| Objective:To determine the technique of 64 multi-slice spiral computed tomography angiography in infants and children;To analyze the capability of 64 multi-slice spiral computed tomography angiography in discovering the structural abnormalities of congenital heart diseases in infants and children;To investigate the clinical application values of 64 multi-slice spiral computed tomography angiography in infants and children with congenital heart diseases.Methods:24 pedo-patients with congenital heart diseases pseudo-diagnosed by clinic underwent 64 multi-slice spiral computed tomography angiography(64-MSCTA)before operation(about 1 month before 64 multi-slice spiral computed tomography angiography), all of the patients were examined by ultrasound(US),the consult were confirmed by operation.Among these patients,male:15,female:9,age:1-18 years old,mean age:8.67±6.34 years old,a patient with tnmcus arteriosus communis underwent 64 multi-slice spiral computed tomography angiography to follow up after end-to-side anastomosis between superior vena cava and right pulmonary artery.64 multi-slice spiral CT(SOMATOM sensation 64)of Siemense company was applied in our study.Patients above 9 years old who were cooperative were trained to hold their breathe before examination;their examination was applied in breathholding;patients less than 9 yares old were examinated in state of eupnea in case that they were commonly incooperative.We adopted the technique of Bolus Tracking in enhancement scanning.Scanning scope was from superior aperture of thorax to facies diaphragmatica sequentiae 2cm(plain scan including epigast); The original images of all the patients were reconstructed using multiplanar reconstruction (MPR),maximum intensity projection-thin(MIP-thin)and volume rendering technique (VRT)et al.Diagnositic images were selected to be evaluated;The consults of 64-MSCTA and US were resulted from two attending physician engageing their profession many years. According to the results of surgical findings,all 64-MSCTA preoperative diagnostic informations were compared with US,and the clinical application values of 64-MSCTA were investigated in infants and children with congenital heart diseases.Results:(1)Among all the postprocessing techniques,MPR can discover intracardiac structural abnormalities better,VRT can discover extracardiac structural abnomalities clearly,and MIP-thin can not only discover the focus of infection but also avoid structure overlapping,and profit to measure quantitately;(2)All of the 24 patients,88 abnormal structures were confirmed by operation,the intracardiac structural abnormalities were 38 places,64-MSCTA found 32,misdiagnosised:2,missed diagnosised:4,US found 35, misdiagnosised:0,missed diagnosised:3;the extracardiac structural abnomalities were 50 places.,64-MSCTA found 48,misdiagnosised:1,missed diagnosised:1,US found 39, misdiagnosised:4,missed diagnosised:7;(3)To the 38 places of the intracardiac structural abnormalities,accurate rates of 64-MSCTA,US and combination diagnosis were 84.32%,92.11%,100%respectively,the every two rates of the three had no obvious difference(all P＞0.05);to the 50 places of the extracardiac structural abnomalities,accurate rates of 64-MSCTA,US and combination diagnosis were 96%,78%,98%respectively,the two rates of 64-MSCTA and US had obvious difference(x2=4.796,P＜0.05),the accurate rate of 64-MSCTA was higher than that of US obviously;the two rates of 64-MSCTA and combination diagnosis had no obvious difference(x2=0.000,P＞0.05);to all the intracardiac and extracardiac structural abnormalities,the total accurate rates of 64-MSCTA,US and combination diagnosis were 90.91%,84.09%,98.86%respectively, the two rates of 64-MSCTA and US had no obvious difference(X2=0.000,P＞0.05);the two rates of combination diagnosis and 64-MSCTA had obvious difference(x2=10.494, P＜0.05),the two rates of combination diagnosis and US had obvious difference also(x2 =4.215,P＜0.05);the accurate rate of combination diagnosis was higher than that of 64-MSCTA or US;(4)pulmonary arterys were measured quantitately by 64-MSCTA and US to assese developmental condition in 7 patients with tetralogy of Fallot which were all definited by 64-MSCTA and US and McGoon indexs were calculated,measurements beteen the two methods had no obvious difference(all P＞0.05).Conclusion:(1)64-MSCTA is an important noninvasive examination technique of congenital heart diseases in infants and children,the reconstructed images of 64-MSCTA can descover the structural abnomalities of congenital heart diseases in infants and children in real time and directly.(2)64-MSCTA has obvious advantages in evaluation of extracardiac vascular anomaly of congenital heart diseases in infants and children compared with US, but about intracardiac structural abnormalities,64-MSCTA has no obvious advantages; combination diagnosis of 64-MSCTA and US can raise accuracy in heart-vascular anomaly of congenital heart diseases in infants and children;(3)64-MSCTA can be used to earlier evaluate the morphology changes in heart and its vascular anomaly of congenital heart diseases in infants and children,measurements in intracardiac great vessels have concordance with US,all these have important clinical significance to treatment plan and postoperative follow-up.
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