64层螺旋CT三联检查在急性胸痛诊断中的应用  

Application of triple rule-out with 64-slice spiral CT in the diagnosis of acute chest pain

作　　者：李鹏雨[1] 李坤成[1] 杜祥颖[1] 曹丽珍[1] 刘佳宾[1] 杨延辉[1] 梁志刚[1] 祝小莲[1] 刘建[1] 

机构地区：[1]首都医科大学宣武医院放射科,北京100053

出　　处：《中华放射学杂志》2007年第10期1032-1035,共4页Chinese Journal of Radiology

基　　金：北京市科学技术委员会重大项目培养专项基金资助项目(Z0005190042691)

摘　　要：目的探讨64层螺旋 CT(MSCT)三联检查显示急性胸痛患者肺动脉、胸主动脉和冠状动脉病变的能力及其临床应用价值。方法 70例患者进行64层 MSCT 回顾性心电门控肺动脉、胸主动脉和冠状动脉联合检查。采用多平面重组(MPR)、最大密度投影(MIP)、曲面重组(CPR)及容积再现(VR)多种重组技术显示肺动脉、胸主动脉和冠状动脉,评价成像质量能否满足临床诊断需要。结果平均扫描时间(8.5±1.0)s,总对比剂用量100 ml。肺动脉和主动脉增强后 CT 值均≥200 HU者占95.7%(67/70);冠状动脉显影图像质量优的节段占85.8%(720/839),图像质量良的节段占8.6%(72/839),图像质量差的节段占5.6%(47/839)。共检出冠状动脉狭窄≥50%者20例,肺动脉栓塞2例,主动脉夹层2例。结论 64层 MSCT 三联检查能够在8 s 左右1次扫描完成肺动脉、胸主动脉和冠状动脉检查,图像质量可以满足临床诊断需要,在急性胸痛病因诊断中具有很高的临床应用价值。Objective To investigate the performance of triple rule-out with 64-slice spiral CT in the combined examination of pulmonary artery, thoracic aorta and coronary artery for patients with acute chest pain. Methods Seventy patients who presented with acute chest pain were included in the study. All of the patients underwent retrospective ECG-gated 64-slice computed tomography triple rule-out examination to evaluate the pulmonary arteries, thoracic aorta and coronary arteries. Multi-planar reconstruction （ MPR）, maximum intensity projection （MIP）, curved-planar reconstruction （CPR） and volume rendering （VR） were used to display pulmonary arteries, thoracic aorta and coronary arteries. We evaluated the image quality of coronary artery and the enhancement of the pulmonary artery and thoracic aorta to estimate if the examination can fulfill the clinical demand for the differential diagnosis of acute chest pain. Results The mean scan time was （8. 5 ± 1.0） s, and the dose of contrast medium injected was 100 ml. There were 95.7% （67/70） of patients whose CT values detected in the pulmonary artery and thoracic aorta after enhancement were 9200 HU. The image quality of 85. 8% （720/839） coronary segments was classified as excellent, 8.6% （72/839） as good, and 5.6% （47/839） as poor. There were 20 cases with coronary stenoses ≥ 50%, 2 cases with pulmonary embolism, and 2 cases with aortic dissection. Conclusion The triple rule-out examination with 64-slice spiral CT could depict pulmonary artery, thoracic aorta, and coronary artery in 8 s with good image quality. It has great potential in the etiological diagnosis for the patients with acute chest pain.

关 键 词：肺栓塞 主动脉夹层 冠状血管 体层摄影术 X线计算机 

分 类 号：R816.4[医药卫生—放射医学]