source CT(DSCT)scanner is characterized by two x-ray tubes and two corresponding detectors mounted onto the rotating gantry with an angular offset of 90°.Regarding cardiac imaging capabilities,the new scanner system offers a high temporal resolution of 83 ms in a mono-segment reconstruction mode. Temporal resolution is independent of the heart rate,which is a major difference from single-source CT systems that rely on multi-segment reconstruction techniques.The first feasibility studies have shown promising results with DSCT coronary angiography regarding image quality of coronary arteries,cardiac valves,and left ventricular myocardium independent of the actual heart rate of the patient.
OBJECTIVE:
To explore the clinical value of low-dose ECG-gated dual-source CT(DSCT) angiography in the diagnosis of congenital heart disease.
METHODS:
Fifty-one patients with suspected congenital heart disease underwent both ECG-gated DSCT angiography and Transthoracic echocardiography(TTE).Twenty-four patients were imaged with cardioangiography(CAG)simultaneously.Surgical confirmation was available in thirty-two patients.Surgical and CAG findings was used the reference standard.
Individual scan parameters were used:For infants younger than 1 year,tube voltage and tube current were 80kV and 50～60mAs respectively;For children aged 2～6 years,100kV and 60～70mAs;For children aged 7～12 years,120kV and 60～80mAs;For children aged 13～18 years,120kV and 80～100mAs.ECG-triggered tube current modulation and full current at 70%of the cardiac cycle for heart rates below 70 beats per minute or full current between 30%and 80%for higher and arrhythmic heart rates.The pitch was adapted to the heart rate(mean 105 beats per minute),ranging from 0.25 to 0.59.Volume and flow rate of contrast material(Ultravist 370)were adapted to the patient's body weight.
Three-dimensional reconstruction were performed in all cases with multiplanar reformation(MPR)、maximum intensity projection(MIP),volume rendering(VR).The two radiologists and one pediatric cardiologist that interpreted the DSCT images and CAG,respectively,were blinded to each other's results.Surgical and CAG findings were compared to the DSCT results.Descriptive statistics were used to compare efficacy.
RESULTS:
Main coronary artery branches and partial sub-branches were visualized in all patients.12 patients were showed abnormal coronary artery.1 case was showed coronary artery-right and left ventricle fistula.1 case was showed coronary artery-left and fight atrium fistula.1 case was showed entirely right-sided coronary arterial system. 1 case was showed entirely left-sided coronary arterial system.2 case was showed LCA coming from pulmonary artery trunk.2 cases were showed left anterior descending (LAD)and right coronary artery(RCA)all coming of right aortic sinus.2 cases were showed RCA and circumflex(CX)coming of right aortic sinus.1 case was showed LAD and CX coming of left aortic sinus respectively.1 case was showed all coronary artery branches circuitous and dilated.
A total of 182 cardiac deformities confirmed by operations and several image methods were studied.The sensitivity,specificity,and accuracy of DSCT in detecting cardiac deformities 100%,97.25%,and 97.25%respectively.
There were 63 incardiac deformities.The definit of diagonosis of DSCT and TTE were 93.65%、98.41%,respectively.DSCT was as accurate as TTE in revealing incardiac deformities(x~2=1.87,P＞0.10).There were 119 extrocardiac deformities.The definit of diagonosis of DSCT and TTE were respectively 99.16%and 67.23%.DSCT was superior to TTE in the identification of extrocardiac deformities(x~2=43.40,P＜0.005). DSCT combined with TTE could increased the definite diagonosis rate to 99.45%.
Estimation of radiation dose:For infants＜1 year mean CTDI_(vol)was1.96±0.19mGy;For children aged 2～6 years mean CTDI_(vol)was5.01±0.71mGy;For children aged 7～12 years mean CTDI_(vol)was9.87±0.89mGy;For children aged 13～18 years mean CTDI_(vol)was 12.11±1.56mGy.
CONCLUSION:
ECG-gated DSCT angiography is superior to TTE in congenital heart disease diagnosis,especially in the diagnodsis of extrocardiac deformities.The combination of DSCT and TTE can raise the diagnosis accuracy rate of various kinds of congenital heart disease.ECG-gated DSCT angiography improves coronary visualization in babies, even when the heart rate is very high.
