前瞻性心电门控在64层CT冠状动脉成像的初步应用

64-slice spiral CT coronary angiography with prospective electrocardiogram-gating： an initial study

目的评价前瞻性心电门控64层CT冠状动脉成像的可行性和临床应用价值。方法60例患者进行前瞻性心电门控64层CT冠状动脉成像检查，分析有效辐射剂量，并采用多平面重组（MPR）、最大密度投影（MIP）、曲面重组（CPR）及容积再现（VR）技术显示冠状动脉，评价其成像质量。结果平均辐射剂量（2．7±0．2）mSv；符合诊断标准的冠状动脉节段为93．3％（720／772），44．2％（341／772）质量优秀，49．1％（379／772）质量中等，6．7％（52／772）质量较差。冠状动脉重度狭窄（〉75％）或闭塞5例（8．3％），中度狭窄（50％～75％）17例（28．4％），管腔不规则或轻度狭窄（〈50％）18例（30．0％），冠状动脉正常者20例（33．3％）。结论前瞻性心电门控64层CT冠状动脉成像的影像质量能达到诊断标准，大大降低了辐射剂量，具有很好的临床应用价值。

Objective To evaluate the feasibility of prospective electrocardiogram （ECG）-gating computed tomography coronary angiography （CTCA）. Methods Sixty patients with suspected or known coronary artery disease underwent 64-slice CTCA using prospective ECG-gating. Multi-planar reconstruction （MPR）, curved-planar reconstruction （CPR）, maximum intensity projection （MIP） and volume rendering （VR） were used to demonstrate the coronary arteries. The image quality and radiation dose was evaluated. Results The mean effective radiation dose was （2.7±0.2） mSv. 93.3% （720/772） segments of all coronary arteries were of diagnostic image quality,44.2% （341/772）was classified as excellent and 49. 1% （379/772）was good. Non-diagnostic coronary segments were found in 6. 7% （52/772） of all coronary arteries. There were 5 （ 8.3 % ） cases with severe coronary stenosis （ 〉 75 % ） or occlusion, 17 （28.4%） cases with moderate stenosis （50% --75% ）, 18 （30. 0% ） cases with mild stenosis （ 〈 50% ） or irregular lumen, 20（33.3% ） cases with normal coronary artery. Conclusion With a low radiation dose, prospective electrocardiogram （ECG）-gated coronary 64-MSCT angiography has a good potential for the detection of coronary stenosis, espeeially for excluding coronary artery disease.