双源CT功能成像对扩张型心肌病的诊断价值

Diagnosis of dilated cardiomyopathy by dual-source CT functional imaging

目的探讨双源CT（DSCT）在扩张型心肌病（DCM）诊断中的应用价值。方法对13例临床确诊为DCM的患者（男9例，女4例，年龄9～74岁，平均48．85±18．96岁）行DSCT冠脉造影检查，利用心功能分析软件评价左室形态与功能，并与13例性别及年龄相匹配的正常人对照，分析DCM患者左心室结构、功能变化及冠状动脉病变特点。结果13例DCM患者DSCT均明确诊断。DCM组Dd、Ld、SI及LADd均大于对照组。DCM组基底部室壁厚度小于对照组，中部及心尖部室壁厚度与对照组相仿，差异无统计学意义。对照组室壁增厚率从基底部到心尖部逐渐递增，DCM组左室各节段（S1～S17）室壁增厚率均小于对照组，且基底部到心尖部室壁增厚率差异无统计学意义。DCM组左室MM、EDV、ESV大于对照组，EF小于对照组；SV、CO、CI虽然小于对照组，但差异无统计学意义。7例DCM患者冠状动脉正常，5例左、右冠状动脉管壁见少量钙化斑块，管腔狭窄程度均小于30％。结论DSCT实现了对DCM解剖形态学、功能学及冠状动脉病变的“一站式”评估，在DCM诊断中具有广阔的临床应用前景。

Objective To evaluate the clinical application of dual-source CT （DSCT） in the diagnosis of dilated cardiomyopathy （DCM）. Methods The clinical data and DSCT imaging of 13 cases with confirmed DCM and 13 normal controls were analyzed retrospectively. Results 13 cases of DCM were clearly diagnosed by DSCT. Dd, Ld, SI and LADd in the DCM group were significantly greater than in the control group. The basal wall thickness in the DCM group was smaller than in the control group, while there were no significant differences in the middleand apical wall thickness between the DCM and control groups. WT increases gradually in the control group from basal to apical wall, and the difference was statistically significant. WT of all segments （S 1 N S 17） in the DCM group were significant lower than in the control group, and there were no significant differences in WT from basal to apical wall in the DCM group. MM, EDV and ESV in the DCM group were significantly greater than those in the control group. EF in the DCM group was significantly smaller than that in the control group. SV, CO and CI in the DCM group were smaller than those in the control group, but the differences were not statistically significant. Of all the 13 cases with DCM, 7 cases did not have obvious lesions in coronary angiography and one case had mild atheromatous plaque. The degrees of coronary artery stenosis were below 30 %. Conclusion DSCT is a promising modality to assess DCM, which can provide one-stop noninvasive evaluation of cardiac morphology, function, as well as coronary artery anatomy.