急性胸痛“一站式”三联CT血管造影检查技术的应用研究

Study on the application of "one-stop" triple-rule-out CT angiography examination for patiants of acute chest pain

目的:对急性胸痛患者行128层螺旋CT三联CT血管造影(CTA)扫描,评价其图像质量,分析影响检查成功率的因素,探讨其临床应用价值。方法:37例急诊科及心脏科提供的急性胸痛患者,怀疑为胸痛三联征之一者,行三联CTA检查,由2名放射科副主任医师对图像进行后处理并作出诊断报告,同时对图像质量进行主观评分。结果:37例患者中,29例图像质量为优,8例为良,所有图像质量均可以满足诊断需要;检查结果分析:主动脉病变(包括夹层、溃疡、壁间血肿等)为10例,肺栓塞6例,冠状动脉粥样硬化伴不同程度狭窄5例,冠心病伴肺栓塞1例,冠状动脉旁路移植术后再狭窄2例,其他胸部及胸廓病变(如肺炎,肿瘤等)3例,未见异常10例。结论:多排螺旋CT可以在较短的时间成本和高效的检出价值基础上,快速甄别急性胸痛的原因;在严格的质量控制下,128层螺旋CT可获得可满足诊断要求的三联CTA图像。

Objective： To evaluate the image quality of 128-slice spiral CT triple-rule-out CTA scans in patients with acute chest pain,analyze the factors that affect the success rate of examination,and discuss its clinical application value. Methods： A total of 37 patients with acute chest pain,who were suspected of being chest pain triad,underwent triple CTA examination,and 2 deputy chief physicians of radiology performed postprocessing of the images and made diagnostic reports. Meanwhile,the quality of the images was scored subjectively. Results： In the 37 patients,image quality of 29 cases is excellent,8 is good,all image quality can meet the diagnostic needs; examination result analysis： aortic lesions（ including dissection,ulcer,intramural hematoma） in 10 cases,6 cases of pulmonary embolism,coronary atherosclerosis with different degree of stenosis in 5 cases,coronary heart disease complicated with pulmonary embolism in 1 cases,restenosis after coronary artery bypass grafting in 2 cases,the other chest and thoracic lesions（ such as pneumonia,cancer） in 3 cases,10 cases were normal. Conclusion： multi slice spiral CT can quickly discriminate the causes of acute chest pain on the basis of shorter time cost and high detection value. Under strict quality control,128 slice spiral CT can get triple CTA images that can meet the diagnostic requirements.