128层双源CT在小儿先天性心脏病诊断中的应用
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摘要
第一部分128层双源CT前瞻性心电门控序列扫描与大螺距扫描在小儿先天性心脏病诊断准确率、图像质量及辐射剂量的对比研究
目的：比较128层双源CT (dual-source CT,DSCT)前瞻性心电门控序列扫描与大螺距扫描对于小儿先天性心脏病的诊断准确率、图像质量和辐射剂量。
方法：前瞻性纳入可疑先天性心脏病患儿96例,最终入选92例。46例(男28例,女18例)行DSCT前瞻性心电门控序列扫描,46例(男27例,女19例)行DSCT前瞻性心电门控大螺距扫描。扫描参数：采用Z轴飞焦点技术,探测器准直2*64*0.6mm,层面采集厚度2*128*0.6mm,球管旋转时间0.28s,管电压80kV,根据患儿体重调节管电流：(5kg,60mAs;5-10kg,60-79mAs;)10kg,80-120mAs。序列扫描组：预设采集时间窗为40%-40%R-R间期。大螺距扫描组：螺距3.4,预设前瞻性触发起始时相10%R-R间期。70例患儿行手术治疗,22例患儿行传统心血管造影检查(conventional cardiac angiography, CCA)。以手术/CCA结果作为参考标准,计算序列扫描组及大螺距扫描组对心血管畸形的诊断灵敏度、特异度、阳性预测值、阴性预测值与诊断准确率。两名有5年以上心血管疾病影像诊断经验的放射科医师以5分法为标准、采用盲法对心内结构、心外大血管和冠状动脉近中段的图像质量进行主观评价。测量所有患儿升主动脉根部及肺动脉主干的CT值、噪声及信噪比。计算有效辐射剂量。比较两组的诊断准确率、图像质量和辐射剂量。
结果：92例患儿均成功完成DSCT前门控序列扫描及大螺距扫描。两组患儿的年龄(t=0.484,P>0.05)、体重(t=0.139,P>0.05)、心率(t=0.516,P>0.05)无统计学差异,大螺距扫描组的扫描时间较序列扫描组显著缩短(t=18.891,P<0.05)。以手术/CCA结果为参考标准,大螺距扫描组和序列扫描组分别发现134例和144例心血管畸形,两者诊断准确率分别为98.79%、99.53%,差别无统计学意义(X2=3.182,P>0.05)。大螺距扫描组和序列扫描组的诊断灵敏度、特异度、阳性预测值、阴性预测值分别为94.03%、99.71%、98.44%、98.86%和97.92%、99.78%、98.60%、99.67%。大螺距扫描组漏诊2例小房间隔缺损、1例小室间隔缺损、1例小动脉导管未闭,将1例肺动脉闭锁误诊为肺动脉重度狭窄。序列扫描组漏诊1例小房间隔缺损和1例动脉导管未闭,将1例肺动脉重度狭窄误诊为肺动脉闭锁。两组均将1例正常的房间隔误诊为小房间隔缺损。序列扫描组中的11例冠状动脉异常均诊断正确；而大螺距扫描组中的6例冠状动脉异常,CT诊断出3例。两名医师对心内结构、心外大血管和冠状动脉近中段图像质量评分的一致性优(K=0.81、0.85、0.85)。大螺距扫描组和序列扫描组在大血管的图像质量评分无统计学差异(u=981.000,P>0.05),序列扫描组对心内结构(u=594.500,P(0.05)和冠状动脉近中段(u=397.500,P(0.05)的显示优于大螺距扫描组。两组在升主动脉根部及肺动脉主干的CT值(t=1.272、0.745,P>0.05)、噪声(t=1.736、1.811,P>0.05)及信噪比(t=0.942、0.795,P>0.05)的差异无统计学意义。大螺距扫描组和序列扫描组的平均有效辐射剂量分别为0.27±0.11mSv、0.39±0.17mSv,两者有统计学差异(t=4.316,P<0.05),大螺距扫描组较序列扫描组有效剂量降低约31%。
结论：128层双源CT前瞻性心电门控序列扫描和大螺距扫描均能为小儿先天性心脏病的诊断提供诊断准确率较高的图像。与序列扫描相比,大螺距扫描虽然受心率的影响图像质量有所下降,但辐射剂量显著降低。
第二部分128层双源CT前瞻性心电门控大螺距扫描在小儿先天性心脏病心外大血管畸形诊断中的应用
