双源CT在主动脉瓣置换术前左心功能评价中的应用

The application of dual-jourse computed tomotraphy to eraluate the global left ventricular function in aortic valve replacement

目的:以磁共振成像(MRI)为金标准,用双源CT(DSCT)定量评价左心功能,探讨DSCT在主动脉瓣置换术前左心功能评价中的应用价值。方法:选取临床诊断主动脉瓣病变欲行主动脉瓣置换术的患者21例,全部病例均行DSCT和MRI心功能分析检查。由有经验的2位放射科医生独立进行,结果以均数±标准差表示。两种仪器间测量值应用配对样本t检验及相关分析检验,同一仪器测量值的差异相互关系用组内相关系数描述,P<0.05为有统计学意义。结果:DSCT和MRI两种方法测量的心功能指标差异无统计学意义,舒张末期容积(EDV)、收缩末期容积(ESV)、每搏输出量(SV)、左室射血分数(EF)相关性高,r值(EDV)=0.93,r值(ESV)=0.94,r值(SV)=0.89,r值(EF)=0.85。EDV均值:DSCT>MRI;ESV均值:DSCT>MRI;SV均值:DSCT>MRI;EF均值:DSCT>MRI。同一仪器三次测量值的差异相互关系(ICC值):MRI测量的EDV、ESV、SV、EF值的ICC值在0.8～1之间;DSCT测量的EDV、ESV、SV、EF值的ICC值在0.6～0.75之间。结论:DSCT在左心室收缩功能定量评价方面准确、可靠,重复性好,并可在不增加放射剂量的前提下,一次DSCT冠状动脉造影检查同时评估冠状动脉狭窄情况和左心室收缩功能,能够为临床主动脉瓣置换术前评估及制订手术方案提供更多重要的参考信息。

Objective：To evaluate diagnostic accuracy of dual source computed tomography （DSCT） for evaluation of left ventricular （LV） function quantification in aortic valve replacement, with magnetic resonance imaging （MRD as the refer- ence standard. Methods ~ We evaluated atotalof 21 patients （9 men,12 womem mean age years 56.7） who underwent both DSCT and MRI. Patients with aortic valve disease who were scheduled to undergo aortic valve replacement（AVR）. Left ventricular ejection fraction, end-diastolic volume, endsystolic volume, stroke volume weremanually assessed for each pa- tient by two blinded readers. Intraobserver variability was calculated using paired-samples t-test and interobserver variabili- ty was calculated using analysis of variance of repeated measure. Their agreement was measured using the intraclass corre- lation coefficient （ICC）. Results： There was no significant difference among the measurements for DSCT and MRI of the ventricular function parameters. A strong correlation between DSCT and MRI （ r =0.85-0.94） was found for all param- eters. However, EDV, ESV, SVand EF were overestimated with DSCT compared to ICC in MRI （EDV, ESV, SV, EF） was 0.8-1, in DSCT （EDV, ESV, SV, EF） was 0.6-0. 75, respectively. Conclusion：A strong correlation between DSCT and MRI is found for all parameters ECG-gated DSCT angiography can evaluate the coronary tree, whereas the a- nalysis of left ventricular parameters provides additional information of cardiac function without further radiation exposure or scan time.