心功能不全患者肺动脉CT血管成像最佳触发点探讨

Optimal trigger position of CT pulmonary artery imaging in patients with cardiac insufficiency

目的探讨心功能不全患者肺动脉CT血管成像(CTPA)最佳触发点。方法选取2020-12-01-2021-09-30聊城市茌平区人民医院临床诊断为心功能不全且疑诊为肺动脉栓塞行CTPA检查的56例患者作为研究对象,随机分为A和B组,各28例。A组触发点置于主肺动脉,B组触发点置于上腔静脉,触发阈值均设为70 HU。比较2组检查成功率、右下肺动脉CT值、右下肺静脉CT值、上腔静脉CT值、6级肺动脉显示率、图像质量评分、上腔静脉伪影评分。结果2组基线心功能分级比较,差异无统计学意义,χ^(2)=0.488,P=0.922。A组检查成功率为100.0%,B组为92.9%,差异无统计学意义,校正χ^(2)=0.519,P=0.471。A组右下肺动脉平均CT值为489.8±42.5,B组为295.8±37.1,差异有统计学意义,t=18.196,P<0.001;A组右下肺静脉平均CT值为91.8±13.1,B组为79.5±17.3,差异有统计学意义,t=2.999,P=0.004;A组上腔静脉平均CT值为566.5±320.4,B组为1427.5±377.8,差异有统计学意义,t=9.197,P<0.001。A组6级肺动脉显示率为96.43%,B组为71.43%,差异有统计学意义,χ^(2)=4.766,P=0.029。A组图像质量评分为(4.71±0.45)分,B组为(4.11±0.97)分,差异有统计学意义,t=2.969,P=0.004。A组上腔静脉伪影评分为(4.50±0.31)分,B组为(4.07±0.72)分,差异有统计学意义,t=2.903,P=0.005。结论CTPA检查前,评估患者的心功能对于触发点的选择非常重要。心功能不全患者CTPA检查选择主肺动脉为触发点,与上腔静脉触发点比较,可获得更高的肺动脉CT值、6级肺动脉显示率和图像质量评分,以及更低的上腔静脉CT值和更小的上腔静脉伪影。

Objective To explore the optimal trigger position of CT pulmonary artery imaging in patients with cardiac insufficiency.Methods From December 1 st,2020 to September 30 th,2021,fifty-six patients with cardiac insufficiency who underwent CTPA in Chiping people’s hospital were randomly distributed to group A and group B,with 28 cases in each group.Trigger position was put on pulmonary artery in group A.Trigger position was put on superior vena cava in group B.Trigger threshold was 70 HU for both groups.The examination success rate,average CT values of right inferior pulmonary artery,right inferior pulmonary vein and superior vena cava,image quality score,image artifact score of superior vena cava were compared between group A and B.Results There was no significant difference as for cardiac function between groups(χ^(2)=0.488,P=0.922).The success rates for group A and B were 100.0%and 92.9%,respectively,there was no significant difference between groups(correctedχ^(2)=0.519,P=0.471).The average CT values of right inferior pulmonary artery in group A and B were 489.8±42.5 and 295.8±37.1,respectively,with a significant difference between groups(t=18.196,P<0.001).The average CT values of right inferior pulmonary vein in group A and B were 91.8±13.1 and 79.5±17.3,respectively,there was significant difference between groups(t=2.999,P=0.004).The average CT values of superior vena cava in group A and B were 566.5±320.4 and 1427.5±377.8,respectively,with a significant difference between groups(t=9.197,P<0.001).The appearing rates of 6 grade pulmonary artery in group A and B were 96.43%and 71.43%,respectively,with a significant difference between groups(χ^(2)=4.766,P=0.029).The image quality scores for group A and B were 4.71±0.45 and 4.11±0.97,with a significant difference between groups(t=2.969,P=0.004).The image artifact scores of superior vena cava for group A and B were 4.50±0.31and 4.07±0.72,with a significant difference between groups(t=2.903,P=0.005).Conclusion It is very important to evaluate cardiac function before CTPA examination.Compared with superior vena cava,pulmonary artery selected as trigger position in cardiac insufficiency patient can acquire better image quality with higher pulmonary CT value,higher appearing rate of 6grade pulmonary artery,lower superior vena cava CT value and smaller superior vena cava artifact.