目的：与经胸壁超声心动图(transthoracic echocardiography, TTE)对照,评价128层双源CT (dual-source CT, DSCT)前瞻性心电门控大螺距扫描在小儿先天性心脏病心外大血管畸形诊断中的价值。
方法：前瞻性收集临床已确诊为先天性心脏病、怀疑合并心外大血管畸形的80例患儿,最终入选75例。其中,男43例,女32例,平均年龄16.84±19.45月,平均体重9.02±4.61kg,平均心率119.73±15.10次/分。在常规TTE检查之后(时间间隔1～7天),75例患儿均成功完成DSCT前瞻性心电门控大螺距扫描,平均扫描时间为0.37±0.06s。DSCT扫描参数：探测器准直2*64*0.6mm,层面采集厚度2*128*0.6mm,球管旋转时间0.28s,管电压80kV,管电流根据患儿体重调节：<5kg,60mAs;5-10kg,60-79mAs;>10kg,80-120mAs。采用大螺距扫描模式,螺距为3.4,前瞻性触发起始时相为10%R-R间期。TTE检查采用SONOS7500多普勒超声诊断仪,常规经胸骨旁、心尖、剑突下及胸骨上窝等切面进行探查,方法包括M型及二维经胸壁超声心动图及彩色多普勒血流显像等。检查由一名有经验的心脏超声医师操作,图像及数据由一名经验丰富的小儿科医师与心脏超声医师共同评价。29例患儿行传统心血管造影检查(conventional cardiac angiography, CCA),46例患儿行手术治疗。以手术/CCA结果为标准,比较DSCT大螺距扫描与TTE的诊断准确率及检出率。两名有5年以上心血管疾病影像诊断经验的放射医师采用盲法、以5分法为评价标准对DSCT大螺距扫描的图像质量进行主观评价,并计算有效辐射剂量。
结果：经手术/CCA证实,75例患儿共17种先天性心脏病,162处独立的心外结构异常。DSCT大螺距扫描和TTE对心外大血管异常的诊断准确率分别为99.67%、97.89%,两者差别有统计学意义(X2=23.561, P <0.05)。DSCT大螺距扫描和TTE对心外大血管异常的检出率分别为97.53%、79.62%,两者差别有统计学意义(X2=28.013, P <0.05)。TTE漏诊2例部分型肺静脉异位引流、1例主动脉发育不良、2例主动脉缩窄、5处肺动脉狭窄、1例肺动脉异常扩张、4例肺动脉吊带、1例动脉导管未闭、8处主-肺动脉侧枝血管、1例永存左上腔静脉、3例冠状动脉异常。TTE将1例肺动脉闭锁误诊为共同动脉干,将2例一侧肺动脉缺如误诊为肺动脉吊带,将1例主动脉缩窄误诊为主动脉弓离断,将1处主-肺动脉侧枝血管误诊为动脉导管未闭。3例完全型肺静脉异位引流TTE虽诊断正确,但将其中1例混合型误诊为心脏型。DSCT大螺距扫描漏诊2例二叶式主动脉瓣、1例单支冠状动脉,将1例动脉韧带误诊为动脉导管未闭,将1例重度主肺动脉狭窄误诊为肺动脉闭锁。两名医师对DSCT大螺距扫描图像质量主观评价的一致性优(K=0.81),平均图像质量评分为4.1±0.7。DSCT大螺距扫描平均有效辐射剂量为0.29±0.088mSv。
结论：128层双源CT前瞻性心电门控大螺距扫描在小儿先天性心脏病心外大血管异常的诊断中较经胸壁超声心动图有明显优势,其诊断准确率及检出率均高于经胸壁超声心动图,且辐射剂量低。
Part I Accuracy, image quality and radiation dose comparison of prospective ECG-gated sequential and high-pitch acquisition on128-slice dual-source CT angiography in infants and children with congenital heart disease
Objective:To compare accuracy, image quality and radiation dose between prospective ECG-gated sequential and high-pitch acquisition on128-slice dual-source CT (DSCT) angiography in infantsandchildren with congenital heart disease (CHD).
