320排容积CT用于冠脉检查阴性结果患者的左心室心肌灌注评价的初步研究

A Preliminary Study of 320-row Volume CT in Evaluating the Left Ventricular Myocardial Perfusion in Patients with Negative Results of Coronary Artery Examination

目的:利用320排容积CT对冠状动脉(冠脉)造影检查阴性结果患者的左心室心肌灌注进行评价,探讨其临床应用价值。方法:回顾性分析520例行冠状动脉血管造影(CTA)和数字减影血管造影(DSA)检查患者病例(CTA与DSA检查间隔不超过1周),筛选出60例两项检查结果均为冠状动脉结果阴性的病例。将重建的心脏CT数据导入Vitrea2.0工作站分析左心室透壁心肌灌注指数(TPR),分析左心室各节段TPR值及其差异性,并同时分析每例CT检查的辐射剂量。结果:①冠状动脉检查结果阴性患者的左心室各节段(16节段)平均TPR约为1.11±0.15。前降支、左回旋支及右冠状动脉供血区域组正常冠脉对应心肌平均TPR值分别约为1.16±0.17、1.07±0.13及1.10±0.14,各供血区域组TPR值存在一定的差异性,组内各节段TPR值存在一定差异性。②平均CT射线辐射剂量约为(7.04±2.06)mSv。结论:320排容积CT对冠脉检查阴性结果患者的左心室心肌灌注的分析显示,各供血区域内不同节段的TPR存在一定的差异,分析灌注图像时应该注意此类差异性,以避免假阳性诊断。320排容积CT心脏检查能够为具有相关临床症状而冠状动脉检查阴性的患者提供准确的心肌功能信息,为临床治疗决策提供更好的依据。其辐射剂量低,还能够清晰显示冠状动脉的解剖影像,实现心脏解剖形态及心肌功能检查。

Purpose:To evaluate the left ventricular myocardial perfusion of patients with negative results of coronary artery examination by 320-row volume CT,and to discuss its clinical value.Methods:A total of 520 patients with coronary artery CT and DSA(the interval between CT and DSA angiography was less than one week)were retrospectively analyzed.Sixty patients with negative coronary artery results were selected.The reconstructed cardiac CT data were imported into the Vitrea2.0 workstation to analyze the left ventricular transmural myocardial perfusion index(TPR),the TPR values and their differences in different segments of the left ventricle,and the radiation dose of each case were examined by CT at the same time.Results:(1)The average TPR of left ventricular segments(16 segments)in patients with negative coronary artery results was about 1.11±0.15.The average TPR values of normal coronary corresponding myocardium in anterior descending branch,left circumflex branch and right coronary artery were 1.16±0.17,1.07±0.13 and 1.10±0.14,respectively.There were differences in TPR values among different blood supply regions,and there were differences in each segment of the group.(2)The average radiation dose of the coronary artery CT is about 7.04±2.06mSv.Conclusions:The analysis of left ventricular myocardial perflision in patients with negative coronary artery results by 320-row volume CT showed that there were some differences in TPR of different segments in different blood supply areas.We should pay attention to such differences when analyzing perfusion images in order to avoid false positive diagnosis.It can provide accurate myocardial function information for patients with related clinical symptoms but negative coronary artery results,and provide a better basis for clinical treatment decision-making.The radiation dose of 320-row volume CT cardiac examination is low,and it can be used to clearly display the anatomical images of coronary artery,realize the examination of cardiac anatomy and myocardial function.