前瞻性心电门控双源CT冠状动脉成像在高心率患者中应用的可行性研究  

Feasibility of prospective -gated dual-source CT coronary angiography in patients with high heart rate

作　　者：段艳华[1] 王锡明[1] 程召平[1] 武乐斌[1] 乌大尉[1] 李剑[1] 晁宝婷[1] 柳澄[1] 

机构地区：[1]山东大学医学院山东省医学影像学研究所,济南250021

出　　处：《中华放射学杂志》2009年第7期714-718,共5页Chinese Journal of Radiology

基　　金：山东省科学技术发展计划资助项目（2008GG30002049）

摘　　要：目的探讨心率不低于91次／分（bpm）患者回顾性心电门控双源CT（DSCT）冠状动脉成像R-R间期的最佳重建时相，从扫描时相选择的角度分析前瞻性心电门控（简称前门控）应用的可行性。方法分析232例行回顾性心电门控DSCT冠状动脉成像患者（体质量指数23～25kg／m^2，心率／〉91bpm）的图像，根据扫描过程中患者屏气时心电监控记录到的心率将其分为3组（A～C组），A组83例，心率91—95bpm，B组68例，心率96—100bpm，C组81例，心率≥101bpm。每隔3％重建1个时相，分别由2名医师独立对横断面图像、薄层MIP、CPR、VRT图像质量采用5分法进行综合评估，按照15段分段法，选出每个节段的R-R间期的最佳重建时相及范围。采用Kappa检验，评价2名医师对冠状动脉图像评分的一致性。结果232例患者中，可评价冠状动脉节段共3343个，其图像最佳重建时相范围集中在81％～61％和51％-31％。3组冠状动脉节段与之相对应的节段数百分比：A组（91—95bpm，83例的1183个节段）分别为5．49％、94．51％；B组（96～100bpm，68例986个节段）分别为0．20％、99．80％；C组（≥101bpm，81例1174个节段）分别为0．17％、99．83％。232例患者的3343个冠状动脉节段中3274个节段（97．94％）最佳重建时相范围集中在以41％为中心的51％～31％R—R间期范围内。2名医师对232例患者的3343个冠状动脉节段图像质量的评分结果得到了较高的一致性（Kappa值=0．883，P〈0．05）。结论具有稳定的窦性心律，且屏气时平均心率≥91bpm患者，冠状动脉节段的最佳重建时相集中于以R—R间期41％为中心的51％～31％，从扫描时相选择的角度考虑，可以对稳定高心率（1〉91bpm）患者行前门控横断面扫描，并且预设41％为曝光时间窗，成功把握较大。Objective To explore the optimal reconstruction windows in patients with heart rate （HR） over 91 （ beats per minute） bpm, and to explore the feasibility of prospective ECG-gated DSCT coronary angiography. Methods Two hundred and thirty-two patients [ body mass index （ BMI ） ： 23- 25 kg/m^2, with stable HR, and average HR ≥91 bpm] with suspected or known coronary artery disease underwent retrospective ECG-gated DSCT coronary angiography. They were divided into 3 groups （ A--C ） according to the average HR of scanning. Images were reconstructed from 29% to 80% of the R-R interval in 3% increments. Two independent readers assessed the overall image quality by a five-point scale and determined the optimal reconstruction windows of each coronary segment and the ranges. Coronary arteries were segmented according to the guideline of the American Heart Association （AHA）. The degree of interobserver agreement was determined by Kappa statistics. Results Three thousand three hundred and fortythree segments were considered to have diagnostic image quality in 232 patients. The ranges of optimal reconstruction windows of images were concentrated on 81%--61% and 51%--31%. In group A （91-- 95 bpm）, there were 1183 segments in 83 patients, and the according proportions were 5.49%, 94. 51% ,respectively; In group B （96--100 bpm）, there were 986 segments in 68 patients, and the according proportions were 0. 20%, 99. 80%, respectively; In group C （≥ 101 bpm）, there were 1174 segments in 81 patients, and the according proportions were 0. 17%, 99. 83%, respectively. The optimal construction windows in 3274 segments out of 3343 segments in 232 patients were concentrated in 41%, ranged from 51%--31%. The image quality assessment in 3343 segments in 232 patients have a high inter-observe agreement （Kappa = 0. 883, P 〈 0. 05 ）. Conclusion The optimal reconstruction windows of patients with stable HR（ 1〉 91 bpm） was concentrated in 41% , ranged from 51%--31%. When nothing except the window

关 键 词：心率 体层摄影术 X线计算机 冠状血管造影术 

分 类 号：R686[医药卫生—骨科学]