0.37秒16层螺旋CT冠状动脉成像在相对高心率患者中的应用

Application of Noninvasive Coronary Angiography in Patients with High Heart-rate Using 16-slice Spiral CT with 0.37s Gantry Rotation Time

目的探讨和评价0.37s16层螺旋CT冠状动脉成像在相对高心率患者中的应用价值。材料和方法对50例临床怀疑或确诊冠状动脉疾病的患者以机架旋转时间为0.37s的16层螺旋CT进行冠状动脉平扫和增强扫描,然后行MIP、MPR及VRT重建,评价冠状动脉的成像质量,其中有12例近期接受了常规冠状动脉造影检查,可作为对照评价16层螺旋CT冠状动脉成像的诊断准确性,评价0.37s16层螺旋CT对高心率患者冠状动脉成像的价值。结果0.37s16层螺旋CT冠状动脉成像可达到94%的满意度,即50例患者中有47例可评价冠状动脉节段≥7,他们的平均心率是69.3±10.7次/min,而所有样本的平均心率是69.5±10.9次/min,两者无显著差别(t检验,P>0.05)。心率<70次/min的28例患者,可评估冠状动脉节段数平均为10.7±2.14,而心率>70次/min的22例患者,可评估冠状动脉节段数平均为9.7±1.78,两者无显著差别(t检验,P>0.05),其中1例患者心率达102±3.5次/min,显示效果良好。导致冠状动脉节段不可评估的主要原因有管腔狭小、心脏搏动伪影和呼吸运动伪影。结论0.37s16层螺旋CT冠状动脉成像在较高心率的患者中可获得相当高的满意度,与冠状动脉造影的初步对照显示了较高的一致性,是一种值得期待的冠状动脉无创检查方法。

Purpose:The aim of our research is to evaluate the value of CT coronary angiography in patients with higher heart rates using16-slice spiral CT with0.37s gantry rotation time.Especially for those patients whose heart rates are over70beats per minute(bpm).Materials And Methods:50patients(42men and8women;mean age,60years±16[SD])with various heart rates underwent retrospectively ECG-gated multi-slice spiral computer tomography(MSCT)coronary angiography in past4months and12of them also accepted conventional coronary angiography.Two experimental doctors evaluated all MSCT coronary angiographic images and calculated the assessable coronary artery segments independently.Then two doctors who were blind of the heart rates of patients judged the coronary artery lesions found by two methods and compared the accordance of them.Results:15coronary artery segments were anaˉlyzed in each patient with regard of image quality(RCA:segment1～4,LM:segment5,LAD:segment6～10,LCX:segment11～15).A total513of739(69.4%)segments were satisfactory visualized.About10.3segments can be evaluated per patient on average.94%(47/50)of the patients could been evaluated satisfactory whose assessable segments were≥7.And the average heart-rate of these47patients was69.3bpm±10.7[SD]while the average heart-rate of all the patients was69.5bpm±10.9[SD].There-386- was no prominent difference between them(t test,P>0.05).In28patients whose heart-rate were below70bpm,the average assessable segments were10.7±2.14[SD].And in the other22patients whose heart-rate were over70bpm,the corresponding segments was9.7±1.78[SD].No prominent difference was found in these two groups either(t test,P>0.05).The main causes of unevaluation were tiny vessel,cardiac motion and respiratory artifacts.The coherence of the MSCT coronary angiography and conventional coronary angiography(CCG)was excellent.Conclusion:The new generation of16-slice spiral CT with0.37sec rotation time can evaluate the coronary arteries of the patients with high heart rates(>70bpm,up to102bpm)successfully and the results were quite accordant with that of conventional coronary angiography.