冠状动脉狭窄左心室结构与功能变化的CT研究

发布时间：2018-12-24 08:31

【摘要】：【目的】以辛普森法（Simpson）算法为参考标准，探讨自动阈值分割（AutomatedThreshold-Based Segmentation）算法评价左心室功能的临床价值；运用256层螺旋CT初步探讨单纯左冠状动脉前降支狭窄程度与左心室结构功能的关系。【方法】将57例行冠状动脉CT血管造影患者的数据导入后处理工作站，分别采用Simpson和Automated Threshold-Based Segmentation两种算法对左心室质量（LVM）、收缩末期容积(ESV)、舒张末期容积(EDV)、每搏输出量(SV)、射血分数(EF)进行评估，将所得结果分别进行配对t检验、Pearson相关性分析、Bland-Altman分析。搜集正常者及单纯左冠状动脉前降支狭窄患者，按照狭窄程度分为正常、轻度、中度、重度四组，，采用单因素方差分析狭窄程度与左心室结构和功能的关系。【结果】 Simpson和Automated Threshold-Based Segmentation两种算法具有较好的相关性，ESV、EDV、SV、EF、LVM均为高度相关（r分别为0.96、0.97、0.93、0.94、0.89），Bland-Altman分析示两种算法所测ESV、EF一致性可被临床接受，EDV、SV、LVM一致性均不被临床所接受。不同狭窄组间，ESV、EDV、SV、EF均无统计学差异，而左室质量指数（LVMI）重度组较正常组增加，差异有统计学意义；中度和重度组，部分节段舒张期心肌壁较正常组增厚，差异有统计学意义，而收缩期各组间肌壁厚度均无统计学差异。【结论】临床工作中不推荐采用Automated Threshold-Based Segmentation算法进行心脏功能评估。左前降支不同程度狭窄对左心室ESV、EDV、SV、EF无明显影响。左前降支重度狭窄造成左心室质量增加，中度及重度狭窄造成其供血区部分节段肌壁厚度增加。
[Abstract]:[objective] to explore the clinical value of automatic threshold segmentation (AutomatedThreshold-Based Segmentation) algorithm in evaluating left ventricular function using Simpson's (Simpson) algorithm as reference standard. The relationship between the degree of stenosis of anterior descending branch of left coronary artery and left ventricular structure and function was preliminarily studied by 256-slice spiral CT. [methods] the data of 57 patients with coronary artery CT angiography were imported into post-processing workstation, and left ventricular mass (LVM), end-systolic volume (ESV), was evaluated by Simpson and Automated Threshold-Based Segmentation algorithms, respectively. The end-diastolic volume (EDV), output (SV), ejection fraction (EF) was evaluated, and the results were analyzed by paired t test, Pearson correlation analysis and Bland-Altman analysis. Patients with left anterior descending coronary artery stenosis were divided into four groups according to the degree of stenosis: normal, mild, moderate and severe. Univariate ANOVA was used to analyze the relationship between stenosis degree and left ventricular structure and function. [results] Simpson and Automated Threshold-Based Segmentation have good correlation, ESV,EDV,SV,EF,LVM is highly correlated (r = 0.960.97). Bland-Altman analysis shows that ESV, measured by the two algorithms is highly correlated. EF conformance can be accepted clinically, but EDV,SV,LVM conformance is not accepted clinically. There was no significant difference in ESV,EDV,SV,EF between different stenosis groups, but the left ventricular mass index (LVMI) in severe group was higher than that in normal group (P < 0.05). In moderate and severe groups, partial diastolic myocardial wall was thicker than that in normal group, but there was no significant difference in contractile myocardial wall thickness. [conclusion] Automated Threshold-Based Segmentation algorithm is not recommended for cardiac function evaluation in clinical work. Left anterior descending branch stenosis had no significant effect on left ventricular ESV,EDV,SV,EF. Severe stenosis of the left anterior descending branch resulted in increased left ventricular mass and increased thickness of some segments of the blood supply area due to moderate and severe stenosis.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.2

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