It is essential to use radiation dose reduction tools whenever possible. ECG-dependent dose modulation and individual adaptation are complementary and have an addictive effect on dose reduction.
双源CT(dual-source CT,DSCT)具有两套呈90°角X-ray球管和采集系统,时间分辨率达到83ms,可以满足任何心率的心脏成像,扫描时间更短、成像速度更快,必将给心血管疾病的诊断带来更广阔的前景。
目的本研究通过低剂量心电门控下使用双源CT对先心脏病患者进行心胸联合血管造影,探讨双源CT心胸联合血管成像在先心病诊断中的应用价值。
方法对51例经临床和TTE初诊为先心病,低剂量心电门控下行双源CT心胸联合血管成像。通过采用实时的心电图适应性剂量调控技术(ECG-Pulsing)、降低管电压和管电流来实现对患者的低剂量扫描。管电压、管电流采用个体化方案:＜1岁患儿:管电压80 kV,管电流50～60mAs;2～6岁的患儿:管电压100kV,管电流60～70mAs;7～12岁患儿:管电压120kV,管电流60～80mAs;13～18岁患儿:管电压120kV,管电流80～100mAs。对扫描参数、辐射剂量进行记录。所得原始图像全部传入后处理工作站,利用工作站进行多平面重组(MPR)、最大密度投影(MIP)以及容积再现(VR)等多种图像重组,所有图像由两位有经验的放射科医师共同进行分析并作出诊断。51例患者均行TTE检查,24例患者做X线心血管造影(CAG)检查,32例患者接受手术治疗。计算DSCT和TTE两种检查方法对心内、外畸形的诊断准确率,利用四格表资料的x~2检验比较二者差异是否具有统计学意义。
结果DSCT共发现心内外畸形结构177处,其中心脏内结构畸形共59处:房间隔缺损16处,室间隔缺损31处,单心房1处,三房心1处,单心室1处,右室双出口1处,右位心1处,瓣膜病变7处。
冠状动脉畸形12例:先天性冠状动脉瘘2例;左冠状动脉起源于主肺动脉2例;单一左冠状动脉1例;左冠状动脉主干闭塞,左冠前降支、回旋支与右冠状动脉形成侧枝循环2例;左冠回旋支与右冠状动脉主干共干起源于主动脉右窦的1例;左冠前降支与右冠共干起源于主动脉右窦的1例;左冠前降支与左冠回旋支各自起源于主动脉左窦的1例;单一右冠状动脉1例;右冠状动脉起源于主动脉左窦,而左冠状动脉起源于主动脉后窦1例;
肺血管畸形:肺动脉起源异常3处;肺动脉狭窄14处;肺动脉闭锁6处,伴有体肺大侧支血管12处;肺静脉异位引流7处。
心外大血管畸形:动脉导管未闭12处;主动脉骑跨15处;主动脉弓缩窄6处,主动脉弓离断6处,永存动脉干1处,大动脉转位1处,主—肺动脉间隔缺损1处,头臂血管起源变异4例,腔静脉异位引流3处,永存上腔静脉7处,右位主动脉弓7处。
经手术和/或CAG证实,51例患者共发现15种心脏畸形,共计182处畸形,其中心脏结构畸形分63处,心脏结构畸形119处。
DSCT诊断总的特异度、敏感度、准确度分别位100%、97.25%、97.25%。心内畸形共63处,DSCT和TTE对心内畸形的诊断准确率分别为93.65%、98.41%,二者的准确率差异无显著性意义(x~2=1.87,P＞0.10)。心外畸形共计119处,DSCT和TTE对心外畸形的诊断准确率分别为99.16%、67.23%,DSCT的诊断准确率明显高于TTE(x~2=43.40,P＜0.005)。DSCT和TTE联合诊断准确率可提高至99.45%。
辐射剂量统计结果:＜1岁患儿、平均CTDI_(vol)1.96±0.19mGy;2～6岁平均CTDI_(vol)5.01±0.71mGy;7～12岁平均CTDI_(vol)9.87±0.89mGy;13～18岁平均CTDI_(vol)12.11±1.56mGy。
结论低剂量心电门控下DSCT心胸联合血管成像对先天性心脏病有重要的诊断价值,尤其对冠状动脉、肺血管等心外血管畸形的诊断明显优于TTE,将DSCT和TTE相结合,可大大提高先心病的诊断准确率。采用个体化的扫描方案,能有效的降低患者所接受的辐射剂量。
BACKGROUND:
Congenital heart disease(CHD)is a common condition with a varying incidence of 4-6 cases per 1,000 live births for complex forms.Transthoracic echocardiography(TTE) remains a first-line imaging examination in patients with suspected CHD.This test has been considered the clinical gold standard,often eliminating the need for cardiac catheterization.However,it is limited by a small field of view,a variable acoustic window,inability to penetrate air and bone,and difficulty in delineating extracardiac vascular structures in their entirety.Angiography is an invasive modality that yields important hemodynamic data while clearly defining anatomy in vessels that are accessible to catheterization.However,angiography often gives only indirect information regarding venous connections and arterial anatomy distal to high-grade stenosis or atresia.It also uses high doses of ionizing radiation and is limited by the risks inherent to iodinated contrast material.Non-invasive coronary angiography using multi-slice computed tomography(CT)has recently emerged as an clinical tool for the accurate assessment of congental heart disease(CHD).
