多排CT对左心房和左心耳容积和功能的评价

Multi-detector CT versus cine magnetic resonance for assessing volume and function of left atrial and left atrial appendage:report of 48 cases

目的与3.0TCMR(cine magnetic resonance)比较,探讨多排CT(multi-detector CT,MDCT)评估左心房和左心耳容积和功能的能力。方法回顾性分析2008年3-12月进行冠状动脉CTA检查的48例患者,同一天完成多排CT和CMR检查,并获得多排CT容积数据及左心房垂直长轴FIESTA电影图像。多排CT采用心功能分析软件、MR采用Report Card2.0心功能分析软件对原始数据进行后处理,分析左心房和左心耳最大容积、最小容积、射血分数。通过线性相关和t检验分析评估多排CT和CMR2种检查方法间的相关性和一致性,操作者间的变异性采用Bland-Altman分析。结果多排CT与CMR测得的左心房和左心耳的容积和功能指标具有较好的相关性(r>0.75)和一致性。与CMR相比,多排CT有过高估计LAVmax、LAVmin、LAAVmax和LAAVmin的趋势,对左心房射血分数(left atrial ejection fraction,LAEF)和左房耳射血分数(left atrial appendage ejection fraction,LAAEF)有低估的趋势。多排CT操作者间测量值的变异性低于CMR操作者间的变异性。结论多排CT对于进行多排CT冠状动脉造影检查的患者,在提供冠状动脉信息的同时,对左心房和左心耳的容积和功能评估较准确、重复性较强。

Objective To assess the performance of multi-detector CT （MDCT） to evaluate left atrial and left atrial appendage volume and function,and compare the results by cardiac cine MR （CMR）. Methods Forty-eight patients who were referred for clinically-indicated CT coronary angiography in our department from March to December 2008,were included in the study. MDCT data sets （Somatom Definition,Siemens Medical Solutions,Forchheim,Germany） and fast imaging employing steady-state acquisition （ FIESTA ） cines （Signa Excite HD 3T,GE ） of the vertical long axis covering the left atrium were obtained on the same day. All images were analyzed to obtain the maximum and minimum of left atrial volume （LAVmax and LAVmin）,the maximum and minimum of left atrial appendage volume （LAAVmax and LAAVmin）,left atrial ejection fraction （LAEF）,and left atrial appendage ejection fraction （LAAEF） using Heart Function software and Report Card 2.0 software,respectively,for MDCT and CMR. Intermodality agreement was tested through linear regression and t test. Interobserver variability were tested by Bland-Altman analyses. Results MDCT measurements resulted in good correlation （r0.75） compared with CMR. However,MDCT has a tendency to overestimate LAVmax,LAVmin,LAAVmax and LAAVmin and to underestimate LAEF and LAAEF but insignificantly. The interobserver variability in the MDCT measurements was lower than that of CMR values. Conclusion MDCT provides highly reliable and reproducible measurements of left atrial and left atrial appendage volume and function in patients referred for coronary CT imaging.