冠状动脉支架术后CTA成像的优化应用及再狭窄危险因素分析

The optimization of CTA imaging and the analysis of risk factors for the patients of coronary artery stent

目的:探讨Siemens Definition Flash Stellar双源CT冠状动脉支架成像最佳重组方案及支架再狭窄相关危险因素。方法:连续收集345例行冠状动脉支架CTA患者,填写自制危险因素调查表,所得图像原始数据采用0.75 mmBf26、0.75 mmBf46、0.75 mmIf46、0.60 mmIf46及0.50 mmIf465组不同重建参数进行重建。测量各重组图像的噪声(SD)值,计算CNR,并分级评价图像质量。最后分析再狭窄相关危险因素。结果:345例共511个支架,其中支架再狭窄29例(8.4%)。不同重建参数图像中,图像噪声值、CNR及支架内噪声值比较差异均有统计学意义(均P<0.005);卷积核参数Bf46图像优于Bf26图像,图像质量分级差异有统计学意义(P<0.05);0.50 mmIf46图像质量在小支架中最优,组间差异均有统计学意义(均P<0.005)。回归分析显示:血压、每日吸烟支数、糖化血红蛋白、支架直径、支架长度及支架植入数量差异均有统计学意义(均P<0.05)。结论:锐利算法(Bf46)结合迭代重建图像能最大程度显示支架内部管腔,小支架中以0.50 mmIf46显示最佳。血压、每日吸烟支数、糖化血红蛋白、支架长度及支架植入数量可能为支架再狭窄的危险因素,支架直径可能为支架再狭窄的保护因素。

Objective:To explore the best recombination imaging of Siemens Definition Flash Stellar CT and the related risk factors of stent restenosis in coronary artery stent.Methods:Patients undergoing coronary stent CTA were continuously collected.Patients filled in self-made risk factor questionnaire during the examination.The original image data were reconstructed with different reconstruction parameters,included 0.75 mmBf26,0.75 mmBf46,0.75 mmIf46,0.60 mmIf46 and 0.50 mmIf46.The noise value of each reorganized image was measured.The CNR was calculated and the image quality was evaluated.Finally,the risk factors of restenosis were analyzed according to the results of stent diagnosis.Results:A total of 345 patients(511 stents)were collected,among which 29 patients(8.4%)had stent restenosis.In the reconstructed images,the image noise value,CNR and in-stent noise value were statistically significant among groups(all P<0.005).The image quality of Bf46 was better than Bf26,and the image quality grading had statistical significance between groups(P<0.05).0.50 mmIf46 had the best image quality among small scaffolds,and the image quality grading had statistical significance among groups(P<0.005).Regression analysis showed that blood pressure,daily smoking,HbA1c value,stent diameter,stent length and number of stent implantation were statistically significant(all P<0.05).Conclusions:Sharp algorithm(Bf46)combined with iterative reconstruction can display the inner lumens of scaffolds in the maximum extent,and 0.50 mmIf46 is the best display in small scaffolds.Blood pressure,smoking history,diabetes,stent length and number of stent implantation may be the risk factors for stent restenosis,and stent diameter may be the protective factors for stent restenosis.