心脏双能量CT与负荷/静息心肌灌注显像和冠状动脉造影的对比研究  

Dual-energy CT in coronary artery disease-comparison with coronary angiography and stress/rest myocardial perfusion image: initial experience

作　　者：王瑞[1,2,3] 张兆琪[1,2,3] 郭淼[1,2,3] 黄小勇[1,2,3] 赵轶轲[1,2,3] 贺毅[1,2,3] 于洋[1,2,4] 焦健[1,2,5] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管疾病研究所 [3]首都医科大学教育部心血管重塑相关疾病实验室医学影像科,北京100029 [4]首都医科大学教育部心血管重塑相关疾病实验室心外科,北京100029 [5]首都医科大学教育部心血管重塑相关疾病实验室核医学科,北京100029

出　　处：《心肺血管病杂志》2011年第6期514-517,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨心脏双能量CT对冠状动脉狭窄和心肌灌注缺损的诊断价值。方法:34例临床可疑或已知冠心病患者行心脏双能量CT检查。重建冠状动脉CTA图像(dual-energy CT angiographyDE-CTA)和双能心肌灌注图(dual-energy CT perfusion DE-CTP)用于冠状动脉狭窄程度和心肌灌注缺损的评判,并与冠状动脉造影和负荷/静息心肌灌注显像(single photo emission computed tomographySPECT)为参考标准,评价心脏双能量CT对冠状动脉狭窄程度和心肌灌注缺损诊断的灵敏度、特异度、阳性预测值及阴性预测值。结果:1.28例符合纳入标准的患者进入本研究;2.DE-CTA显示408段冠状动脉,其中44段冠状动脉狭窄≥50%,以冠状动脉造影为参考标准,DE-CTA诊断冠状动脉狭窄的灵敏度、特异度、阳性预测值及阴性预测值分别为89.28%、97.70%、86.20%及98.29%,准确性为96.58%;3.DE-CTP显示心肌节段476段,其中90段显示心肌灌注缺损,以负荷/静息心肌灌注显像为参考标准,DE-CTP诊断心肌灌注缺损的灵敏度、特异度、阳性预测值及阴性预测值分别为85.71%、93.09%、74.07%及96.58%,准确性为91.71%,DE-CTP诊断心肌灌注缺损与负荷/静息心肌灌注显像,诊断心肌灌注缺损具有较好的一致性,kappa值0.74(P<0.001)。结论:双能量CT作为一项新的成像方法,不仅能够诊断冠状动脉狭窄,还能对病变冠状动脉的血流动力学改变做出准确判断。Objective：To determine the diagnostic value of dual source dual-energy CT（DECT） in detecting coronary stenosis and myocardial perfusion.Methods： Thirty-four patients were examined using dual-source dual-energy CT.For DE-CTA（dual energy CT angiography） we used a contrast-enhanced ECG-gated coronary scan protocol with energy levels of the two tube detector arrays at 140 and 100 kVp.Two acquired images were fused for the CT angiogram and further calculated to construct a perfusion map（dual energy CT perfusion DE-CTP,Siemens DE Heart PBV）.We compared the following results： DE-CTA vs.CA,DE-CTP vs.SPECT and DE-CTP vs.CA to establish sensitivity,specificity,positive predictive value and negative predictive value.Results： In 28 patients,DECT obtained diagnostic image quality to visualize coronary tree and myocardial perfusion.408 coronary segments from DE-CTA were analyzed,and 44 segments were classified as stenosis.Using CA as reference,DE-CTA shows overall sensitivity of 89.28%,specificity of 97.70%,positive predictive value 86.20%,negative predictive value 98.29%,and accuracy 96.58%.Of 476 myocardial segments by DE-CTP,90 segments showed perfusion defects.Using SPECT as reference,DE-CTP has sensitivity of 85.71%,specificity of 93.09%,positive predictive value 74.07%,negative predictive value 96.58%,and accuracy 91.71%.Kappa test demonstrates good agreement between the DE-CTP and SPECT（kappa=0.74,P0.001）.Conclusion： DECT is a new clinical tool to manage CAD,not only diagnose coronary anatomy,also offer homodynamic information of the lesion.

关 键 词：冠状动脉病变 冠状动脉造影 心肌灌注显像 

分 类 号：R541.4[医药卫生—心血管疾病]