多排螺旋CT血管成像和延迟强化成像在诊断冠心病心肌梗死病灶中的价值

The value of multidetector CT angiography and delayed enhancement imaging in the diagnosis of coronary heart disease with myocardial infarction

目的探讨多排螺旋CT检查对评估冠心病冠状动脉狭窄和心肌梗死病灶的可行性。方法收集自2017年4月—2018年4月在北京中医医院顺义医院诊断为心肌梗死并行心脏CT和心脏磁共振(CMR)检查的患者25例。心脏CT检查包括冠状动脉CT血管成像(CCTA)和延迟期扫描,CMR包括电影成像和延迟强化扫描。以CMR延迟强化作为参照标准,分析心脏CT延迟期图像检出梗死心肌的准确性。结果 CCTA结果示:以血管支为单位(每例3支计)计算,冠状动脉正常29支(38. 7%),管腔狭窄≤50%18支(24. 0%),冠状动脉管腔狭窄> 50%28支(37. 3%)。以CMR延迟强化图像为心肌梗死参照标准,以心肌节段为单位统计,以心肌节段为单位CT诊断敏感度63. 3%(69/109),特异度99. 1%(313/316),阳性预测值95. 8%(69/72),阴性预测值88. 7%(313/353),总体符合率89. 9%(382/425),kappa值0. 641(P <0. 01),一致性好。CT共有62个节段的延迟强化结果与CMR一致,比较CT与CMR测量的梗死病灶体积,可见二者的相关性良好(r=0. 623,P <0. 05)。结论以CMR作为诊断标准,CT延迟强化扫描可定性、定量准确检出在冠心病心肌梗死病灶,为冠心病的干预治疗提供信息。

Objective To investigate the feasibility of cardiac CT examination in evaluating coronary artery stenosis and myocardial infarction. Methods From October 2017 to April 2018, a total of 25 patients diagnosed as myocardial infarction in our hospital were collected. All patients underwent cardiac CT and cardiac magnetic resonance （CMR） examination. Cardiac CT examination included coronary artery CT angiography （CCTA） and delayed phase scan. CMR includes cine imaging and delayed enhanced scan. Taking CMR delayed enhancement as a reference standard, we analyzed the accuracy of detecting infarcted myocardium in CT delayed phase images. Results CCTA results showed that 2 cases （8.0%） were normal coronary artery, 9 cases （36.0%） were〈50.0% stenosis, 14 cases （56.0%） were〉50% stenosis in coronary artery. In terms of blood vessel branches, 29 cases（38.7%） coronary arteries were normal, 18 coronary arteries with〈50% stenosis （24.0%） and 28 coronary artery with〉50% stenosis （37.3%）. With CMR delayed enhancement image as the reference standard, the sensitivity, specificity, positive predictive value, negative predictive value and kappa value were 63.3% （69/109）, 99.1% （313/316）, 95.8% （69/72）, 88.7% （313/353）, 89.9% （382/425） and 0.641 （ P 〈0.01） respectively. Delayed enhancement CT has 62 segments showed the consistent results. The volume of fibrosis lesions measured by CT and CMR was compared. The correlation between the two parameters was good （ r =0.623, P 〈0.05）. Conclusion With CMR as the diagnostic standard, CT delayed enhanced scan can qualitatively and quantitatively detect myocardial infarction in coronary heart disease, and provide information for the intervention treatment of coronary heart disease.