不同重组视野影响冠状动脉支架成像质量及支架内再狭窄的初步研究

A Preliminary Study of the Influence of Different Reconstruction FOV for Coronary Stent Imaging Quality and ISR

目的评估宝石CT高清HD-Detail模式下视野(FOV)的变化对冠状动脉支架成像质量的影响及对支架内再狭窄的检出率。方法搜集冠状动脉支架植入术后随访的患者76例,均行标准化的宝石CT高清冠状动脉扫描。扫描图像以不同FOV进行重组,以标准扫描FOV 25 cm为参照,对比不同重组FOV 15 cm、10 cm图像质量并进行统计学分析。另与32例同期行冠状动脉造影(CAG)检查的患者结果做一致性分析。结果对支架的客观指标(支架腔内直径、支架内CT值差值及信噪比)进行测量并进行配对t检验,差异有统计学意义(P<0.05);图像主观评分:对比标准扫描FOV,在小视野重组下对支架所在冠状动脉评分值较高,差异有统计学意义(P<0.05);与"金标准"CAG对比,小FOV 10 cm重组图像对于支架再狭窄诊断的灵敏度(94.4%)、阳性预测值(89.5%)及诊断符合率(93.1%)显著提高,且小FOV重组与CAG检查对于支架再狭窄的检出率具有高度一致性(K=0.853)。结论宝石CT HD高清扫描HD-Detail重组模式下,当减小FOV时,能够有效改善冠状动脉支架细节及支架管径内部的显示,提高支架血管的可判读性,对支架再狭窄的判别性更高。

Objective To evaluate the effect of FOV changes in HDCT of HD-Detail mode on the imaging quality and the detection rate of ISR. Methods 76 patients were enrolled in this study and underwent coronary CT angiography on HDCT with high-resolution（ Hi-Res） scan mode. For each patient,images with regular FOV（ 25 cm） and small FOV（ diameter of 15 cm and 10 cm） was reconstructed respectively,other reconstruction parameters were the same and consistent with the results of 32 patients who underwent coronary angiography during the same period. Results 1. Measured the objective indicator of the stent（ In-stent lumen diameter,ΔCT and SNR）,analyzed by paired t test,the difference was statistically significant（ P 〈 0. 05）. 2. The subjective score： In the DFOV reconstruction coronary stent where the coronary score value is higher,the difference was statistically significant（ P 〈 0. 05）. 3. Contrast with the gold standard CAG,the sensitivity（ 94. 4%）,positive predictive value（ 89. 5%） and diagnostic coincidence rate（ 93. 1%） of DFOV had significantly improved. DFOV reconstruction and CAG had a high degree of consistency in the ISR（ Kappa = 0. 853）. Conclusion HDCT HD-Detail mode with DFOV can effectively improve the visualization of coronary stents and the display of internal stent details,raise the interpretation of vessel of stent and enhanced the interpretation of ISR.