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目的评价多层螺旋 CT(MSCT)在小儿川崎病冠状动脉损害中应用的可行性及价值。方法 34例川崎病患儿进行16层或64层 CT 冠状动脉增强扫描,其中18例有同期二维超声心动图检查对照。计算各支冠状动脉的显示情况。观察病变形态,测量左、右冠状动脉主干的直径,计算2种方法的相关系数。结果除4例左旋支及8例右冠状动脉中段显示不清外,其余冠状动脉均可清楚显示。MSCT 发现34例患者中,14例有冠状动脉损害,共22支冠状动脉受累。冠状动脉主干扩张6例,主干扩张伴动脉瘤形成3例,主干未扩张而中远段有动脉瘤形成2例,冠状动脉狭窄1例,钙化2例,串珠状改变3例。MSCT 及二维超声在冠状动脉主干测量值上差异无统计学意义(P>0.05),左、右冠状动脉主干测量值的相关系数分别为0.85、0.91(P<0.05)。3例右冠状动脉中远段的动脉瘤及1例冠状动脉狭窄超声未发现。2例轻至中度二尖瓣反流及5例血管壁增厚 MSCT 未发现。结论 MSCT 用于探查小儿川崎病冠状动脉损害是可行的,可以作为心脏超声的补充和替代方法用于川崎病冠状动脉损害的诊断及随访。
Objective To evaluate the feasibility and value of multi-slice spiral CT (MSCT) in the diagnosis of coronary artery lesion in children with Kawasaki disease. Methods Thirty-four children with Kawasaki disease underwent 16-slice or 64-slice CT coronary angiography. Among them, 18 cases had simultaneous two-dimensional echocardiography. Calculate the display of each coronary artery. Observe the morphology of the lesion, measure the diameters of the left and right coronary arteries, and calculate the correlation coefficient of the two methods. Results In addition to 4 cases of left circumflex artery and 8 cases of right coronary artery showed unclear, the rest of the coronary arteries can be clearly shown. MSCT found that 34 patients, 14 cases of coronary artery lesions, a total of 22 coronary involvement. Coronary artery dilatation in 6 cases, the main expansion with aneurysm formation in 3 cases, the main trunk did not expand in the middle and distal aneurysm formation in 2 cases, 1 case of coronary stenosis, calcification in 2 cases, beaded change in 3 cases. MSCT and two-dimensional ultrasound had no significant difference in the measurements of coronary artery (P> 0.05), and the correlation coefficients of the left and right coronary arteries were 0.85,0.91 (P <0.05) respectively. Three cases of aneurysm in the middle and distal segments of the right coronary artery and one case of coronary artery stenosis were not found. Two cases of mild to moderate mitral regurgitation and five cases of vascular wall thickening MSCT were not found. Conclusion MSCT is a feasible method to detect coronary artery lesion in children with Kawasaki disease. It can be used as a supplementary and alternative method to diagnose and follow-up of coronary artery lesion in Kawasaki disease.