The recently introduced dual-source CT(DSCT)scanner is characterized by two x-ray tubes and two corresponding detectors mounted onto the rotating gantry with an angular offset of 90°.Regarding cardiac imaging capabilities,the new scanner system offers a high temporal resolution of 83 ms in a mono-segment reconstruction mode. Temporal resolution is independent of the heart rate,which is a major difference from single-source CT systems that rely on multi-segment reconstruction techniques.The first feasibility studies have shown promising results with DSCT coronary angiography regarding image quality of coronary arteries,cardiac valves,and left ventricular myocardium independent of the actual heart rate of the patient.
OBJECTIVE:
To explore the clinical value of low-dose ECG-gated dual-source CT(DSCT) angiography in the diagnosis of congenital heart disease.
METHODS:
Fifty-one patients with suspected congenital heart disease underwent both ECG-gated DSCT angiography and Transthoracic echocardiography(TTE).Twenty-four patients were imaged with cardioangiography(CAG)simultaneously.Surgical confirmation was available in thirty-two patients.Surgical and CAG findings was used the reference standard.
Individual scan parameters were used:For infants younger than 1 year,tube voltage and tube current were 80kV and 50～60mAs respectively;For children aged 2～6 years,100kV and 60～70mAs;For children aged 7～12 years,120kV and 60～80mAs;For children aged 13～18 years,120kV and 80～100mAs.ECG-triggered tube current modulation and full current at 70%of the cardiac cycle for heart rates below 70 beats per minute or full current between 30%and 80%for higher and arrhythmic heart rates.The pitch was adapted to the heart rate(mean 105 beats per minute),ranging from 0.25 to 0.59.Volume and flow rate of contrast material(Ultravist 370)were adapted to the patient's body weight.
Three-dimensional reconstruction were performed in all cases with multiplanar reformation(MPR)、maximum intensity projection(MIP),volume rendering(VR).The two radiologists and one pediatric cardiologist that interpreted the DSCT images and CAG,respectively,were blinded to each other's results.Surgical and CAG findings were compared to the DSCT results.Descriptive statistics were used to compare efficacy.
RESULTS:
Main coronary artery branches and partial sub-branches were visualized in all patients.12 patients were showed abnormal coronary artery.1 case was showed coronary artery-right and left ventricle fistula.1 case was showed coronary artery-left and fight atrium fistula.1 case was showed entirely right-sided coronary arterial system. 1 case was showed entirely left-sided coronary arterial system.2 case was showed LCA coming from pulmonary artery trunk.2 cases were showed left anterior descending (LAD)and right coronary artery(RCA)all coming of right aortic sinus.2 cases were showed RCA and circumflex(CX)coming of right aortic sinus.1 case was showed LAD and CX coming of left aortic sinus respectively.1 case was showed all coronary artery branches circuitous and dilated.
