单支冠状动脉重度以上狭窄患者碘对比剂首次通过时的心肌强化程度CT评价
发布时间：2018-03-13 00:33
本文选题：冠状动脉CT血管成像 切入点：首过灌注 出处：《大连医科大学》2017年硕士论文 论文类型：学位论文
【摘要】：目的:在冠状动脉 CT 成像(coronary computed tomography angiograph,CCTA)上对三支冠状动脉正常或轻度狭窄患者的相应供血区心肌CT密度值进行测量,评价其碘对比剂首次通过时的心肌强化程度;对单支冠状动脉重度以上狭窄患者,测量单支冠状动脉重度狭窄、亚闭塞和闭塞的相应供血区CT密度值,初步评价其碘对比剂首次通过的心肌强化程度在三者之间的差异性。材料与方法:对2012年1月～2016年8月期间因怀疑冠心病在我院先后接受冠状动脉 CT 成像(coronary computed tomography angiograph,CCTA)和导管法冠状动脉造影检查的524例患者行回顾性分析。男365例,女159例,年龄28～92(65.82±8.96)岁。两种检查的间隔时间为1～25(6.32±4.11)天。524例患者中,导管法冠状动脉造影显示三支冠状动脉正常或轻度狭窄(50%)的患者76例;导管法冠状动脉造影显示单支冠状动脉(其余两支冠状动脉正常或轻度狭窄)重度以上狭窄(≥75%)的患者448例,其中冠状动脉重度狭窄患者154例,冠状动脉亚闭塞患者146例,冠状动脉闭塞患者148例。使用二代双源CT行CCTA检查,机架旋转时间:0.28 s/r;探测器准直:2×64×0.6 mm,Z轴飞焦点技术采集:2× 128×0.6 mm;管电压:120kV～140kV,管电流:330mAs～400mAs;重建时间分辨率:75ms;层厚:0.75mm,层间隔:0.7mm;显示野:250～270mm;矩阵:512×512;图像重建算法:滤波反投影(filtered back projection,FBP),图像重建的卷积核值:B26f;根据患者自身情况,采用回顾性心电门控螺旋扫描方式(Retrospective ECG-gated spiral mode)或前瞻性心电触发适应性序列扫描方式(Prospective-ECG triggered sequential scan mode)。采用欧利奇高压注射器,在肘正中静脉置入18G套管针,经套管针以5～6ml/s的流率注入50～60ml对比剂碘海醇(300mgI/ml),随后以同样速率注射0.9%生理盐水30～50 ml,采用碘造影剂示踪法,将感兴趣区(region of interest,ROI)设在升主动脉约气管分叉水平层面并监测其CT值,触发阈值为100HU,达到阈值后延迟6S自动开始心脏扫描。选取最佳重建时相的原始横断面CT图像和用于图像后处理、评价冠状动脉狭窄程度和测量左室心肌密度。分析CCTA图像,运用多平面重组(multiple planar reformation,MPR)技术以左心室长轴为基准,获得垂直左室长轴的水平短轴切面,按照美国心脏协会(AHA)在水平短轴上将左室心肌分为17心肌节段,绘制"牛眼图",选取心肌节段中心测量3次取平均值,分别测量和计算三支冠状动脉正常或轻度狭窄患者和单支冠状动脉重度以上狭窄患者相应供血区的左心室各节段心肌CT密度值及其校正值,进行统计学分析,评价正常或轻度狭窄患者碘对比剂首次通过时左心室心肌强化程度和冠状动脉重度狭窄、亚闭塞和闭塞患者碘对比剂首次通过的心肌强化程度在三者之间的差异性。结果:①三支冠状动脉正常或轻度狭窄患者左心室各节段心肌CT密度值及其校正值分别为:心尖段(96.24±0.57)HU和(0.304±0.003);中段(96.81±0.41)HU和(0.313±0.002)H;基底段(97.19±0.27)HU 和(0.327±0.002),心尖段平均CT密度值及其校正值与中段和基底段比较差异均有统计学意义(P0.05),中段与基底段平均CT密度值及其校正值比较差异无统计学意义(P0.05)。冠状动脉正常或轻度狭窄患者三支冠状动脉相应供血区心肌CT密度值及其校正值分别为:左前降支(96.71±3.67)HU和(0.322±0.012),左回旋支(96.58±3.84)HU和(0.322±0.009),右冠状动脉(96.63±4.01)HU和(0.322±0.010),三支冠状动脉相应供血区心肌平均CT密度值及校正值比较无统计学意义(P0.05)。②单支冠状动脉重度以上狭窄患者的三支冠状动脉相应供血区心肌CT密度值及其校正值比较:病变支与同组内非病变支相应供血区左心室心肌平均CT密度值及其校正值比较差异均有统计学意义(P0.05)。单支冠状动脉重度以上狭窄相应供血区左室心肌CT密度值及其校正值比较:左前降支、左回旋支和右冠状动脉重度狭窄组与亚闭塞组和闭塞组的心肌平均CT密度值及其校正值比较差异均有统计学意义(P0.05);而亚闭塞组与闭塞组的心肌平均CT密度值比较差异无统计学意义(P0.05),但两组心肌平均校正值比较差异有统计学意义(P0.05)。结论:1)在CCTA图像上测得并代表心肌强化程度的左心室心肌CT密度值能够间接提示碘对比剂首次通过时的心肌血流灌注情况。2)在三支冠状动脉正常或轻度狭窄患者,三支冠状动脉相应供血区心肌CT密度值无显著性差异;在单支冠状动脉重度以上狭窄患者,其狭窄程度越重,相应供血区心肌CT密度值越低,提示碘对比剂首次通过时的心肌血流灌注越少。
[Abstract]:Objective: coronary artery CT imaging (coronary computed tomography angiograph, CCTA) was used to measure the values of corresponding blood supply to the myocardium CT density of three coronary artery stenosis in patients with normal or mild, evaluate the iodine contrast enhancement degree by the first of myocardial; single coronary artery stenosis in patients with severe, severe single measurement coronary artery stenosis, occlusion and occlusion of the corresponding sub supply area CT density differences between the three of the preliminary evaluation of iodine contrast agent for the first time by the myocardial enhancement degree. Materials and methods: from January 2012 to August 2016 in our hospital during the period of suspected coronary heart disease underwent coronary artery imaging (CT coronary computed tomography angiograph, CCTA analysis of 524 cases) and catheter coronary angiography