Materials and Methods:Ninety-six children suspected with CHD were prospectively enrolled, and a total of92patients were finally included in this study. Forty-six patients (male28, female19) underwent DSCT angiography with sequential mode, and the other46patients (male27, female19)were examined withhigh-pitch mode. CT parameters were as follows:0.28s gantry rotation time,2x64x0.6mm detector collimation, a slice collimation2x128x0.6mm by z-flying focal spot technique,80kV tube voltage and weight adapted setting for tube current (60mAs/rotation for patients＜5kg body weight,60-79mAs/rotation for patients5-10kg body weight,80-120mAs/rotation for patients>10kg body weight). In the sequential group, the acquisition window was set at40%-40%of the R-R interval. In the high-pitch group, data acquisition was prospectively ECG-triggered starting at10%of the R-R interval using a pitch of3.4. Surgery was performed in70patients, and conventional cardiac angiography (CCA) was performed in22patients. With surgical and/or CCA results as the standard, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the diagnostic accuracy of the two groups for the cardiovascular abnormalities was evaluated. Blinded to the results of surgical and/or CCA findings, two cardiac radiologists with more than5years' experience interpreted the image quality of intracardiac structures, great vessels and the proximal and middle segments of coronary arteries using a5-grade scoring system.The CT attenuation, the noise and signal-to-noise ratio (SNR) in the ascending aorta and the pulmonary trunk were measured. The effective radiation dose was calculated. The diagnostic accuracy, the subjective and objective image quality and radiation doseof the two groups were compared.
Results:All92patients underwent successful DSCT angiography with either sequential or high-pitch acquisition. Patients of the two groups were adequately matched regarding to the age (t=0.484, P＞0.05), body weight (t=0.139, P＞0.05) and heart rate (t=0.516, P＞0.05). The mean scan time in high-pitch group was significantly lower (t=18.891, P＜0.05) than that in the sequential group. Using surgical and/or CCA findings as the reference standard, a total of134and144separate cardiovascular anomalies were confirmed in high-pitch group and sequential group, respectively. The diagnostic accuracy of high-pitch group and sequential group was98.79%and99.53%, respectively. There was no significant difference in the diagnostic accuracy between high-pitch group and sequential group (x2=3.182, P＞0.05). The sensitivity, specificity, PPV and NPV were94.03%,99.71%,98.44%and98.86%, respectively by high-pitch group, and97.92%,99.78%,98.60%and99.67%, respectively by sequential group. Two small atrial septal defects,1small ventricular septal defect and1small patent ductus arteriosus were not identified, and1pulmonary artery atresia was misdiagnosed as severe pulmonary artery stenosis in the high-pitch group. One small atrial septal defect and1patent ductus arteriosus were not identified, and1severe pulmonary artery stenosis was misdiagnosed as pulmonary artery atresia in the sequentialgroup. Both high-pitch and sequential CT data acquisitions misdiagnosed the normal atrial septum as1small atrial septal defect. Eleven cases of coronary artery anomalies were all identified in the sequential group. There were6cases of coronary artery anomalies in thehigh-pitch group, only3cases were identified. There was excellent agreement for the image quality scoring of the intracardiac structures (k=0.81), great vessels (k=0.85) and the proximal and middle coronary arteries (k=0.85) between the two observers. There was no significant difference in the image quality of extracardiac great vessels (u=981.000, P＞0.05) between the two groups. The image quality of intracardiac structures and coronary arteries was significantly better in theacquisition group than that in the high-pitch group (u=594.500and397.500, P＜0.05). There was no significant difference between the high-pitch group and the sequential group regarding to the CT attenuation (t=1.272and0.745, P＞0.05), the noise (t=1.736and1.811, P＞0.05) and the SNR (t=0.942and0.795, P＞0.05) in the ascending aorta and pulmonary trunk. The mean effective dose of the high-pitch group and the sequential group was0.27±0.11mSv and0.39±0.17mSv, respectively.There was significant difference in the mean effective dose (t=4.316, P<0.05) between the two groups. A decrease of31%dose reduction was shown in the high-pitch group.