A total of 182 cardiac deformities confirmed by operations and several image methods were studied.The sensitivity,specificity,and accuracy of DSCT in detecting cardiac deformities 100%,97.25%,and 97.25%respectively.
There were 63 incardiac deformities.The definit of diagonosis of DSCT and TTE were 93.65%、98.41%,respectively.DSCT was as accurate as TTE in revealing incardiac deformities(x~2=1.87,P＞0.10).There were 119 extrocardiac deformities.The definit of diagonosis of DSCT and TTE were respectively 99.16%and 67.23%.DSCT was superior to TTE in the identification of extrocardiac deformities(x~2=43.40,P＜0.005). DSCT combined with TTE could increased the definite diagonosis rate to 99.45%.
Estimation of radiation dose:For infants＜1 year mean CTDI_(vol)was1.96±0.19mGy;For children aged 2～6 years mean CTDI_(vol)was5.01±0.71mGy;For children aged 7～12 years mean CTDI_(vol)was9.87±0.89mGy;For children aged 13～18 years mean CTDI_(vol)was 12.11±1.56mGy.
CONCLUSION:
ECG-gated DSCT angiography is superior to TTE in congenital heart disease diagnosis,especially in the diagnodsis of extrocardiac deformities.The combination of DSCT and TTE can raise the diagnosis accuracy rate of various kinds of congenital heart disease.ECG-gated DSCT angiography improves coronary visualization in babies, even when the heart rate is very high.
It is essential to use radiation dose reduction tools whenever possible. ECG-dependent dose modulation and individual adaptation are complementary and have an addictive effect on dose reduction.
引文
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19. Paul J.-F, Abada H. T. Strategies for reduction of radiation dose in cardiac Multislice CT. Eur Radiol, 2007,17(8):2028-2037.
20. Hohl C, Muhlenbrich G, Wildberger J. E, et al. Estimation of radiation exposure in Low dose Multislice CT tomography of the heart andcomparison with a calculation program. Eur Radiol, 2007,16:1841-1846.
21. Vork P.CT reduction dose in children. Eur Radiol, 2005, 15:2330-2040.
22.Hatenell GG.Developments in echocardiography[J].Radiol Clin North Am,1934,32:461-475.
23.陶子瑜,黄国英,林其珊,等。彩色多普勒超色心动图诊断先天性心脏的准确性及其对外科手术指导价值的研究[J]。Chin J Based Pediatr,2007,12(5):338-346.
24.Casdidy SC,Schmidt KG,Van Hare GH,et al.Complication of pediatric cardiae catheterization A-3 year study[J].Am Cardiol,1992,19:1285.
25.TonkinI L.Imaging of pediatric congenital heart disease[J].J Thorac Imaging,2000,15(4):274-279.
26.Lee JJ,Kang D.Feasibility of electron beam tomography in diagnosis of congenital heart disease:comparison with echocardiography[J].Eur J Radiol,2001,38(3):185-190.
27.Beier UH,Jelnin V,Jain S et al.Cardiac computed tomography compared to transthoracic echocardiography in the management of congenital heart disease[J].Catheter Cardiovasc Interv]2006 Sep;Vol.68(3),pp.441-9.
28.Crean.A Cardiovascular MR and CT in congenital heart disease[J].Heart 2007,93(12):1637-47.
29.Boxt LM.Magnetic resonance and computed tomographic evaluation of congenital heart disease[5].J Magn Reson Imaging,2004,19(6):827-47.
30.Samyn MM.A review of the complementary information available with ardiac magnetic resonance imaging and multi2slice computed tomography (CT)during the study of congenital heart disease.Inter J Cardiovas Imag,2004,20:569
31.黄国英.先天性心脏病无创影像学诊断.中国实用儿科学杂志,2002,17(2):72-74。
32.Westra SJ,Hill JA,Alejos JC,et al.Three-dimensional helical CT of pulmonary arteries in infants and children with congenital heart disease[J].AJR Am J Roentgenol,1999,173(1):109-15.