review. Male 365 cases, female 159 cases, age 28~92 (65.82 + 8.96) years old. Among the two kinds of inspection Every time is 1~25 days (6.32 + 4.11).524 patients, catheter coronary angiography showed three coronary artery normal or mild stenosis (50%) of 76 cases of patients; catheter coronary angiography showed single vessel coronary artery (the other two normal coronary artery stenosis or mild and severe stenosis (more than 75%) 448) patients with severe coronary artery stenosis in patients with coronary artery occlusion in 154 cases, and 146 patients with coronary artery occlusion in 148 cases. The use of the two generation dual source CT CCTA, rotation time: 0.28 s/r: 2; detector collimating * 64 * 0.6 mm, Z axis flying focus technology acquisition: 2 * 128 * 0.6 mm; tube voltage: 120kV ~ 140kV, tube current: 330mAs ~ 400mAs; the reconstruction time resolution: 75ms; thickness: 0.75mm, interval: 0.7mm; display field: 250 ~ 270mm; matrix: 512 * 512; image reconstruction algorithm: filter back projection (filtered back, projection, FBP) that image reconstruction Convolution kernel value: B26f; according to the patient's own situation, using retrospective ECG gated spiral scan mode (Retrospective ECG-gated spiral mode) or prospective ECG triggering adaptive sequence scan mode (Prospective-ECG triggered sequential scan mode). The odd Orly high-pressure injector in 18G venous trocar through median cubital trocar, in 5 ~ 6ml/s the flow rate of the injected 50 ~ 60ml contrast agent iohexol (300mgI/ml), then at the same rate injection of 0.9% saline 30~50 ml, using iodine contrast agent tracer method, will be a region of interest (region of, interest, ROI) in ascending aorta around the tracheal bifurcation level and monitor the CT value, triggering threshold is 100HU, achieve after the threshold delay 6S automatic start heart scan. Select the best reconstruction phase and the original cross-sectional CT images for image postprocessing, evaluate the degree of coronary artery stenosis and left ventricular measurements Muscle density. CCTA image analysis, using multi planar reconstruction (multiple planar reformation, MPR) in the left ventricular long axis as a benchmark, obtained level short axis view of left ventricular long axis vertical, according to the American Heart Association (AHA) in the left ventricular short axis will be divided into 17 segments, draw the "bull's-eye map" selected, myocardial segment center measuring 3 times the average, the left ventricular myocardium CT density were measured and calculated three coronary artery stenosis in patients with normal or mild and single coronary artery stenosis in patients with severe blood supply area value and the corresponding correction value, statistical analysis, evaluation of normal or mild stenosis in patients with iodine contrast for the first time through the agent of left ventricular myocardium enhancement degree and severe coronary artery stenosis, occlusion and occlusion in patients with mild iodine contrast agent for the first time by the difference in myocardial enhancement degree between the three. Results: the three branch of coronary artery 鑴夋甯告垨杞诲害鐙獎鎮ｈ，
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