血管造影 CT 成像在先天性心脏病心导管检查室的应用。
Use of angiographic CT imaging in the cardiac catheterization laboratory for congenital heart disease.
机构信息
Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
出版信息
JACC Cardiovasc Imaging. 2010 Nov;3(11):1149-57. doi: 10.1016/j.jcmg.2010.09.011.
OBJECTIVES
This study sought to retrospectively evaluate our initial experience using angiographic computed tomography (ACT) in a pediatric cardiac catheterization laboratory.
BACKGROUND
ACT provides cross-sectional CT images from a rotational angiography run using a C-arm mounted flat-panel detector in the interventional suite. A 3-dimensional (3D) angiographic image can be created from the CT volume set and used in real time during the procedure. To our knowledge, its use has never previously been described for congenital heart disease.
METHODS
3D reconstructions were created and we retrospectively reviewed cases during our first year of ACT use. Images obtained were independently evaluated to determine their diagnostic utility. Radiation dose reduction protocols were defined using phantom testing and radiation dose calculation.
RESULTS
ACT was used during 41 cardiac catheterizations in patients at a median age of 5.1 years (range: 0.4 to 58.8 years) for evaluation of: right ventricular outflow tract (RVOT)/central pulmonary arteries (PAs) in 20; cavopulmonary connection (CPC) in 11; pulmonary veins in 5; distal PAs in 4; and other locations in 5. Four subjects had 2 anatomic areas studied by ACT. The mean contrast volume for ACT was 1.2 ± 0.4 ml/kg. Diagnostic-quality imaging was obtained in 71% of cases: 13/20 RVOT/central PAs; 9/11 CPC; 4/5 pulmonary veins; 2/4 distal PAs; and 4/5 others. In 12 cases, ACT contributed to clinical outcomes beyond standard angiography. Radiation dose reduction protocols allowed ACT to be comparable in exposure to a standard biplane cineangiogram.
CONCLUSIONS
Diagnostic-quality imaging can be obtained using ACT in 71% of cases without a significant increase in contrast or radiation exposure. In certain cases, ACT provides additional anatomic detail and may aid complex catheter manipulations. Future work is needed to continue to define applications of this new technology.
目的
本研究旨在回顾性评估我们在儿科心导管实验室中使用血管造影计算机断层扫描（ACT）的初步经验。
背景
ACT 使用安装在介入套件中的 C 臂式平板探测器从旋转血管造影运行中提供横截面 CT 图像。可以从 CT 体积集创建三维（3D）血管造影图像，并在手术过程中实时使用。据我们所知，以前从未将其用于先天性心脏病。
方法
创建 3D 重建，并在使用 ACT 的第一年回顾性地回顾病例。独立评估获得的图像以确定其诊断效用。通过体模测试和辐射剂量计算定义了降低辐射剂量的方案。
结果
ACT 在 41 例中位年龄为 5.1 岁（范围：0.4 至 58.8 岁）的患者的心脏导管检查中使用，用于评估：右心室流出道（RVOT）/中央肺动脉（PA）20 例；腔肺连接（CPC）11 例；肺静脉 5 例；远端 PA 4 例；和其他 5 个部位。4 个患者有 2 个解剖区域接受了 ACT 研究。ACT 的平均造影剂用量为 1.2±0.4ml/kg。71%的病例获得了诊断质量的图像：20 例 RVOT/中央 PA 中有 13 例；11 例 CPC 中有 9 例；5 例肺静脉中有 4 例；4 例远端 PA 中有 2 例；5 例其他部位中有 4 例。在 12 例中，ACT 除了标准血管造影外，还对临床结果有贡献。辐射剂量降低方案允许 ACT 的曝光与标准双平面电影血管造影相当。
结论
在不增加造影剂或辐射暴露的情况下，71%的病例可以获得诊断质量的图像。在某些情况下，ACT 提供了额外的解剖细节，并可能有助于复杂的导管操作。需要进一步的工作来继续定义这项新技术的应用。
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