33.高云华.先天性心脏病的超声诊断方法及进展.临床超声医学杂志,2002,4:188
34.李江林,李渝芬,张智伟,等.多层螺旋CT和经胸二维超声心动图检查在先天性 心脏病诊断中的意义.中国实用儿科杂志,2005,20:300.
35.Haramati LB,Glickstein JS,Issenberg HJ,et al.MR imaging and CT of vascular anomalies and connections in patients with congenital heart dis2 ease:Significance in surgical planning.Radiographics,2002,22:337
36.郑敏文,孙立军,宦怡,等.先天性心脏病的电子束CT诊断.临床放射学杂志,2004,23:1048
37.黄尚飞.先天性心脏病影像学诊断及评价.中国煤炭工业医学杂志,2000,3:959.
38.Klingerbeck R,Schaller S,Fhlor T,et al Subsecond multislice comput2 ed tomography,basis and applications.Eur J Radiol,1999,31:110
39.Carrascosa PM,Capunay CM,Parodi J C,et al.General utilitiesof multislice tomography in the cardiac field.Herz,2003,28:44
40.周阳泱,韩萍,冯敢生.多层螺旋CT血管造影在小儿复杂先天性心脏病中的临床应用价值中华小儿外科杂志,2005,26:579
41.Westra SJ,Hill JA,Alejos JC,et al.Three-dimensional helical CT of pulmonary arteries in infants and children with congenital heart disease[J].AJR Am J Roentgenol,1999,173(1):109-15.
42.郝晶,李坤成.心脏的多层螺旋CT检查.中国医学影像技术,2002,18:601.
43.黄美萍,梁长虹,曾辉,等.多层螺旋CT在小儿复杂先天性心脏病诊断中的应中华放射学杂志,2004,38:726.
44.杨敏洁,夏黎明,江文涛,等.肺动脉闭锁伴室间隔缺损的多层螺旋CT诊断.放射学实践,2005,20:489.
45.黄美萍,梁长虹,曾辉,等.多层螺旋CT在小儿肺静脉畸形引流诊断中的价值.中华放射学杂志,2005,39:520.
46.Raman SV,Cook SC,McCarthy B,et al.Usefulness of multi-detector row computed tomography to quantify right ventricular size and function in adults with either tetralogy of Fallot or transposition of the great arteries.J Am Cardio,2005,95:683
47.Goo HW;Park IS;Ko JK,et al.Computed tomography for the diagnosis of congenital heart disease in pediatric and adult patients[J]. Int J Cardiovasc Imaging] 2005,21(2-3):347-65.
48. Ou P; Voisenet N; Billeau J, et al. Multislice CT scan in congenital heart diseased]. Arch Mal Coeur Vaiss, 2006,99(5):497-502.
49. Ou P, Celermajer DS, Calcagni G, et al. Three-dimensional CT scanning: a new diagnostic modality in congenital heart disease [J]. Heart, 2007, 93 (8): 908-13.
50. Bush S, Johnson T. R. C, Wintersperger B. J, et al. Quantitative assessment of left ventriculiar function with dual-source CT in comparision to cardiac magnetic resonance imaging :initial findings.Eur Radiol 2008 18(3): 570-575.
2. Kawano T, Ishii M, Takagi J, et al. Three-dimensional helical computed tomographic angiography in neonates and infants with complex congenital heart disease[J]. Am Heart J, 2000 Apr; Vol. 139 (4), pp. 654-60.
3. Gilkeson RC, Ciancibello L, Kenneth Z. Multi-detector CT evaluation of congentital heart disease in pediatric and adult patients[J]. Am Radio J, 2003, 180:973.
4. Kim TH, Kim YM, Suh CH, et al. Helical CT angiography and three dimensional reconstruction of total anomalous pulmonary venous connections in neonates and infants[J]. Am Radio J, 2000,175:1381.
5. Flohr TG, McCollough CH, Bruder H, et al. First performance evaluation of a dual-source CT (DSCT) system. Eur Radiol. 2006 Feb;16(2):256-68.
6. Johnson TR, Nikolaou K, Wintersperger BJ, et al. Dual-source CT cardiac imaging: initial experience. Eur Radiol, 2006, 16(7):1409-15.