Conclusion:Bothsequential and high-pitch mode for128-slice DSCT angiography provide high accuracy for the assessment of CHD in infantsandchildren, while the high-pitch mode, even with some image quality declined, further significantly lowers the radiation dose.
Part II Application of prospective ECG-gated high-pitch128-slicedual-source CT angiography in the diagnosis of congenital extracardiac vascular anomalies in infants and children
Objective:To investigate the value of prospective ECG-gated high-pitch128-slicedual-source CT (DSCT) angiography in the diagnosis of congenital extracardiac vascular anomalies ininfants and children in comparison with transthoracic echocardiography (TTE).
Materials and Methods:Eighty consecutive infants or children clinically diagnosed of congenital heart disease and suspected with extracardiac vascular anomaly were enrolled, and75patients were finally included in this prospective study. There were43males and32females. The mean age was16.84±19.45months, the mean body weight was9.02±4.61kg, and the mean heart rate was119.73±15.10bpm. All patients underwent prospective ECG-gated high-pitch DSCT angiography after TTE with an interval of1-7days. The mean scan time was0.37±0.06seconds. DSCT parameters were as follows:0.28s gantry rotation time,2x64x0.6mm detector collimation, a slice collimation2x128x0.6mm by z-flying focal spot technique,80kV tube voltage and weight adapted setting for tube current (60mAs/rotation for patients<5kg body weight,60-79mAs/rotation for patients5-10kg body weight,80-120mAs/rotation for patients＞10kg body weight). The high-pitch mode was used with a pitch of3.4and the prospectively ECG-triggered data acquisition starting at10%of the R-R interval. All patients underwent two-dimensional TTE and Doppler Flow from the parasternal, apical, subxiphoid and suprasternal approaches using a SONOS7500ultrasound system. The examinations were performed by an experienced echocardiographic technician, and the data were evaluated by a trained pediatrician and the echocardiographic technician. Conventional cardiac angiography (CCA) was performed in29patients, and surgery was performed in46patients. The diagnostic accuracy and sensitivity of high-pitchDSCT angiography and TTE were compared according to the surgical/CCA findings. The image quality of DSCT was independently assessed by two cardiac radiologists with more than5years'experience using a five-point scale. The effective radiation dose (ED) was calculated.
Results:A total of17congenital heart diseases and162separate extracardiac vascular anomalies were confirmed by surgical/CCA findings in75patients. The diagnostic accuracy of high-pitchDSCT angiography and TTE was99.67%and97.89%, respectively. The sensitivity of high-pitchDSCT angiography and TTE was97.53%and79.62%, respectively. There was significant difference regarding to the diagnostic accuracy and the sensitivity between high-pitchDSCT angiography and TTE (x2=23.561and28.013, P＜0.05). TTE failed to identify2partial anomalous pulmonary venous returns,1aortic dysplasia,2coarctations of the aorta,5pulmonary artery stenoses,1pulmonary artery dilation,4pulmonary slings,1patent ductus arteriosus,8 major aortopulmonary collateral arteries,1persistent left superior vena cava and3coronary artery anomalies. TTE misdiagnosed1case of pulmonary artery atresia as truncus arteriosus,2cases of absence of one pulmonary artery as pulmonary sling,1coarctation of the aort as interruption of the aortic arch and1major aortopulmonary collateral artery as patent ductus arteriosus. Although3total anomalous pulmonary venous returns were identified by TTE,1mixed type was misdiagnosed as cardiac type. Two bicuspid aortic valves and1single coronary artery were not identified by high-pitchDSCT angiography. High-pitchDSCT angiography misdiagnosed a normal arterial ligament as patent ductus arteriosus and a severe pulmonary artery stenosis as pulmonary artery atresia. The agreement on the image quality scoring of DSCTbetween the two observers was excellent (k=0.81), and the mean score of image quality was4.1±0.7. The mean ED of DSCT was0.29±0.08mSv.
Conclusion:Prospective ECG-gated high-pitch128-sliceDSCT angiography with low radiation dose and high diagnostic accuracy and sensitivity has an obvious advantage over TTE in the diagnosis of congenital extracardiac vascular anomalies in infants and children.
