Department of Anesthesiology, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA.
AJR Am J Roentgenol. 2013 Jan;200(1):171-6. doi: 10.2214/AJR.12.8758.
The purpose of this study was to compare the image quality of thoracic CT angiography (CTA) studies performed with two techniques--with general anesthesia and without general anesthesia--for infants and for children younger than 5 years.
All consecutively registered infants and young children (age, ≤ 5 years) who underwent contrast-enhanced thoracic CTA from November 2005 to October 2010 were categorized into two groups: general anesthesia and awake (i.e., no general anesthesia). Two radiologists independently evaluated image quality by quantifying the degree of motion artifact at three anatomic levels (upper, middle, and lower lung zones). Motion artifacts were graded on an ordinal scale (0, no motion; 1, mild; 2, moderate; 3, severe), and the Pearson chi-square test was used to assess whether the degree of motion artifact differed between the general anesthesia and awake groups in the upper, middle, and lower lung zones. Logistic regression analysis was performed to determine whether image quality based on the presence or absence of motion artifact in any lobe was related to general anesthesia versus the awake state; age and sex were covariates. Interobserver agreement between two reviewers was evaluated with kappa statistics.
There were a total of 135 patients (mean age 1.0 year), 95 in the awake group (70%) and 40 in the general anesthesia group (30%). No significant difference was found between the two groups in percentage of studies with motion artifact detected in each lung zone and the total motion artifact score. Results of multivariable logistic regression analysis indicated that image quality was not influenced by age (p = 0.52) or sex (p = 0.20). There was excellent interobserver kappa agreement between reviewers for detecting motion artifact in the upper, middle, and lower lung zones (all κ > 0.90, p < 0.001).
There is no significant difference in image quality of thoracic CTA with 64-MDCT assessed by degree of motion artifact with and without general anesthesia. The results of this study support use of thoracic CTA without general anesthesia in the care of young pediatric patients who meet screening criteria for awake imaging studies.
本研究旨在比较两种技术——全身麻醉和非全身麻醉——在婴儿和 5 岁以下儿童行胸部 CT 血管造影（CTA）检查的图像质量。
回顾性分析 2005 年 11 月至 2010 年 10 月间所有连续行增强胸部 CTA 检查的婴儿和幼儿（年龄≤5 岁），并将其分为两组：全身麻醉组和清醒组（即非全身麻醉组）。两名放射科医生独立对三个解剖层面（上、中、下肺区）的运动伪影程度进行量化评估，并采用有序量表（0 级：无运动；1 级：轻度；2 级：中度；3 级：重度）对运动伪影进行分级，采用 Pearson 卡方检验评估上、中、下肺区运动伪影程度在全身麻醉组和清醒组之间是否存在差异。采用 Logistic 回归分析判断是否存在任何叶段的运动伪影与全身麻醉和清醒状态之间的关系；年龄和性别为协变量。采用 Kappa 统计评估两名观察者之间的一致性。
共纳入 135 例患者（平均年龄 1.0 岁），其中清醒组 95 例（70%），全身麻醉组 40 例（30%）。两组在每个肺区及总的运动伪影评分检测到的存在运动伪影的研究百分比之间无显著差异。多变量 Logistic 回归分析结果表明，年龄（p=0.52）或性别（p=0.20）对图像质量无影响。观察者在检测上、中、下肺区运动伪影方面具有极好的一致性（所有 Kappa 值均＞0.90，p＜0.001）。
在运动伪影程度评估方面，全身麻醉与非全身麻醉行 64 层 MDCT 胸部 CTA 的图像质量无显著差异。本研究结果支持对符合清醒成像研究筛查标准的年轻儿科患者使用非全身麻醉行胸部 CTA。