7. Leschka S, Scheffel H, Desbiolles L, et al. Image quality and reconstruction intervals of dual-source CT coronary angiography: recommendations for ECG-pulsing windowing. Invest Radiol. 2007 ,42(8): 543-9.
8. Jakobs TF, Becker CR, Ohnesorge R, et al. Multislice Helical of the heart with resptrospective ECG gating:reduction of radiation exposure by ECG-controlled tube current modulation[J]. Eur Radiol. 2002,12(5) :1081-1086.
9. Scheffel H, Alkadhi H, Plass A, et al . Accuracy of dual-source CT coronary angiography: First experience in a high pre-test probability population without heart rate control. Eur Radiol, 2006, 16(12):2739-47.
10. Paul JF; Abada HT. Strategies for reduction of radiation dose in cardiac multislice CT[J]. Eur Radiol 2007 17 (8):2028-37.
11. Wang XM, Wu LB, Sun C et al. Clinical application of 64-slice spiral CT in the diagnosis of the Tetralogy of Fallot[J]. Eur J Radiol, 2007, 64(2): 296-301
12. Johnson TR, Nikolaou K, Busch S, et al. Diagnostic accuracy of dual-source computed tomography in the diagnosis of coronary artery diseased]. Invest Radiol, 2007, 42(10):684-91.
13. Ropers U, Ropers D, Pflederer T, et al. Influence of heart rate on the diagnostic accuracy of dual-source computed tomography coronary angiography. J Am Coll Cardiol, 2007, 50(25):2393-8.
14. Chen SJ; Lin MT; Lee WJ; Liu KL et ah Coronary artery anatomy in children with congenital heart disease by computed tomography [J]. Int J Cardiol 2007,120 (3): 363-70.
15. Haramati LB, Glickstein JS, Issenberg HJ, et al. MR imaging and CT of vascular anomalies and connections in patients with congenital heart disease: significance in surgical planning [J]. Radiographics, 2002, 22 (2): 337-47.
16. Leschka S, Oechslin E, Husmann L et al.. Pre- and postoperative evaluation of congenital heart disease in children and adults with 64-section CT[J]. Radiographics, 2007, 27(3):829-46
17. Mahnken AH, Bruder H, Suess C, et al. Dual-source computed tomography for assessing cardiac function: a phantom study [J]. Invest Radiol. 2007 Jul;42(7):491-8.
18. D'Agotion A. G, Rami-Jardin M, Khalil C, et al. Low dose ECG-gated 64-slices helical CT angiograph of the chest :evaluation image quality of 105 patients. Eur Radiol 2006 16(8):2137-2146.
19. Paul J.-F, Abada H. T. Strategies for reduction of radiation dose in cardiac Multislice CT. Eur Radiol, 2007,17(8):2028-2037.
20. Hohl C, Muhlenbrich G, Wildberger J. E, et al. Estimation of radiation exposure in Low dose Multislice CT tomography of the heart andcomparison with a calculation program. Eur Radiol, 2007,16:1841-1846.
21. Vork P.CT reduction dose in children. Eur Radiol, 2005, 15:2330-2040.
22.Hatenell GG.Developments in echocardiography[J].Radiol Clin North Am,1934,32:461-475.
23.陶子瑜,黄国英,林其珊,等。彩色多普勒超色心动图诊断先天性心脏的准确性及其对外科手术指导价值的研究[J]。Chin J Based Pediatr,2007,12(5):338-346.
24.Casdidy SC,Schmidt KG,Van Hare GH,et al.Complication of pediatric cardiae catheterization A-3 year study[J].Am Cardiol,1992,19:1285.
25.TonkinI L.Imaging of pediatric congenital heart disease[J].J Thorac Imaging,2000,15(4):274-279.
26.Lee JJ,Kang D.Feasibility of electron beam tomography in diagnosis of congenital heart disease:comparison with echocardiography[J].Eur J Radiol,2001,38(3):185-190.
27.Beier UH,Jelnin V,Jain S et al.Cardiac computed tomography compared to transthoracic echocardiography in the management of congenital heart disease[J].Catheter Cardiovasc Interv]2006 Sep;Vol.68(3),pp.441-9.
