CT-MPI结合CCTA诊断冠心病心肌缺血的应用价值

Application of Dynamic CT Myocardial Perfusion Combined With Coronary CT Angiography in Diagnosis of Myocardial Ischemia in Coronary Heart Disease

目的评价负荷动态CT心肌灌注(CT-MPI)结合冠状动脉CT血管成像(CCTA)在冠心病心肌缺血诊断中的应用效果。方法选择2018年6月—2019年5月于我院治疗的疑似冠心病心肌缺血患者74例。入选者均接受CCTA、CT-MPI检查。观察CCTA、CCTA+CT-MPI诊断结果及对比造影剂剂量、放射剂量、管腔狭窄比例、斑块长度,以冠状动脉造影检查作为金标准,评估CCTA、CCTA+CT-MPI诊断敏感度、特异度、准确率。结果CCTA+CTMPI诊断敏感度(94.64%)、特异度(77.78%)、准确率(90.54%)高于CCTA的(67.86%)、(33.33%)、(59.46%),差异有统计学意义(P<0.05);CCTA+CT-MPI诊断斑块长度(11.39±0.57)mm、管腔狭窄比例(65.80±1.54)%,高于CCTA的(6.24±0.32)mm、(53.56±1.18)%;放射剂量(8.12±0.04)mSv、对比造影剂剂量(89.74±0.93)mL,低于CCTA的(9.26±0.08)mSv、(114.36±1.57)mL,差异有统计学意义(P<0.05)。结论CT-MPI结合CCTA可作为冠心病心肌缺血诊断中准确方法,利于减少放射剂量及造影剂剂量,评估斑块病变及冠脉狭窄程度,提升疾病检出率。

Objective To evaluate the effect of dynamic CT myocardial perfusion(CT-MPI)combined with coronary CT angiography(CCTA)in the diagnosis of myocardial ischemia in coronary heart disease.Methods 74 patients with suspected coronary heart disease and myocardial ischemia were selected from June 2018 to May 2019.All the candidates were examined by CCTA and CT-MPI.The diagnostic results of CCTA and CCTA+CT-MPI were observed and compared with the dose of contrast medium,radiation dose,ratio of lumen stenosis and plaque length.The sensitivity,specificity and accuracy of CCTA and CCTA+CT-MPI were evaluated by using coronary angiography as the gold standard.Results The diagnostic sensitivity(94.64%),specificity(77.78%)and accuracy(90.54%)of CCTA+CT-MPI were higher than those of CCTA(67.86%),(33.33%)and(59.46%)(P<0.05).The diagnostic plaque length(11.39±0.57)mm and lumen stenosis ratio(65.80±1.54)%of CCTA+CT-MPI were higher than those of CCTA(6.24±0.32)mm,(53.56±1.18)%,radiation dose(8.12±0.04)mSv,contrast agent dose(89.74±0.93)mL were lower than those of CCTA(9.26±0.08)mSv,(114.36±1.57)mL,the difference was statistically significant(P<0.05).Conclusion CT-MPI combined with CCTA can be used as an accurate method in the diagnosis of myocardial ischemia in coronary heart disease.It is helpful to reduce the dose of radiation and contrast agent,evaluate the degree of plaque lesion and coronary stenosis,and improve the detection rate of disease.