目的：比较128层双源CT (dual-source CT,DSCT)前瞻性心电门控序列扫描与大螺距扫描对于小儿先天性心脏病的诊断准确率、图像质量和辐射剂量。
方法：前瞻性纳入可疑先天性心脏病患儿96例,最终入选92例。46例(男28例,女18例)行DSCT前瞻性心电门控序列扫描,46例(男27例,女19例)行DSCT前瞻性心电门控大螺距扫描。扫描参数：采用Z轴飞焦点技术,探测器准直2*64*0.6mm,层面采集厚度2*128*0.6mm,球管旋转时间0.28s,管电压80kV,根据患儿体重调节管电流：(5kg,60mAs;5-10kg,60-79mAs;)10kg,80-120mAs。序列扫描组：预设采集时间窗为40%-40%R-R间期。大螺距扫描组：螺距3.4,预设前瞻性触发起始时相10%R-R间期。70例患儿行手术治疗,22例患儿行传统心血管造影检查(conventional cardiac angiography, CCA)。以手术/CCA结果作为参考标准,计算序列扫描组及大螺距扫描组对心血管畸形的诊断灵敏度、特异度、阳性预测值、阴性预测值与诊断准确率。两名有5年以上心血管疾病影像诊断经验的放射科医师以5分法为标准、采用盲法对心内结构、心外大血管和冠状动脉近中段的图像质量进行主观评价。测量所有患儿升主动脉根部及肺动脉主干的CT值、噪声及信噪比。计算有效辐射剂量。比较两组的诊断准确率、图像质量和辐射剂量。
结果：92例患儿均成功完成DSCT前门控序列扫描及大螺距扫描。两组患儿的年龄(t=0.484,P>0.05)、体重(t=0.139,P>0.05)、心率(t=0.516,P>0.05)无统计学差异,大螺距扫描组的扫描时间较序列扫描组显著缩短(t=18.891,P<0.05)。以手术/CCA结果为参考标准,大螺距扫描组和序列扫描组分别发现134例和144例心血管畸形,两者诊断准确率分别为98.79%、99.53%,差别无统计学意义(X2=3.182,P>0.05)。大螺距扫描组和序列扫描组的诊断灵敏度、特异度、阳性预测值、阴性预测值分别为94.03%、99.71%、98.44%、98.86%和97.92%、99.78%、98.60%、99.67%。大螺距扫描组漏诊2例小房间隔缺损、1例小室间隔缺损、1例小动脉导管未闭,将1例肺动脉闭锁误诊为肺动脉重度狭窄。序列扫描组漏诊1例小房间隔缺损和1例动脉导管未闭,将1例肺动脉重度狭窄误诊为肺动脉闭锁。两组均将1例正常的房间隔误诊为小房间隔缺损。序列扫描组中的11例冠状动脉异常均诊断正确；而大螺距扫描组中的6例冠状动脉异常,CT诊断出3例。两名医师对心内结构、心外大血管和冠状动脉近中段图像质量评分的一致性优(K=0.81、0.85、0.85)。大螺距扫描组和序列扫描组在大血管的图像质量评分无统计学差异(u=981.000,P>0.05),序列扫描组对心内结构(u=594.500,P(0.05)和冠状动脉近中段(u=397.500,P(0.05)的显示优于大螺距扫描组。两组在升主动脉根部及肺动脉主干的CT值(t=1.272、0.745,P>0.05)、噪声(t=1.736、1.811,P>0.05)及信噪比(t=0.942、0.795,P>0.05)的差异无统计学意义。大螺距扫描组和序列扫描组的平均有效辐射剂量分别为0.27±0.11mSv、0.39±0.17mSv,两者有统计学差异(t=4.316,P<0.05),大螺距扫描组较序列扫描组有效剂量降低约31%。
结论：128层双源CT前瞻性心电门控序列扫描和大螺距扫描均能为小儿先天性心脏病的诊断提供诊断准确率较高的图像。与序列扫描相比,大螺距扫描虽然受心率的影响图像质量有所下降,但辐射剂量显著降低。
第二部分128层双源CT前瞻性心电门控大螺距扫描在小儿先天性心脏病心外大血管畸形诊断中的应用
目的：与经胸壁超声心动图(transthoracic echocardiography, TTE)对照,评价128层双源CT (dual-source CT, DSCT)前瞻性心电门控大螺距扫描在小儿先天性心脏病心外大血管畸形诊断中的价值。
