Objective:To evaluate the value of ECG-gated cardiac CT in the diagnosis of complex congenital heart disease(CHD) in children.Methods:Thirty children with complex CHD treated in our hospital from January 2015 to March 2017 were enrolled,and randomly assigned into two groups:Fifteen patients underwent MSCT angiography with prospective ECG-gated mode(group A),and fifteen patients were examined with retrospective ECG-gated mode(group B).Patients' CT attenuation,image noise and signal to noise ratio(SNR) in the ascending aorta and the pulmonary trunk as well as radiation dose were compared.The diagnostic accuracy was evaluated.A five grade scoring system was used to analyze the image quality.Results:The diagnostic accuracy of group A and group B were respectively 99.8％(569/570) and 99.6％(568/570),and the sensitivity were 98 ％ (49/50) and 96.2 ％ (51/53).No significant difference was found between the two groups(P＜0.05).The image quality scores of group A and group B were respectively 4.6±0.5 and 4.7±0.4(Kappa =0.70,P＞0.05).All images met the requirement.There was no significant difference in CT attenuation,noise and SNR of the ascending aorta and pulmonary trunk between the two groups(P＞0.05).The CT dose index volume(CTDIvol) of group A and group B were respectively(1.00±0.20) mGy and(1.75 ± 0.16) mGy,the dose-length product (DLP) were(13.53±5.01) mGy · cm and(32.60±9.17) mGy · cm,and the effective radiation dose (ED) were(0.62±0.17) mSv and(1.56±0.43) mSv.Conclusion:The prospective ECG-gated 128-slice spiral CT angiography exhibited great application value in the diagnosis of complex CHD.It could reduce the radiation dose compared with retrospective ECG-gated mode.%目的:探讨前瞻性心电门控在儿童复杂先天性心脏病诊断中的价值.方法:选择复杂先天性心脏病患儿30例,15例行MSCT前瞻性心电门控扫描(前瞻组),15例行MSCT回顾性心电门控扫描(回顾组).记录两组患儿的升主动脉根部及主肺动脉的CT值、噪声、信噪比及辐射剂量.以手术结果作为金标准,计算两组诊断准确率.采用5分法进行图像质量评估.结果:前瞻组和回顾组的诊断准确率分别为99.8％(569/570)、99.6％(568/570),敏感性为98％(49/50)、96.2％(51/53),差异均无统计学意义(P＞0.05).前瞻组和回顾组图像质量评分分别为(4.6±0.5)分、(4.7±0.4)分,均符合诊断要求.2名医师对图像质量评分的一致性为优(Kappa=0.70,P＜0.05).两组升主动脉根部及主肺动脉的CT值、噪声及信噪比差异无统计学意义(P＞0.05).前瞻组和回顾组的容积CT剂量指数(CTDIvol)分别为(1.00±0.20) mGy、(1.75±0.16) mGy;剂量长度乘积(DLP)分别为(13.53±5.01)mGy·cm、(32.60±9.17)mGy·cm;有效辐射剂量(ED)分别为(0.62±0.17)mSv、(1.56±0.43)mSv,差异均有统计学意义(P＜0.05).结论:128层MSCT前瞻性心电门控扫描在儿童复杂性先天性心脏病诊断中具有重要的临床价值,较回顾性心电门控辐射剂量明显降低.
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