宽体探测器CT冠状动脉成像联合CT-MPI一站式扫描方案在冠心病心肌缺血中诊疗价值分析

The Value of Wide Detector Coronary CT Angiography Combined with CT-MPI One-Stop Scanning Protocol in Diagnosis and Treatment of Coronary Heart Disease and Myocardial Ischemia

目的分析宽体探测器CT冠状动脉成像(CCTA)联合负荷动态CT心肌灌注成像(CT-MPI)一站式扫描方案在冠心病心肌缺血中的诊疗价值。方法选取2018年1月至2018年12月于我院就诊的疑似冠心病患者80例为研究对象,均进行一站式宽体探测器CCTA联合CT-MPI检查,选择SCCT-18段评估CCTA图像质量,参考AHA-17段模型,测量心肌灌注正常与异常区域的心肌血流量(MBF),以冠状动脉造影(CAG)为金标准,评估CCTA联合CT-MPI的诊断效能,并记录有效辐射剂量(ED)。结果宽体探测器CCTA共观察到1177个冠状动脉节段,其中1125个节段(95.58%)的图像质量可用于诊断,图像质量评分1分52个(4.42%)、2分113个(9.60%)、3分544个(46.22%)、4分468个(39.76%);CT-MPI下共评估心肌节段血流灌注情况840个,其中35例患者的134个心肌节段(15.95%)有血流灌注缺损,其MBF为(70.92±8.54)mL/(100mL·min),较血流灌注正常心肌节段(113.46±12.78)mL/(100mL·min)低(P<0.01);宽体探测器CCTA+CT-MPI一站式扫描诊断冠心病心肌缺血的灵敏度、特异度、准确度高于单独CCTA或CT-MPI检查。结论宽体探测器CCTA联合CT-MPI一站式扫描方案应用于冠心病心肌缺血诊疗中有较高价值,值得进一步推广。

Objective To analyze the value of wide detector coronary CT angiography(CCTA)combined with load dynamic CT myocardial perfusion imaging(CT-MPI)one-stop scanning protocol in the diagnosis and treatment of coronary heart disease and myocardial ischemia.Methods Eighty patients with suspected coronary heart disease who were treated in the hospital from January to December 2018 were selected as study subjects.All patients underwent one-stop wide detector CCTA combined with CTMPI.The CCTA images quality was evaluated with SCCT-18 segment.Referring to the AHA-17 model,the myocardial blood flow(MBF)in normal and abnormal areas of myocardial perfusion was measured,and the diagnostic efficiency of CCTA combined with CT-MPI was evaluated with coronary angiography(CAG)as the golden standard.The effective dose(ED)was recorded.Results A total of 1177 coronary artery segments were observed by wide detector CCTA.The image quality of 1125 segments(95.58%)could be used for diagnosis.There were 52 segments(4.42%)with image quality score of 1 point,113(9.60%)with 2 points,544(46.22%)with 3 points and 468(39.76%)with 4 points.The blood perfusion of 840 myocardial segments was evaluared by CT-MPI.There were 134 myocardial segments in 35 patients(15.95%)with perfusion defects,and the MBF[(70.92±8.54)mL/(100mL·min)]was lower than that of the normal myocardial segment[(113.46±12.78)mL/(100mL·min)](P<0.01).The sensitivity,specificity and accuracy of one-stop scanning of wide detector CCTA combined with CT-MPI for diagnosis of myocardial ischemia in coronary heart disease were higher than those of CCTA or CTMPI alone.Conclusion The wide detector CCTA combined with CT-MPI one-stop scanning protocol is of great value in the diagnosis and treatment of myocardial ischemia in coronary heart disease.