Eichhorn Joachim G, Long Frederick R, Hill Sharon L, O'Donovan Julie, Chisolm Joanne L, Fernandez Soledad A, Cheatham John P
Department of Radiology, Ohio State University College of Medicine, Columbus, USA.
Catheter Cardiovasc Interv. 2006 Jul;68(1):11-20. doi: 10.1002/ccd.20760.
Our purpose was to investigate the diagnostic reliability of multi-detector computed tomography (MDCT) in assessing in-stent stenosis compared to digital angiography (DA) in small children.
Little is known about the feasibility of using MDCT to assess stents placed to treat children with congenital heart disease (CHD).
Twenty-two children (median age [range], 2(3/4) [(1/2) to 12] years) with 42 transcatheter placed stents (median diameter: 7.2 [3.4-16.3] mm) in the pulmonary arteries (n = 36), aorta (2), PDA (1), and SVC (3) underwent both MDCT and DA due to suspected hemodynamic problems.
Independent "blinded" observers were able to measure stent and minimal luminal diameters in 115 out of 124 (93%) stent segments on MDCT and DA. The interobserver variability was low (mean difference: 0.5, SD 0.8 mm) with high correlation (r = 0.97; P < .0001). The percent stenosis by MDCT correlated well with DA (r = 0.89, P < .0001; mean error 2.7, SD 10.4%). For all grades of stenosis, the sensitivity and specificity for MDCT were 58% and 97%, respectively. At a threshold of approximately > or =20% stenosis sensitivity became >98%. All stent associated complications [fracture (4), vascular narrowings (11)] were diagnosed by MDCT. As the stent diameter increased, there was significantly reduced variability between MDCT and DA for in-stent stenosis (P < .0001).
In small children, MDCT is a feasible and promising method for assessing stent associated complications in the treatment of CHD. Cardiac surgeons and interventional cardiologists might rely on this imaging modality to plan specific interventions more precisely and to assess the results upon follow up.
我们的目的是研究与数字血管造影（DA）相比，多排螺旋计算机断层扫描（MDCT）在评估小儿支架内狭窄方面的诊断可靠性。
关于使用MDCT评估用于治疗先天性心脏病（CHD）患儿的支架的可行性知之甚少。
22名儿童（中位年龄[范围]，2（3/4）[（1/2）至12]岁），在肺动脉（n = 36）、主动脉（2）、动脉导管未闭（PDA）（1）和上腔静脉（SVC）（3）中放置了42个经导管支架（中位直径：7.2 [3.4 - 16.3] mm），由于怀疑存在血流动力学问题，均接受了MDCT和DA检查。
独立的“盲法”观察者能够在MDCT和DA上对124个支架节段中的115个（93%）测量支架和最小管腔直径。观察者间变异性较低（平均差异：0.5，标准差0.8 mm），相关性较高（r = 0.97；P <.0001）。MDCT测得的狭窄百分比与DA相关性良好（r = 0.89，P <.0001；平均误差2.7，标准差10.4%）。对于所有狭窄等级，MDCT的敏感性和特异性分别为58%和97%。在狭窄阈值约为≥20%时，敏感性>98%。所有与支架相关的并发症[骨折（4例）、血管狭窄（11例）]均通过MDCT诊断。随着支架直径的增加，MDCT和DA在支架内狭窄方面的变异性显著降低（P <.0001）。
在小儿中，MDCT是评估CHD治疗中与支架相关并发症的一种可行且有前景的方法。心脏外科医生和介入心脏病学家可能会依赖这种成像方式更精确地规划特定干预措施并在随访时评估结果。
