光谱CT心肌多参数成像在经皮冠状动脉介入术术前无创评估中的应用

The application of spectral CT multiparametric myocardial imaging in preoperative non-invasive assessment for percutaneous coronary intervention

目的探讨双层探测器光谱CT心肌多参数图像在冠心病患者经皮冠状动脉介入术(PCI)术前无创评估中的应用价值。方法回顾性分析2021年1月至2022年10月在南通大学附属常熟医院采用双层探测器光谱CT行冠状动脉CT血管成像(CCTA)检查并于30 d内接受侵入性冠状动脉造影(ICA)检查的90例患者的临床及影像数据,共纳入189支冠状动脉。根据患者行ICA检查评估后是否接受PCI治疗,将患者分为PCI组(44例)和非PCI组(46例)。基于CCTA及光谱CT心肌多参数图像获取患者冠状动脉的直径狭窄率、心肌碘浓度(IC)值、有效原子序数(Zeff)值。比较灌注异常区心肌及灌注正常区心肌的IC值及Zeff值,通过受试者操作特征(ROC)曲线及曲线下面积(AUC)评价并比较冠状动脉管腔直径狭窄率、心肌IC值、Zeff值及其联合模型在冠心病患者PCI术前评估中的价值。结果PCI组和非PCI组间患者基线资料差异均无统计学意义(P均>0.05)。所有患者灌注异常区心肌与灌注正常区心肌的IC值[分别为(0.42±0.28)、(2.26±0.48)mg/ml]、Zeff值(分别为7.39±0.33、8.50±0.25)差异有统计学意义(P均<0.001)。利用心肌IC值和Zeff值评估冠心病患者是否需要进行PCI治疗的AUC分别为0.865和0.853,显著高于单纯的管腔直径狭窄率评估(AUC=0.726,P均<0.001)。结论光谱CT心肌灌注IC值、Zeff值可以诊断冠心病患者心肌灌注异常,使用光谱CT心肌多参数图像对患者进行PCI术前评估可以提高评估的效能,避免额外的侵入性操作。

Objective To investigate the clinical value of multiparametric myocardial imaging using a dual-layer detector spectral CT in the non-invasive preoperative assessment of patients with coronary atherosclerotic heart disease(CHD)undergoing percutaneous coronary intervention(PCI).Methods The clinical and imaging data of 90 patients who underwent coronary CT angiography(CCTA)with dual-layer spectral detector CT and invasive coronary angiography(ICA)within 30 days at the Affiliated Changshu Hospital of Nantong University from January 2021 to October 2022 were retrospectively analyzed.A total of 189 coronary arteries were included in the study cohort.The patients were divided into PCI(n=44)and non-PCI groups(n=46)according to whether they received PCI after evaluation with ICA.The diameter stenosis rate of the coronary arteries,myocardial iodine concentration(IC)and effective atomic number(Zeff)values were obtained from CCTA conventional and spectral images.The IC values and Zeff values of the myocardium in the areas with abnormal perfusion were compared with those in the areas with normal perfusion.The diagnostic performance of these parameters,as well as their combined model,was evaluated and compared using receiver operating characteristic(ROC)curve and area under the curve(AUC)in the pre-PCI assessment of patients with CHD.Results Baseline patient data did not show statistically significant differences between the PCI and non-PCI groups(all P>0.05).There were statistically significant differences in IC values[(0.42±0.28)and(2.26±0.48)mg/ml]and Zeff values(7.39±0.33 and 8.50±0.25)between the myocardium areas with abnormal perfusion and the myocardium areas with normal perfusion in all patients(all P<0.001).The AUC for assessing whether patients with CHD need PCI treatment using myocardial IC and Zeff values were 0.865 and 0.853,respectively,which were significantly higher than assessment based only on lumen diameter stenosis rate(AUC=0.726,P<0.001).Conclusions The IC and Zeff derived from myocardial spectral images can be used to diagnose myocardial perfusion abnormalities in patients with CHD.The spectral myocardial multi-parameters imaging shows promising potentials in pre-PCI assessment of patients with CHD,which can improve the efficiency of evaluation and may help to avoid unnecessarily invasive procedures.