胸痛三联一站式动态容积CT检查的临床价值及意义

Clinical value and significance of one-step examination using dynamic volume CT in the acute chest pain triad syndrome

目的提高胸痛三联一站式动态容积CT检查的临床诊断价值。方法选择76例急性胸痛患者行320排一站式动态容积CT检查。通过多平面重建（MPR）、最大密度投影（MIP）、曲面重建（CPR）及容积再现（VR）等后处理技术显示肺动脉、胸主动脉及冠状动脉。结果所有患者均检查成功，并清晰地显示了冠状动脉、肺动脉、胸主动脉及肺部情况。图像质量为5分者59例，4分者17例，优良率为100％。64层螺旋CT血管成像检查优良率为42．6％，优良率明显低于320排一站式动态容积CT检查（P〈0．05）。76例急诊胸痛患者，27例冠状动脉狭窄，16例主动脉夹层动脉瘤，13例肺动脉栓塞，气胸2例，18例正常。76例急诊胸痛患者中死亡2例，其中1例因肺动脉广泛栓塞死亡，1例因主动脉夹层动脉瘤术前破裂死亡；其余74例均病愈出院。结论胸痛三联一站式动态容积CT检查能一次性显示冠状动脉、胸主动脉及肺动脉，对急性胸痛患者的病因诊断具有很高的临床价值及意义。

Objective To explore the clinical value of one-step imaging technology using dynamic volume CT in the acute chest pain triad syndrome. Methods A total of 76 patients underwent one-step examination using 320-row detector dynamic volume CT. Multi-planar reconstruction （MPR）, maximum intensity projection（MIP） , curved planar reformation（ CPR）, and volume rendering（VR） was performed in all patients to display pulmonary artery, thoracic aorta and coronary artery. Results Coronary artery trunk and main branches, pulmonary artery and branches, the thoracic aorta and thoracic structures of all patients could be clearly displayed. Image quality of 59 cases were 5 points, 17 cases of 4 points, fine rate was 100%. Fine rate of 64 slice spiral CT angiography examination was 42.6% , significantly lower than one-step examination using dynamic volume CT（ P 〈 0.05 ）. In 76 cases of emergency patients with chest pain, 27 cases of coronary artery stenosis, 16 cases of aortic dissecting aneurysm, 13 cases of pulmonary embolism, 2 case of pneumothorax, and normal in 18 cases. 2 cases died in 76 cases of emergency chest pain, 1 case died due to pulmonary embolism extensively, 1 case died for aortic dissecting aneurysm rupture before operation; the 74 cases were recovered. Conclusions The one-step examination using dynamic volume CT can complete the scan of coronary artery, thoracic aorta, and pulmonary artery on one time, it has very high clinical value in etiological diagnosis of acute chest pain.