320排动态容积CT心肌灌注成像诊断猪急性心肌缺血再灌注损伤的实验研究  

Diagnosis of acute myocardial ischemic reperfusion injury by 320-row dynamic volume CT perfusion imaging:an experimental study in swine

作　　者：彭晋[1] 颜志平[1] 吴贵华[1] 曾英琅[1] 陈思敏[1] 

机构地区：[1]厦门大学附属成功医院医学影像科,福建省361003

出　　处：《中华临床医师杂志（电子版）》2012年第12期56-60,共5页Chinese Journal of Clinicians(Electronic Edition)

基　　金：南京军区"十一.五"重点科研课题(10Z020)

摘　　要：目的评价320排CT心肌灌注成像(CTP)是否可以准确诊断猪急性心肌缺血再灌注损伤引起的心肌灌注异常。方法 8只猪通过介入球囊栓塞左冠状动脉前降支(LAD)中远段30min后再通90min建立再灌注损伤模型,术后行CTP扫描。检查结束后立即处死动物,取出心脏,进行氯化三苯基四氮唑(TTC)染色,分析心肌缺血再灌注损伤范围,显微镜下观察病理学改变;以病理结果为参照,测量CTP左心室短轴位二维图中损伤区、非损伤区心肌的CT值。将左心室壁分为17个节段,确定二维图、心肌透壁灌注率(TPR)图和大体病理上心肌损伤的节段数。以病理结果为金标准分别评价二维图、TPR图两组图像显示心肌损伤节段的敏感性、特异性和一致性。利用配对t检验分析损伤区和非损伤心肌CT值的差异。结果 8只猪TPR图见心尖前壁、心尖间隔灌注稀疏甚至缺损,左心室短轴位二维图中再灌注损伤区较正常心肌呈明显低密度,损伤区心肌CT值[(56.23±8.68)HU]较正常心肌[(120.57±15.36)HU]明显降低(t=8.83,P<0.01)。与病理金标准对照,TPR图诊断再灌注损伤的敏感性、特异性、阴性预测值和阳性预测值分别为89.3%(25/28)、93.5%(101/108)、78.1%(25/32)、97.1%(101/104),Kappa值为0.79;而二维图的敏感性、特异性、阴性预测值、阳性预测值和Kappa值分别为85.7%(24/28)、92.6%(100/108)、75.0%(24/32)、96.2%(100/104)和0.74。结论320排CT心肌灌注成像可用于检测猪急性心肌缺血再灌注损伤,与病理诊断一致性好。Objective To investigate whether 320-row CT myocardial perfusion imaging （CTP）is an accurate diagnosis method of acute myocardial ischemia reperfusion injury in a swine model. Methods The distal left anterior descending coronary artery （LAD） of 8 swine heart were clogged half an hour by balloon catheter and opened up 1.5 hours, and then the acute myocardial ischemic reperfusion injury model was created and was detected by CTP. Pigs were sacrificed after the inspection, and the hearts were removed, triphenyhetrazolium chloride staining was performed. The CT numbers of injuries and non-injuries regions were measured. In the short axis of the left ventricle, the ventricular wall was divided into 17 segments for analysis, segments with myocardial perfusion defect in myocardial transmural perfusion ratio （TPR） maps, two-dimension imaging were determined and compared with histopathology. The sensitivity, specificity and inter-modality agreement of CTP in detecting myocardial injury were calculated. Paired t test was used to analyze the differences of the CT number between injuries and normal regions in two-dimension imaging. Results Partial sparse or defective perfusion in the apical anterior and septal wall were demonstrated in TPR maps. The CT number of injured myocardium [ （ 56. 23 ± 8. 68 ） HU ] was significantly lower than that of normal myocardium [ （ 120. 57 ± 15.36 ） HU ] in two-dimension imaging. The sensitivity, specificity of TPR maps were 89. 3 % （25/28） ,93.5 % （ 101/108）, and Kappa value was 0.79. The sensitivity, specificity of two- dimension imaging were 85.7% （ 24/28 ）, 92. 6% （ 100/108 ）, and Kappa value was 0. 74. Conclusions DVCT myocardial perfusion imaging can detect acute myocardial ischemic reperfusion injury in a swine model and have a good correlation with histopathology.

关 键 词：体层摄影术 X线计算机 心肌再灌注损伤 心肌缺血 

分 类 号：R541[医药卫生—心血管疾病]