320层CT心电门控双期心脏功能扫描一站式检查的初步研究

320 slice CT electrocardiograph-gating double phase cardiac function angiography scan mode： a preliminary investigation of one-stop-shop exam

目的 初步探讨应用320层CT心电门控双期心功能扫描模式（DPCFA）一站式评价心脏、冠状动脉、肺动脉形态及左、右心室功能的能力。方法回顾性分析40例经临床确诊患者的320层CTDPCFA扫描数据，分别以肺动脉期重建并观察肺动脉分支，以主动脉期重建并观察冠状动脉。分别以两期数据进行MPR重组并分析左、右心室功能，结果与超声心动图相对照。5例因图像质量欠佳排除组外，35例图像质量达到2级以上，可用作诊断，扫描平均心率（71．2±11．2）次／min，全部患者扫描期间未出现心律失常。应用Pearson检验进行相关性分析，应用配对t检验分析二者测量左心室射血分数（LVEF）的一致性。结果（1）35例最终人组患者中，诊断单发肺动脉栓塞11例，冠心病支架术后7例，单发冠心病5例，先天性心脏病房间隔缺损3例，特发性肺动脉高压3例，左房黏液瘤1例，肺动脉栓塞合并冠心病5例，全部符合临床诊断。（2）CT与超声心动图对照，35例患者的左、右心室舒张末期最大径分别为（36．7±3．3）、（43．3±3．4）mm，左、右心室收缩末期最大径分别为（31．6±5．1）、（41．3±5．1）mm，LVEF为47．1±15．1。超声心动图测得左、右心室舒张末期最大径分别为（40．3±3．1）、（47．3±4．2）mm，左、右心室收缩末期最大径分别为（37．3±5．6）、（45．3±5．3）mm，LVEF为46．0±14．8。CT与超声测量结果有显著的相关性（r=0．886～0．988，P值均〈0．01），LvEF的测量结果差异无统计学意义（t=0．692，P〉0．05）。（3）应用DPCFA技术，平均射线剂量（5．4±0．5）mSv。结论320层CT心电门控双期心功能扫描模式，可以用于心血管疾病一站式影像检查，可为临床心血管疾病的诊断、鉴别诊断、治疗方案的确定提供丰富的影像学信息，对左、右心功能不全相关临床问题的处理具有指导作用。

Objective To explore the feasibility of evaluating cardiac structure, coronary artery, pulmonary artery and cardiac function in one single scan by 320-row CT ECG-gated double phase cardiac function scan mode. Methods Forty patients underwent the 320-detector row CT double phase cardiovascular angiography. The pulmonary phase and aortic phase were reconstructed in order to evaluate the pulmonary and coronary artery. MPR reconstructions of both pulmonary and aortic phase were used to analyze the function of the two ventricles. And the results of the cardiac function were compared with those of transthoracic echocardiography. Thirty-five cases could be analyzed and diagnosed, while the other 5 cases had to be given up because of the poor imaging quality. The mean heart rate was （71.2 ± 11.2） beat per min （bpm）. No arrhythmia case included. Results （ 1 ） Pulmonary embolism were diagnosed in 11 cases, coronary artery disease （CAD） were ＇found in 5 cases, while post-stent implantation were observed in 7 cases. Six cases of congenital heart disease were diagnosed with 3 ASD and 3 primary pulmonary hypertension. Another one was diagnosed with left atrial myxoma, and 5 cases were pulmonary embolism associated with CAD. All of above cases were verified by final clinical diagnosis. （2） The heart function parameters including LVEDd , RVEDd, LVESd, RVESd and LVEF were （36. 7 ± 3.3 ）, （43.3±3.4） mm,（31.6±5. 1）, （41.3 ±5.1） mm and （47. 1 ±15. 1） for CT, while those were （40.3 ±3. 1）, （47.3 ± 4. 2） mm, （ 37. 3 ± 5.6 ）, （ 45.3± 3. 3 ） mm, and （ 46.0 ± 14. 8 ） for ultrasound, respectively. The CT results were correlated with the ultrasound （ n = 35, r = 0. 886-0. 988, P 〈 0. 01 ） . （ 3 ） The average radiation exposure was （ 5.4± 0. 5 ） mSv. Conclusions 320-row CT ECG-gated double phase cardiac function scan mode is feasible for the ＂one-stop-shop＂ examination of the cardiovascular disease. This noninvasive method is recommended for the diagnosis, differential diagnosis, treatment and prognosis of cardiovascular disease.