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目的探讨320排动态容积CT(320-slice dynamic volume CT,DVCT)血管成像在婴幼儿冠状动脉瘘(coronary artery fistula,CAF)诊断中的应用价值。方法回顾性分析8例诊断冠状动脉瘘患儿的临床和影像资料,年龄最小者61 d,最大者3岁,男3例,女5例。所有患儿均行低剂量前瞻性心电门控下DVCT血管成像,将获得的数据进行容积再现、多平面重建、最大密度投影,分析冠状动脉走行及心内外结构,计算有效辐射剂量,并与心脏彩超及手术结果对照。结果所有患儿的图像均为可诊断图像,左冠状动脉-右心室瘘2例,右冠状动脉-右心室瘘3例,左、右冠状动脉-右心室瘘1例(合并肺动脉闭锁,动脉导管未闭,左肺动脉发育不良),左冠状动脉-左心耳瘘1例(合并左冠状动脉走行变异),肺动脉主干-左心房瘘1例(合并主动脉骑跨,室间隔缺损,右位主动脉弓,左、右肺动脉起源于降主动脉)。平均辐射剂量约3.786 m Sv。结论低剂量DVCT血管成像可清晰显示婴幼儿冠状动脉瘘的起源、走行及瘘口情况,同时可明确诊断有无合并其他发育畸形,检查快速、无创、安全。
Objective To investigate the value of 320-slice dynamic volume CT (DVCT) angiography in the diagnosis of infantile coronary artery fistula (CAF). Methods The clinical and imaging data of 8 children diagnosed as having coronary artery fistula were analyzed retrospectively. The youngest was 61 days, the oldest was 3 years old, 3 males and 5 females. All patients underwent low-dose prospective ECG-guided DVCT angiography. Volumetric reconstruction, multiplanar reconstruction, maximum density projection, coronary artery walking and intracardiac and cardiac structures were performed, and the effective radiation dose was calculated. Echocardiography and surgical results of the control. Results All children were diagnosed with images of left coronary artery - right ventricular fistula in 2 cases, right coronary artery - right ventricular fistula in 3 cases, left and right coronary artery - right ventricular fistula in 1 case (with pulmonary atresia, Left atrial fistula, left atrial fistula, left atrial fistula, left atrial fistula, left atrial fistula, left atrial fistula, left ventricular septal defect, right aortic arch, Left and right pulmonary arteries originate in the descending aorta). The average radiation dose is about 3.786 m Sv. Conclusions Low-dose DVCT angiography can clearly show the origin, pathology and fistula of infants with coronary fistula. At the same time, they can confirm the diagnosis of other developmental malformations with fast, noninvasive and safe diagnosis.