方法：前瞻性收集临床已确诊为先天性心脏病、怀疑合并心外大血管畸形的80例患儿,最终入选75例。其中,男43例,女32例,平均年龄16.84±19.45月,平均体重9.02±4.61kg,平均心率119.73±15.10次/分。在常规TTE检查之后(时间间隔1～7天),75例患儿均成功完成DSCT前瞻性心电门控大螺距扫描,平均扫描时间为0.37±0.06s。DSCT扫描参数：探测器准直2*64*0.6mm,层面采集厚度2*128*0.6mm,球管旋转时间0.28s,管电压80kV,管电流根据患儿体重调节：<5kg,60mAs;5-10kg,60-79mAs;>10kg,80-120mAs。采用大螺距扫描模式,螺距为3.4,前瞻性触发起始时相为10%R-R间期。TTE检查采用SONOS7500多普勒超声诊断仪,常规经胸骨旁、心尖、剑突下及胸骨上窝等切面进行探查,方法包括M型及二维经胸壁超声心动图及彩色多普勒血流显像等。检查由一名有经验的心脏超声医师操作,图像及数据由一名经验丰富的小儿科医师与心脏超声医师共同评价。29例患儿行传统心血管造影检查(conventional cardiac angiography, CCA),46例患儿行手术治疗。以手术/CCA结果为标准,比较DSCT大螺距扫描与TTE的诊断准确率及检出率。两名有5年以上心血管疾病影像诊断经验的放射医师采用盲法、以5分法为评价标准对DSCT大螺距扫描的图像质量进行主观评价,并计算有效辐射剂量。
结果：经手术/CCA证实,75例患儿共17种先天性心脏病,162处独立的心外结构异常。DSCT大螺距扫描和TTE对心外大血管异常的诊断准确率分别为99.67%、97.89%,两者差别有统计学意义(X2=23.561, P <0.05)。DSCT大螺距扫描和TTE对心外大血管异常的检出率分别为97.53%、79.62%,两者差别有统计学意义(X2=28.013, P <0.05)。TTE漏诊2例部分型肺静脉异位引流、1例主动脉发育不良、2例主动脉缩窄、5处肺动脉狭窄、1例肺动脉异常扩张、4例肺动脉吊带、1例动脉导管未闭、8处主-肺动脉侧枝血管、1例永存左上腔静脉、3例冠状动脉异常。TTE将1例肺动脉闭锁误诊为共同动脉干,将2例一侧肺动脉缺如误诊为肺动脉吊带,将1例主动脉缩窄误诊为主动脉弓离断,将1处主-肺动脉侧枝血管误诊为动脉导管未闭。3例完全型肺静脉异位引流TTE虽诊断正确,但将其中1例混合型误诊为心脏型。DSCT大螺距扫描漏诊2例二叶式主动脉瓣、1例单支冠状动脉,将1例动脉韧带误诊为动脉导管未闭,将1例重度主肺动脉狭窄误诊为肺动脉闭锁。两名医师对DSCT大螺距扫描图像质量主观评价的一致性优(K=0.81),平均图像质量评分为4.1±0.7。DSCT大螺距扫描平均有效辐射剂量为0.29±0.088mSv。
结论：128层双源CT前瞻性心电门控大螺距扫描在小儿先天性心脏病心外大血管异常的诊断中较经胸壁超声心动图有明显优势,其诊断准确率及检出率均高于经胸壁超声心动图,且辐射剂量低。
Part I Accuracy, image quality and radiation dose comparison of prospective ECG-gated sequential and high-pitch acquisition on128-slice dual-source CT angiography in infants and children with congenital heart disease
Objective:To compare accuracy, image quality and radiation dose between prospective ECG-gated sequential and high-pitch acquisition on128-slice dual-source CT (DSCT) angiography in infantsandchildren with congenital heart disease (CHD).
