256排160 mm探测器CT冠状动脉成像联合心肌灌注成像在冠心病心肌缺血中的应用

Application of 256-slice 160 mm wide-detector CT coronary angiography combined with myocardial perfusion imaging in myocardial ischemia of coronary heart disease

目的:初步探讨256排160 mm宽体探测器CT冠状动脉成像(CCTA)联合CT心肌灌注成像(CT-MPI)一站式扫描方案在冠心病心肌缺血中的临床应用价值。方法:应用256排CT(探测器宽度16 cm)对2017年1月—2017年11月就诊疑似或确诊冠心病患者73例行一站式CCTA联合CT-MPI,以SCCT-18段为标准,评价CCTA图像质量,以AHA-17段模型为参考,计算心肌血流量(MBF),比较心肌灌注正常区域和灌注异常区域的MBF数值。将冠状动脉造影(CAG)作为诊断的金标准,评价CCTA和CT-MPI的诊断准确性,统计扫描方案的有效辐射剂量。结果:73例完成CCTA联合CT-MPI检查的患者中,32例(43.8%)患者中的154个(15.9%)心肌节段有血流灌注缺损,MBF值低于血流灌注正常心肌节段[(71±26)mL·100 mL^(-1)·min-1vs(113±33)mL·100 mL^(-1)·min-1;t=15.971,P=0.000]。CCTA中,图像质量可用于诊断的节段为1 026个(95.5%)。随后,46例患者后续完成CAG检查,CCTA对CAD诊断的敏感性、特异性以及准确性分别为91.4%、93.2%、93.0%,CT-MPI对CAD诊断的敏感性、特异性及准确性分别为85.3%、83.3%、84.8%。CCTA联合CT-MPI一站式扫描方案总有效辐射剂量为(4.6±1.2)m Sv[包含CCTA扫描有效辐射剂量:(2.2±0.6)m Sv)],对比剂总用量为65 mL,生理盐水用量为50 mL。结论:256排CT联合扫描方案可一站式获得良好的CCTA和CT-MPI图像,在较低辐射剂量水平下,保障较高的诊断价值。

Objective： To investigate the clinical application of one stop imaging of coronary angiography（ CCTA） combined with myocardial perfusion imaging（ MPI） using 256-slice 160 mm wide-detector CT in myocardial ischemia of coronary heart disease. Methods： All 73 cases of suspected or confirmed coronary heart disease patients under-went one-stop coronary artery imaging combined with myocardial perfusion imaging using 256 slice CT（ detector width 16 cm） from January to November 2017. According the standard of SCCT-18 segments,CCTA image quality was evaluated. According the reference of model AHA-17,the myocardial blood flow（ MBF） was calculated and compared between that of normal and abnormal segments. Coronary angiography（ CAG） as the gold standard,the diagnostic accuracy of CCTA and MPI were evaluated. And the effective radiation dose was counted. Results： Among 73 patients underwent CCTA combined with CT-MPI examination,32 patients（ 43. 8%） with 154 myocardial segments（ 15. 9%） were detected blood perfusion coming down,the MBF value was lowerthan that of normal segments [（ 71 ± 26） mL ·100 mL-1·min-1 VS（ 113 ± 33） mL ·100 mL-1·min-1; t = 15. 971,P = 0. 000]. There were 1 026 segments（ 95. 5%） whose quality can be used for the diagnosis in CCTA. 46 patients were followed up for CAG,and the diagnostic sensitivity,specificity and accuracy of CCTA for CAD were 91. 4% 、93. 2% 、93. 0% respectively. The diagnostic sensitivity,specificity and accuracy of MPI were 85. 3% 、83. 3% 、84. 8% respectively. The total effective radiation dose of one stop scanning CCTA combined with CT-MPI was（ 4. 6 ± 1. 2） m Sv which including the radiation dose of CCTA（ 2. 2 ± 0. 6） m Sv. Conclusion： Both good CCTA and CT-MPI images can be obtained at the one stop scanning by 256-slice 160 mm wide-detector CT. It has high potential for clinical application because of its high diagnostic value and low radiation dose.