第3代双源CT低剂量心脏一站式成像的可行性

发布时间：2018-08-06 18:42

【摘要】：目的评估第3代双源CT低剂量心脏一站式成像的可行性。方法 2016年3月至9月在北京协和医院就诊的冠心病患者23例,采用第3代双源CT行ATP负荷70 kV动态心肌灌注成像(MPI)(前瞻性心电触发摇篮床扫描模式,收缩末期采集,扫描时间32 s)联合前瞻性心电触发大螺距扫描冠状动脉血管成像(CCTA)。基于AHA-17段模型,定量计算ATP负荷下心肌血流量(MBF),比较血流灌注正常及异常节段MBF值;基于SCCT-18段模型评价CCTA图像质量,计算CT检查有效剂量(ED)。以后续介入冠状动脉造影(CCA)为参照,分析CCTA(对CCA≥50%狭窄)及MPI(分别对CCA≥50%及≥70%狭窄)的诊断准确性。结果 23例行ATP负荷MPI联合CCTA检查的患者中,有12例行后续CCA检查。ATP负荷MPI中,共13例(56.5%)患者的77个(19.7%)心肌节段有血流灌注缺损,其MBF值明显低于血流灌注正常心肌节段[(93±22)ml/(100 ml·min)比(147±27)ml/(100 ml·min);t=15.978,P=0.000]。CCTA检查中,93.9%(308/328)的冠状动脉节段图像可用于诊断。分别以冠状动脉血管及节段为单位评价,CCTA对CCA中≥50%狭窄病变的诊断敏感性、特异性和准确性分别为94.1%、93.5%和93.7%及90.9%、97.8%、96.8%;ATP负荷MPI对CCA中单支血管≥50%及≥70%狭窄的诊断敏感性、特异性和准确性分别为68.7%、100%和89.5%及91.7%、100%和97.9%。MPI联合CCTA一站式扫描的总ED为(3.9±1.3)m Sv[MPI:(3.5±1.2)m Sv,CCTA:(0.3±0.1)m Sv]。结论第3代双源CT下ATP负荷70 kV动态MPI联合前瞻性大螺距CCTA扫描方案具有临床可行性和诊断可靠性,并可显著降低检查辐射剂量。
[Abstract]:Objective to evaluate the feasibility of third generation dual source CT low dose cardiac imaging. Methods 23 patients with coronary heart disease in Peking Union Medical College Hospital from March 2016 to September were treated with third generation dual source CT ATP load 70 kV dynamic myocardial perfusion imaging (MPI) (prospective electrocardiogram triggered lullaby pattern, end systolic collection, and scanning time 32 s). Prospective electrocardiogram triggered large pitch scanning coronary angiography (CCTA). Based on the AHA-17 segment model, the quantitative calculation of myocardial blood flow (MBF) under ATP load was used to compare the normal blood flow and MBF of abnormal segments. Based on the SCCT-18 segment model, the quality of CCTA images was evaluated and the effective dose of CT examination (ED) was calculated. Further interventional coronary angiography (CCA) was used. The diagnostic accuracy of CCTA (CCA > 50% stenosis) and MPI (CCA > 50% and 70% stenosis respectively) was analyzed. Results in 23 cases of ATP load MPI combined with CCTA examination, 12 cases were followed up with.ATP load MPI, 13 (56.5%) patients (19.7%) had blood perfusion defects in 77 (19.7%) myocardial segments, and the MBF value was significantly lower than that of blood perfusion. The normal myocardial segments [(93 + 22) ml/ (100 ml. Min)) were (147 + 27) ml/ (100 ml. Min); in t=15.978, P=0.000].CCTA examination, 93.9% (308/328) coronary artery segmental images could be used for diagnosis. The diagnostic sensitivity, specificity and accuracy of CCTA to the stenosis of 50% stenosis in CCA were 94.1%, respectively. 93.5% and 93.7% and 90.9%, 97.8%, 96.8%; ATP load MPI was sensitive to the diagnostic sensitivity of single vessel more than 50% and 70% stenosis in CCA, the specificity and accuracy were 68.7%, 100% and 89.5% and 91.7% respectively. The total ED of CCTA one-stop scanning of 100% and 97.9%.MPI was (3.9 + 1.3) m Sv[MPI: m Sv, CCTA: ( The combination of 70 kV dynamic MPI and prospective CCTA scanning with large pitch has clinical feasibility and diagnostic reliability, and can significantly reduce the radiation dose.
【作者单位】：中国医学科学院北京协和医学院北京协和医院放射科;中国医学科学院北京协和医学院北京协和医院心内科;
【基金】：国家自然科学基金(81471725) 北京市自然科学基金(7142133) 卫生公益性行业科研专项项目(201402019、201402001)~~
【分类号】：R816.2;R541.4

【相似文献】