Materials and Methods:Ninety-six children suspected with CHD were prospectively enrolled, and a total of92patients were finally included in this study. Forty-six patients (male28, female19) underwent DSCT angiography with sequential mode, and the other46patients (male27, female19)were examined withhigh-pitch mode. CT parameters were as follows:0.28s gantry rotation time,2x64x0.6mm detector collimation, a slice collimation2x128x0.6mm by z-flying focal spot technique,80kV tube voltage and weight adapted setting for tube current (60mAs/rotation for patients＜5kg body weight,60-79mAs/rotation for patients5-10kg body weight,80-120mAs/rotation for patients>10kg body weight). In the sequential group, the acquisition window was set at40%-40%of the R-R interval. In the high-pitch group, data acquisition was prospectively ECG-triggered starting at10%of the R-R interval using a pitch of3.4. Surgery was performed in70patients, and conventional cardiac angiography (CCA) was performed in22patients. With surgical and/or CCA results as the standard, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the diagnostic accuracy of the two groups for the cardiovascular abnormalities was evaluated. Blinded to the results of surgical and/or CCA findings, two cardiac radiologists with more than5years' experience interpreted the image quality of intracardiac structures, great vessels and the proximal and middle segments of coronary arteries using a5-grade scoring system.The CT attenuation, the noise and signal-to-noise ratio (SNR) in the ascending aorta and the pulmonary trunk were measured. The effective radiation dose was calculated. The diagnostic accuracy, the subjective and objective image quality and radiation doseof the two groups were compared.
Results:All92patients underwent successful DSCT angiography with either sequential or high-pitch acquisition. Patients of the two groups were adequately matched regarding to the age (t=0.484, P＞0.05), body weight (t=0.139, P＞0.05) and heart rate (t=0.516, P＞0.05). The mean scan time in high-pitch group was significantly lower (t=18.891, P＜0.05) than that in the sequential group. Using surgical and/or CCA findings as the reference standard, a total of134and144separate cardiovascular anomalies were confirmed in high-pitch group and sequential group, respectively. The diagnostic accuracy of high-pitch group and sequential group was98.79%and99.53%, respectively. There was no significant difference in the diagnostic accuracy between high-pitch group and sequential group (x2=3.182, P＞0.05). The sensitivity, specificity, PPV and NPV were94.03%,99.71%,98.44%and98.86%, respectively by high-pitch group, and97.92%,99.78%,98.60%and99.67%, respectively by sequential group. Two small atrial septal defects,1small ventricular septal defect and1small patent ductus arteriosus were not identified, and1pulmonary artery atresia was misdiagnosed as severe pulmonary artery stenosis in the high-pitch group. One small atrial septal defect and1patent ductus arteriosus were not identified, and1severe pulmonary artery stenosis was misdiagnosed as pulmonary artery atresia in the sequentialgroup. Both high-pitch and sequential CT data acquisitions misdiagnosed the normal atrial septum as1small atrial septal defect. Eleven cases of coronary artery anomalies were all identified in the sequential group. There were6cases of coronary artery anomalies in thehigh-pitch group, only3cases were identified. There was excellent agreement for the image quality scoring of the intracardiac structures (k=0.81), great vessels (k=0.85) and the proximal and middle coronary arteries (k=0.85) between the two observers. There was no significant difference in the image quality of extracardiac great vessels (u=981.000, P＞0.05) between the two groups. The image quality of intracardiac structures and coronary arteries was significantly better in theacquisition group than that in the high-pitch group (u=594.500and397.500, P＜0.05). There was no significant difference between the high-pitch group and the sequential group regarding to the CT attenuation (t=1.272and0.745, P＞0.05), the noise (t=1.736and1.811, P＞0.05) and the SNR (t=0.942and0.795, P＞0.05) in the ascending aorta and pulmonary trunk. The mean effective dose of the high-pitch group and the sequential group was0.27±0.11mSv and0.39±0.17mSv, respectively.There was significant difference in the mean effective dose (t=4.316, P<0.05) between the two groups. A decrease of31%dose reduction was shown in the high-pitch group.
