Glöckler Martin, Koch Andreas, Halbfaß Julia, Greim Verena, Rüffer Andrè, Cesnjevar Robert, Achenbach Stephan, Dittrich Sven
Department of Pediatric Cardiology, University Hospital Erlangen, Erlangen, Germany.
Cardiol Young. 2013 Feb;23(1):18-26. doi: 10.1017/S104795111200025X. Epub 2012 Mar 8.
To investigate the impact of flat-detector computed tomography on the clinical assessment of patients with cavopulmonary connections, and to evaluate the obtained diagnostic accuracy and supplementary information, as well as the value of overlaid three-dimensional reconstructions on fluoroscopic images during catheter-based interventions.
We analysed 31 consecutive patients retrospectively in whom flat-detector computed tomography was used to visualise the cavopulmonary connection. We investigated patients with cavopulmonary connections either early post-operatively (first group), before converting to a total cavopulmonary connection (second group), and patients with failing total cavopulmonary connection (third group). Flat-detector computed tomography based on a single rotational angiography was used to create a three-dimensional vascular model. The clinical value of flat-detector computed tomography was evaluated using standard categories of diagnostic utility. Used contrast volume and radiation exposure were quantified.
Within 18 months, flat-detector computed tomography was performed in 31 cases with cavopulmonary connections. The median age was 1.9 years (range 0.3-43 years). In the first group, we found anomalies in 4 out of 8 cases, which led to therapeutic or prophylactic procedures; in the second and third groups, we performed interventions in 14 out of 23 cases. The overall clinical value was always rated superior to conventional biplane angiography. The median dose area product was 91.8 microgray square metres (range 33.0-679.3 microgray square metres). The required contrast medium was 2.08 millilitres per kilogram (range 0.66-4.7 millilitres per kilogram).
Flat-detector computed tomography improves the diagnostic accuracy in cavopulmonary connections and provides additional diagnostic information, which may lead to therapeutic or prophylactic procedures. Overlaid three-dimensional images on fluoroscopy facilitate and provide security for interventions.
探讨平板探测器计算机断层扫描对腔肺连接患者临床评估的影响，评估其诊断准确性和补充信息，以及在基于导管的介入治疗过程中荧光透视图像上叠加三维重建的价值。
我们回顾性分析了31例连续使用平板探测器计算机断层扫描来观察腔肺连接的患者。我们研究了术后早期（第一组）、在转换为全腔肺连接之前（第二组）以及全腔肺连接失败的患者（第三组）。基于单次旋转血管造影的平板探测器计算机断层扫描用于创建三维血管模型。使用标准诊断效用类别评估平板探测器计算机断层扫描的临床价值。对使用的对比剂体积和辐射暴露进行量化。
在18个月内，对31例腔肺连接患者进行了平板探测器计算机断层扫描。中位年龄为1.9岁（范围0.3 - 43岁）。在第一组中，我们在8例中有4例发现异常，这导致了治疗或预防性手术；在第二组和第三组中，我们在23例中有14例进行了干预。总体临床价值始终被评为优于传统双平面血管造影。中位剂量面积乘积为91.8微格雷平方米（范围33.0 - 679.3微格雷平方米）。所需对比剂为每千克2.08毫升（范围0.66 - 4.7毫升/千克）。
平板探测器计算机断层扫描提高了腔肺连接的诊断准确性，并提供了额外的诊断信息，这可能导致治疗或预防性手术。荧光透视上叠加的三维图像便于介入操作并提供安全性。
