双源CT对急性胸痛的诊断价值  

Assessment of Acute Chest Pain with Dual--Source CT

作　　者：李宇[1] 范占明[1] 余婧[1] 耿冀[1] 叶红[1] 晏子旭[1] 张兆琪[1] 

机构地区：[1]首都医科大学附属北京安贞医院医学影像科,北京100029

出　　处：《实用放射学杂志》2011年第1期51-55,61,共6页Journal of Practical Radiology

摘　　要：目的评价双源CT胸痛三联扫描计划对急诊胸痛诊断的准确性。方法按照入选标准连续选取急性胸痛患者56例，采用西门子双源CT扫描仪胸痛三联扫描计划进行胸部CTA扫描，采集时间83ms，按照体质指数调整对比剂注射的流速及流量。扫描范围自第1肋骨到心脏膈面的整个胸部，自气管隆突水平启动心电门控。对比剂采用三相注射法以便同时显示主动脉、冠状动脉、肺动脉三大血管床。评价三大血管床的图像质量，测量血管增强CT值。对15例同时有冠状动脉造影者进行对照分析，其他患者均随诊30d以上。结果除1例患者因屏气不好影响图像评价被排除本研究外，余55例患者的三大血管床（主动脉、冠状动脉、肺动脉）均得到明显均匀强化和良好图像质量。冠状动脉图像质量评分平均3．8分。对比剂平均用量为（88±5）ml。平均辐射剂量为11．6mSv（95％CI6．9～13．1）。本组病例中13例CTA为阴性，其余42例中14例冠状动脉粥样硬化，其中13例冠状动脉狭窄程度〉50％，12例行冠状动脉造影支架植入术。11例患者为StanfordA型主动脉夹层，肺栓塞11例。总的胸痛病因分布较为复杂。7例患者合并2种以上胸部疾病。CTA在本组病例“急性胸痛三联征”诊断中总的敏感性为98％，特异性96％。CTA阴性的随访人群2例随后诊断为反流性食管炎，其余患者30d内均无严重不良事件发生。结论双源CT的胸痛三联扫描计划为急性胸痛患者的快速诊断及急诊分类提供了安全、有效的手段。Objective To assess the accuracy of triple rule out protocol for acute chest pain with dual--source CT in emergency department. Methods 56 consecutive patients with acute chest pain were examined with triple rule out protocol on a dual--source scanner {Siemens） at a temporal resolution of 83 ms using a body mass--adapted contrast material injection. The scanning range included the whole chest from the first ribs to the diaphragm. The level of the carina was defined as the trigger point where the second tube was switched on additionally. The tri--phase injection protocol was used to get enough enhancement of coronary arteries, pulmonary arteries and aortas. One patient was excluded because he was unable to hold breath during scanning. The remaining sub- jects underwent more than 30 days follow--up. Results All examinations showed an adequate contrast enhancement of the pulmo- nary arteries, coronary arteries and aortas. The mean volume of contrast medium was （88±5） ml. The median radiation exposure was 11.6 mSv （95 %CI 6.9--13.1 ）. 14 patients showed coronary arteries atherosclerosis, including coronary arterial stenosis more than 50 % in 13 and 12 patients underwent the coronary stent implantation. 11 patients suffered from aortic dissection（Stanford type A）, and 11 patients with pulmonary embolism （PE）. In brief, the reasons of the chest pain were complex. 7 of the patients suffered from several kinds of chest diseases. The sensitivity and specificity in diagnosing acute chest pain were 98 %and 96%,respectively with CTA. There were no adverse outcomes follow-- up for 30 days in this group. Conclusion Triple rule out coronary CT angiography in evaluation of the patients with acute chest pain presented to the emergency department is very helpful, safety and effective way.

关 键 词：胸部 胸痛 体层摄影术 X线计算机 

分 类 号：R561[医药卫生—呼吸系统] R814.42[医药卫生—内科学]