急性不典型胸痛患者320排CT心肺血管一站式成像分析

Value of triple rule out 320-detector-row CT angiography in acute atypical chest pain

目的探讨320排CT心肺血管一站式成像对急性不典型胸痛的诊断价值。方法收集79例表现为急性胸痛行320排CT心肺血管一站式成像检查的连续病例资料。对比剂使用三期双流速方案同时显示肺动脉、冠状动脉和胸主动脉,并测量三大血管强化CT值,评价图像质量及右心腔对比剂伪影。以传统冠状动脉血管造影为金标准,分析CTA诊断冠状动脉狭窄超过50%的准确性。结果所有患者肺动脉、冠状动脉、胸主动脉均得到良好强化。可诊断冠状动脉血管段比例为95.69%,仅有2例右心腔对比剂伪影影响右冠状动脉评价。所有患者中,22例结果为阴性,肺栓塞13例;胸主动脉病变16例,其中主动脉夹层9例,壁内血肿2例,穿透性溃疡3例,胸主动脉瘤2例;冠状动脉病变为17例,其中7例冠状动脉狭窄超过50%。以血管段为计算单位,CTA诊断冠状动脉狭窄的敏感性、特异性、阳性预测值、阴性预测值、准确度为90.91%、97.65%、83.33%、98.81%、96.88%。结论 320排CT心肺血管一站式成像能快速排查肺动脉、冠状动脉和胸主动脉病因,是急性胸痛鉴别诊断的有效方法。

Objective To evaluate triple rule-out 320-detector-row CT angiography in patients with acute atypical chest pain. Methods 79 consecutive patients with acute atypical chest pain underwent triple rule-out 320-detector-row CT angiography.Volume data were acquired in 3 phases after dual flow-rate contrast injection in the cranial-to-caudal direction.The pulmonary and coronary arterial and thoracic aortic attenuation values were measured.Image quality and streak artifacts from the right heart were evaluated. The sensitivity,specificity,positive predictive value,negative predictive value,and agreement rate for demonstrating 50%or greater coronary artery stenosis were calculated in comparison with conventional coronary angiography.Results The mean attenuation values of pulmonary arteries（370.35±101.34 HU）,coronary arteries（396.37±83.54 HU）and thoracic aorta（383.56±68.76 HU）were above the diagnostic threshold of 250 HU.Of 1069 coronary segments,801（95.69%）were evaluable with severe streak artifacts in 2.53%（2/79）.Findings included pulmonary embolism（13）,aortic dissection（9）,aortic intramural hematoma（2）,penetrating aortic ulcer （3）,thoracic aneurysm（2）,and coronary artery atherosclerosis（17）including 7 patients with significant lumen stenosis≥50%.There was high agreement（96.88%）of coronary artery assessment compared to conventional coronary angiography with 90.91%sensitivity, 97.65% specificity,83.33% positive predictive value,and 98.81% negative predictive value.Conclusion Triple rule-out CT angiography with 320-detector-row CT can rapidly exclude fatal causes of acute atypical chest pain in combined evaluation of pulmonary artery,thoracic aorta,and coronary artery.