28.Crean.A Cardiovascular MR and CT in congenital heart disease[J].Heart 2007,93(12):1637-47.
29.Boxt LM.Magnetic resonance and computed tomographic evaluation of congenital heart disease[5].J Magn Reson Imaging,2004,19(6):827-47.
30.Samyn MM.A review of the complementary information available with ardiac magnetic resonance imaging and multi2slice computed tomography (CT)during the study of congenital heart disease.Inter J Cardiovas Imag,2004,20:569
31.黄国英.先天性心脏病无创影像学诊断.中国实用儿科学杂志,2002,17(2):72-74。
32.Westra SJ,Hill JA,Alejos JC,et al.Three-dimensional helical CT of pulmonary arteries in infants and children with congenital heart disease[J].AJR Am J Roentgenol,1999,173(1):109-15.
33.高云华.先天性心脏病的超声诊断方法及进展.临床超声医学杂志,2002,4:188
34.李江林,李渝芬,张智伟,等.多层螺旋CT和经胸二维超声心动图检查在先天性 心脏病诊断中的意义.中国实用儿科杂志,2005,20:300.
35.Haramati LB,Glickstein JS,Issenberg HJ,et al.MR imaging and CT of vascular anomalies and connections in patients with congenital heart dis2 ease:Significance in surgical planning.Radiographics,2002,22:337
36.郑敏文,孙立军,宦怡,等.先天性心脏病的电子束CT诊断.临床放射学杂志,2004,23:1048
37.黄尚飞.先天性心脏病影像学诊断及评价.中国煤炭工业医学杂志,2000,3:959.
38.Klingerbeck R,Schaller S,Fhlor T,et al Subsecond multislice comput2 ed tomography,basis and applications.Eur J Radiol,1999,31:110
39.Carrascosa PM,Capunay CM,Parodi J C,et al.General utilitiesof multislice tomography in the cardiac field.Herz,2003,28:44
40.周阳泱,韩萍,冯敢生.多层螺旋CT血管造影在小儿复杂先天性心脏病中的临床应用价值中华小儿外科杂志,2005,26:579
41.Westra SJ,Hill JA,Alejos JC,et al.Three-dimensional helical CT of pulmonary arteries in infants and children with congenital heart disease[J].AJR Am J Roentgenol,1999,173(1):109-15.
42.郝晶,李坤成.心脏的多层螺旋CT检查.中国医学影像技术,2002,18:601.
43.黄美萍,梁长虹,曾辉,等.多层螺旋CT在小儿复杂先天性心脏病诊断中的应中华放射学杂志,2004,38:726.
44.杨敏洁,夏黎明,江文涛,等.肺动脉闭锁伴室间隔缺损的多层螺旋CT诊断.放射学实践,2005,20:489.
45.黄美萍,梁长虹,曾辉,等.多层螺旋CT在小儿肺静脉畸形引流诊断中的价值.中华放射学杂志,2005,39:520.
46.Raman SV,Cook SC,McCarthy B,et al.Usefulness of multi-detector row computed tomography to quantify right ventricular size and function in adults with either tetralogy of Fallot or transposition of the great arteries.J Am Cardio,2005,95:683
47.Goo HW;Park IS;Ko JK,et al.Computed tomography for the diagnosis of congenital heart disease in pediatric and adult patients[J]. Int J Cardiovasc Imaging] 2005,21(2-3):347-65.
48. Ou P; Voisenet N; Billeau J, et al. Multislice CT scan in congenital heart diseased]. Arch Mal Coeur Vaiss, 2006,99(5):497-502.
49. Ou P, Celermajer DS, Calcagni G, et al. Three-dimensional CT scanning: a new diagnostic modality in congenital heart disease [J]. Heart, 2007, 93 (8): 908-13.
50. Bush S, Johnson T. R. C, Wintersperger B. J, et al. Quantitative assessment of left ventriculiar function with dual-source CT in comparision to cardiac magnetic resonance imaging :initial findings.Eur Radiol 2008 18(3): 570-575.