Conclusion:Bothsequential and high-pitch mode for128-slice DSCT angiography provide high accuracy for the assessment of CHD in infantsandchildren, while the high-pitch mode, even with some image quality declined, further significantly lowers the radiation dose.
Part II Application of prospective ECG-gated high-pitch128-slicedual-source CT angiography in the diagnosis of congenital extracardiac vascular anomalies in infants and children
Objective:To investigate the value of prospective ECG-gated high-pitch128-slicedual-source CT (DSCT) angiography in the diagnosis of congenital extracardiac vascular anomalies ininfants and children in comparison with transthoracic echocardiography (TTE).
Materials and Methods:Eighty consecutive infants or children clinically diagnosed of congenital heart disease and suspected with extracardiac vascular anomaly were enrolled, and75patients were finally included in this prospective study. There were43males and32females. The mean age was16.84±19.45months, the mean body weight was9.02±4.61kg, and the mean heart rate was119.73±15.10bpm. All patients underwent prospective ECG-gated high-pitch DSCT angiography after TTE with an interval of1-7days. The mean scan time was0.37±0.06seconds. DSCT parameters were as follows:0.28s gantry rotation time,2x64x0.6mm detector collimation, a slice collimation2x128x0.6mm by z-flying focal spot technique,80kV tube voltage and weight adapted setting for tube current (60mAs/rotation for patients<5kg body weight,60-79mAs/rotation for patients5-10kg body weight,80-120mAs/rotation for patients＞10kg body weight). The high-pitch mode was used with a pitch of3.4and the prospectively ECG-triggered data acquisition starting at10%of the R-R interval. All patients underwent two-dimensional TTE and Doppler Flow from the parasternal, apical, subxiphoid and suprasternal approaches using a SONOS7500ultrasound system. The examinations were performed by an experienced echocardiographic technician, and the data were evaluated by a trained pediatrician and the echocardiographic technician. Conventional cardiac angiography (CCA) was performed in29patients, and surgery was performed in46patients. The diagnostic accuracy and sensitivity of high-pitchDSCT angiography and TTE were compared according to the surgical/CCA findings. The image quality of DSCT was independently assessed by two cardiac radiologists with more than5years'experience using a five-point scale. The effective radiation dose (ED) was calculated.
Results:A total of17congenital heart diseases and162separate extracardiac vascular anomalies were confirmed by surgical/CCA findings in75patients. The diagnostic accuracy of high-pitchDSCT angiography and TTE was99.67%and97.89%, respectively. The sensitivity of high-pitchDSCT angiography and TTE was97.53%and79.62%, respectively. There was significant difference regarding to the diagnostic accuracy and the sensitivity between high-pitchDSCT angiography and TTE (x2=23.561and28.013, P＜0.05). TTE failed to identify2partial anomalous pulmonary venous returns,1aortic dysplasia,2coarctations of the aorta,5pulmonary artery stenoses,1pulmonary artery dilation,4pulmonary slings,1patent ductus arteriosus,8 major aortopulmonary collateral arteries,1persistent left superior vena cava and3coronary artery anomalies. TTE misdiagnosed1case of pulmonary artery atresia as truncus arteriosus,2cases of absence of one pulmonary artery as pulmonary sling,1coarctation of the aort as interruption of the aortic arch and1major aortopulmonary collateral artery as patent ductus arteriosus. Although3total anomalous pulmonary venous returns were identified by TTE,1mixed type was misdiagnosed as cardiac type. Two bicuspid aortic valves and1single coronary artery were not identified by high-pitchDSCT angiography. High-pitchDSCT angiography misdiagnosed a normal arterial ligament as patent ductus arteriosus and a severe pulmonary artery stenosis as pulmonary artery atresia. The agreement on the image quality scoring of DSCTbetween the two observers was excellent (k=0.81), and the mean score of image quality was4.1±0.7. The mean ED of DSCT was0.29±0.08mSv.
Conclusion:Prospective ECG-gated high-pitch128-sliceDSCT angiography with low radiation dose and high diagnostic accuracy and sensitivity has an obvious advantage over TTE in the diagnosis of congenital extracardiac vascular anomalies in infants and children.
引文
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