| BackgroundThe congenital heart disease in infants and children has been a large proportionwhether Abroad or domestic. It is the most common in children who with heartdisease, heart disease, for a long time, the doctors used the ultrasonic to diagnosis theCHD and give the surgery guidance. because there is no radiation, the ultrasound isvery safety, the application of the ultrasonic is very common in young children’sheart disease examine,the ultrasound display the inside structure of the heart verywell, it can give the well diagnosis for the common ventricular septal defect as well asatrial septal defect. But for the complex congenital heart disease with peripheralvascular malformation, such as arteries transposition, pulmonary vein malformationsdrainage, arterial catheter was not closed and coronary artery anomalies, ultrasoundas a result of the limitation of the imaging principle, the development of theseabnormalities is restricted.with the development of medicine and the progress of examination methods, theradiation dose greatly reduced, it is no longer the limitation for children’s CTexamination.so cardiac CT examination is more and more applied in children, the advantages of high resolution, can be saved, visible repeatly,and can be read by manypeaple at the same time make it have great advantage in children’s blood vesselsexamination. especially for the cardiac peripheral vascular malformation. Althoughthe proportion of the coronary artery deformity is not so high, but it does a verynotable lesions, whether found or not in the children with combined coronary arterymalformation directly influence the outcome of the operation and the function of theheart.Because even if the surgery was successful, but coronary artery anomalies is notsolved, it can result in the emergence of postoperative cardiac problems.And, if thepreoperative coronary contorts was did not know, it is likely to lead to intraoperatieinjury of coronary artery, causing trouble for surgery.for the Congenital heart disease with preoperative examination, the detailedunderstanding of origin and contorts of the coronary artery is a very important project,both ultrasound and CT, the more detailed image information, the more help for thechoice of operation.The second generation dual-source CT makes the progress of thechildren cardiac CT examination.This study used the dual-source CT low-doseretrospective scanning mode, scored the coronary artery imaging of children withCHD. expect to find the best phase of the heart coronary artery imaging, for laterwhether use prospective or Flash scanning mode, can improve the quality of coronaryartery imaging, diagnostic accuracy on the basis of CT radiation dose reduced,improve the quality of the imaging information for clinical surgery.PurposeBy score the different phase of the coronary CTA,to explore the best phase of thecoronary CTA imaging and provide the accurate image data for congenital heartdisease surgery. And provide theoretical guidancea for the later patients to choose theCT examination method.The material methodRetrospective analysis the patients38cases during July,2012to December2013clinical suspicion for complex heart should have CTA for further understand the cardiovascular,and the38cases of patients with a median age of1.375years(1months to5years old), the average weight of9.47±2.55Kg (2.5Kg to15Kg),the average heart rate was122.79±20.04times/min (74-148times/min).choose theDual-source CT low-dose retrospective ECG-gated scaning mode, all childrenscaned under the quiet breathing, and can’t cooperator scaned after anesthesia.AdoptDSCT preset children’s heart scanning mode (Cardiac DS childern heart ECG), usedthe head to foot scanning sequence, the chest positioned firstly, the scope wasthoracic inlet to the liver, contrast medium adopt the optimal370mgI/ml, thehigh-pressure Stellant injector was applicated(Stellant dual flow), injected at a rate of0.4-2.0ml/s,5.0-30ml of contrast agent by the back of hand vein or scalp vein, then3-20ml saline solution was injected.we used the manual trigger scanning methods,monitored the level in the Tudor cavity, we decided the monitoring started timeaccording to the contrast infusion time(2s to start earlier than contrast infusion time)we started the scanning after the right heart completely filled contrast agents,3-6sscanning delay.Scan parameters:80KVP-100KVP tube voltage, electric current:80mAs.the original image willl be reconstructed by10%interval, the reconstructedthickness was0.6mm, and reconstructed interval was0.5mm, the reconstructionmethod was conventional B26. ten phases of the heart was analyzed in dual-sourcepost-processing workstation, which used the multi-plane reorganization, maximumdensity projection and curved surface reconstruction for3D reconstruction, and werecorded the DLP, through the radiation dose table to calculate the radiation dose ofinspection, two CT physicians evaluated quality of the coronary imaging, andrecorded the quality score. the evaluation of the coronary artery imaging used thethree points method, three points: the origin of the coronary and the relationshipbetween the pulmonary artery and the coronary can be clearly shown. The two points:the origin of the coronary and the relationship between pulmonary arteryand thecoronary can be shown, but not so clearly overally. The one point: the coronaryopenings could be clearly diagnosed, but the relationship between the pulmonaryartery was fuzzy.the0point, the openings and the relationship between pulmonaryarteries were all not judgment.Respectively on the left and right coronary artery imaging score of10when phase records, data recording the mean-variance said.And statistical analysis.ResultsLCA:5%phase average score was2.00±1.33points,15%phase average scorewas1.95±0.97points,25%phase average score was2.21±0.92points,35%phaseaverage score was2.21±0.92points,45%phase average score was2.11±0.94points,55%phase average score was1.84±1.21points,65%phase averagescore was1.58±1.01points,75%phase average score was1.79±1.23points,85%phase average score was2.32±1.06points,95%phase average score was2.32±0.89.the highest score of left coronary artery (LCA) was at95%, single factoranalysis of variance between two groups, the score of left coronary artery (LCA) hadstatistical significance difference between95%phase and65%(P=0.033), the meanscore of95%phase had no statistically significant difference with5%,5%,25%,35%,45%,55%,75%,85%(P value were:0.288,0.285,0.288,0.285,0.541,0.169,0.541,0.169). RCA:5%phase average score was1.53±1.17points,15%phaseaverage score was1.42±1.07points,25%phase average score was1.47±1.31points,35%phase average score was1.68±1.34points,45%phase average scorewas2.26±0.99points,55%phase average score was1.78±1.26points,65%phase average score was1.21±1.27points,75%phase average score was1.21±1.27points,85%phase average score was1.63±1.07points,95%phase averagescore was2.53±0.90.the highest score of the RCA was at95%, single factor analysisof variance between two groups,there was no statistical significance differencebetween95%phase score and45%score (P=0.489), but the95%phase score hadstatistically significant difference with the rest phses score.The left coronary artery had the highest average score in85%phase and95%phase, were2.32±1.06points,2.32±0.89points,, the right coronary artery had thehighest average score in95%phase was2.53±0.90points, followed by45%inaverage score was2.26±0.99points.Left coronary had lowest average score at65%,was1.58±1.01mm, right coronary had the lowest score in65%and75%, were1.21±1.27. for the left and right coronary used the single factor variance analysis group, there was no statistically significant difference in95%phase (F=0.705, P=0.705).Conclusion1. The dual-source CT low-dose retrospective ECG-gated scanning mode forpediatric heart coronary artery imaging, the best left coronary artery imagingappeared in95%phase, right coronary artery imaging best phase appeared in45%and95%.2. The findings in this study of best imaging coronary, has the theory guidancevalue for the future patients with abnormal coronary artery origin, contorts or fistula,whether select the prospective or Flash scanning technology. |
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