双能量CT冠状动脉成像结合CT心肌灌注诊断冠心病准确性的初步研究  

Dual-energy CT angiography plus CT perfusion-diagnostic value in coronary artery disease： initial experience

作　　者：王瑞[1] 张兆琪[1] 郭淼[1] 黄晓勇[1] 于薇[1] 王永梅[1] 晏子旭[1] 毕涛[1] 于洋[2] 池立群[2] 

机构地区：[1]首都医科大学附属北京安贞医院医学影像科教育部心血管重塑相关疾病重点实验室,100029 [2]首都医科大学附属北京安贞医院心脏外科,100029

出　　处：《中华放射学杂志》2011年第2期111-115,共5页Chinese Journal of Radiology

摘　　要：目的探讨心脏双能量cT冠状动脉造影（DE—CTA）结合CT心肌灌注（DE-CTP）对冠心病诊断的准确性。方法对31例临床可疑或已知冠心病的患者行心脏双能量CT和负荷一静息SPECT检查，所有患者在1个月内接受导管造影检查。重建冠状动脉DE-CTA和DE．CTP图像用于冠状动脉狭窄程度和心肌灌注缺损的评判，并以冠状动脉造影为参考标准，建立DECT对冠状动脉狭窄诊断价值的基线值，进而计算DE—CTA加DE．CTP对冠心病诊断的敏感性、特异性、阳性预测值、阴性预测值和准确性。结果28例患者获得满意的图像质量，以冠状动脉造影为参考标准：（1）DE-CTA显示112支冠状动脉，其中41支冠状动脉狭窄≥50％，诊断冠状动脉狭窄的敏感性、特异性、阳性预测值、阴性预测值分别为81％（38／47）、95％（62／65）、93％（38／41）、87％（62／71），准确性为89％（100／112）；（2）DE—CTP显示46支狭窄冠状动脉供血区域心肌灌注缺损，诊断狭窄≥50％冠状动脉的敏感性、特异性、阳性预测值、阴性预测值分别为76％（36／47）、85％（55／65）、78％（36／46）、83％（55／66），准确性为81％（9l／112）；（4）DE．CTA加DE—CTP诊断52支冠状动脉狭窄≥50％，诊断冠状动脉狭窄的敏感性、特异性、阳性预测值、阴性预测值分别为96％（45／47）、89％（58／65）、86％（45／52）、97％（58／60），准确性为92％（103／112）。结论DE-CT一次扫描即能获得冠状动脉解剖学和血流灌注信息，可以对冠心病做出综合性诊断。DE—CTP能够为CTA提供有益的补充。Objective To evaluate the combination of dual-energy CT angiography （DE-CTA） and dual-energy CT perfusion （DE-CTP） in the diagnosis of coronary artery disease. Methods Thirty-one patients with angina pectoris were examined using dual-source dual energy CT and conventional coronary angiography. For DE-CTA, we used a contrast-enhanced ECG-gated coronary scan protocol with energy levels of two tube detector arrays at 140 and 100 kVp. Two kinds of acquired images were fused for the CT angiogram and further calculated to construct a perfusion map （ Siemens DE Heart PBV）. The compared the following results： DE-CTA vs. CA, DE-CTP vs. CA to assess the sensitivity and specificity, and further compared DE-CTA plus DE-CTP with CA. Results DECT obtained diagnostic image quality in 28 patients. DE-CTA detected 41/112 arterial stenosis. Using CA as a reference, the sensitivity of DE-CTA was 81% （38/47）, specificity was 95% （62/65）, positive predictive value was 92% （38/41）, negative predictive value was 87% （62/71） , and accuracy was 89% （100/112）. DE-CTP detected 46 perfusion defects in artery territories. Using CA as a reference, the sensitivity of DE-CTP was 76% （36/47） , specificity was 85% （55/65）, positive predictive value was 78% （36/46）, negative predictive value was 83% （55/66）, and accuracy was 81% （91/112）. DE-CTA plus DE-CTP diagnosed 52 arteries stenosis. Using CA as a reference, combination of DE-CTA and DE-CTP gave sensitivity of 95% （45/47）, specificity of 89% （58/65） , NPV of 97% （58/60）, and accuracy of 92% （103/112）. Conclusions DECT can provide perfusion blood volume information as well as vessel pathology in one scan. DECT can provide comprehensive diagnosis and improve diagnosis of CAD.

关 键 词：冠状动脉疾病 心肌 灌流 体层摄影术 x线计算机 

分 类 号：R541.4[医药卫生—心血管疾病]