多层螺旋CT首过及延迟心肌灌注结合冠状动脉CTA评价心肌活性的研究

Multislice spiral CT first pass and delayed myocardial perfusion imaging combined with coronary CTA evaluation of myocardial viability

目的探讨多层螺旋CT心肌首过及延时灌注成像结合冠状动脉CT血管成像(CTA)在识别及定位心肌活性中的诊断价值。方法对23例临床可疑冠心病患者,测定冠状动脉CTA责任血管与病变节段心肌的对应关系,测量正常心肌、缺血心肌首过及延时灌注CT值的差异性;391个节段心肌根据心肌强化方式、部位,判定心肌是否存活,并对缺血心肌进行分类。结果心肌缺血部位与其责任血管有良好的对应关系,心肌首过灌注时正常心肌CT值高于缺血心肌,而延时灌注时正常心肌CT值低于缺血心肌,两者间差异有统计学意义(P<0.05);391个节段心肌,包含321个节段存活心肌,18个节段缺血心肌(可逆性心肌包括6例心肌缺血,3例心内膜下心肌梗死;无活性心肌为4例透壁性心肌梗死;混合型5例)。结论多层螺旋CT首过及延迟灌注显像结合冠状动脉CTA能够识别及定位缺血心肌,并诊断其有无活性。

Objective To explore multislice CT myocardial first pass and delay perfusion imaging combined with coronary CTA in identifying and locating the diagnostic value of myocardial activity. Methods Determination of 23 cases of patients with clinically sus- pected coronary heart disease, coronary CTA responsible blood vessels and myocardial lesion segments corresponding relation;Measure the normal myocardium,ischemic myocardial first and delay perfusion CT value difference;391 segment myocardial according to strength- ening methods, site, determine whether the myocardial survive, and classify the myocardial isehemia. Results Myocardial ischemia area and its responsible blood vessels have good corresponding relationship. Myocardial first too perfusion during normal CT value is higher than that of ischemie myocardium, and delay perfusion in normal cardiac CT value is lower than the ischemic myocardial perfusion （P 〈 0.05 ）. Myocardial section 391, contains 321 segmental survival myocardium, 18 segmental ischemic myocardium （reversible myocardial including 6 cases of myocardial ischemia,3 cases of myocardial infarction;beneath the inactive myocardial for 4 cases of myocardial in- farction wall permeability hybrid 5 cases）. Conclusion MDCT first and delayed perfusion imaging combined with coronary CTA can i- dentify and locate isehemie myocardium, and diagnose the presence of activity.