中国心血管影像技术应用现状调查与医疗质量报告

Survey of the Application Status of Cardiovascular Imaging Modalities and Medical Quality Report in China

无创心血管影像技术的应用,正逐渐成为稳定性冠心病诊断的主力军。然而,目前在我国缺乏诊断冠心病影像学技术应用情况的调研数据。“心血管影像质控专家工作组”于2018年开始,对全国二级以上医院进行随机抽样横断面调查,结果显示经导管冠状动脉造影的开展率为65.8%,冠状动脉CT血管成像(CTA)的开展率为64.5%,而负荷超声心动图(9.0%)、心脏磁共振成像(13.5%)及核素心肌灌注显像(12.9%)等检查技术均未得到广泛开展。本研究通过收集冠状动脉CTA操作规程及原始图像,对图像质量进行评估,结果显示三级医院冠状动脉CTA图像质量优良率为90.8%,二级医院为87.3%,检查失败率分别为3.7%和8.5%。无论三级医院(平均11.5 mSv)还是二级医院(平均12.7 mSv),给予患者的辐射剂量均过高。本次调查还包括放射影像工作人员现状,以及其它常见心血管病的影像检查现状。通过本次调查,得到以下初步结论:冠状动脉CTA检查成为我国冠心病早期诊断和筛查的主要技术工具,其普及使用率与经导管冠状动脉造影接近,而负荷超声心动图、心脏磁共振成像和核素心肌灌注显像技术的应用明显不足。冠状动脉CTA图像质量基本能够满足临床诊断要求,但是有进一步提高图像质量的空间,特别是低辐射剂量的规范化扫描技术亟待普及提高。

Non-invasive cardiac imaging technologies are promising tools for diagnosis of stable coronary artery disease(CAD).However,data about the status of the application using non-invasive imaging technologies for diagnosis of CAD in China are scanty now.A randomized sampling and cross-sectional survey all over China was performed by“the expert working group of cardiovascular imaging”beginning from 2018.The primary results showed that the utilization rate was as follows:invasive coronary angiography,65.8%;coronary computed tomography angiography(CTA),64.5%;stress echocardiography,9.0%;cardiac MRI,13.5%and nuclear myocardial perfusion imaging,12.9%.Coronary CTA image data were collected and evaluated,and the image quality was scored.Results showed that the rates of excellent and good image quality were 90.8%and 87.3%,whereas the rates of examination failure were 3.7%and 8.5%in the tertiary hospitals and secondary hospitals,respectively.The radiation dose given to coronary CTA patients was too high both in tertiary(11.5 mSv)and secondary hospitals(12.7 mSv).This cross-sectional survey also investigated the status of staff members in the department of radiology,as well as status of imaging examination for other common cardiovascular diseases.Based upon the survey,we conclude that coronary CTA is the major diagnostic tool for the early detection and screening of CAD,similarly to invasive coronary angiography.But stress echocardiography,cardiac MRI and myocardial perfusion imaging are underused in China.Coronary CTA image quality is sufficient to make correct diagnosis in general,but there is space for improvement.The standardized protocols for reduction of radiation dose to coronary CTA patients should be extensively introduced and followed.