第二代双源CTFlashSpiral模式高心率冠状动脉成像的图像质量及准确性评价  

The image quality and diagnostic accuracy of high-pitch dual-source coronary angiography using flash spiral mode in patients with high heart rates

作　　者：韩瑞娟[1] 孙凯[2] 赵瑞平[1] 岳强[1] 马利军[2] 李立刚 陈九宏 

机构地区：[1]包头市中心医院心内科,内蒙古自治区014040 [2]包头市中心医院影像中心,内蒙古自治区014040 [3]西门子中国CT事业部

出　　处：《中国心血管病研究》2012年第10期737-742,799,800,共8页Chinese Journal of Cardiovascular Research

基　　金：内蒙古科学技术基金

摘　　要：目的评价第二代双源CT大螺距前瞻性螺旋扫描（Flash Spiral）高心率冠脉成像的图像质量、准确性及有效射线剂量。方法前瞻性入选心率〉65次／min的连续性患者268例，随机分为两组。A组134例，采用Flash Spiral模式扫描，采集图像时间为RR间期20％-30％；B组134例，采用回顾性心电门控扫描模式（Spiral）扫描。30d内A组有47例行冠状动脉造影术（CCA）检查（A1组），B组中有45例行CCA检查（B1组）。比较两组患者一般情况、图像质量评分、图像噪声、对比信噪比（CNR）和有效射线剂量。以CCA结果为金标准，分别计算A1、B1两组FlashDSCT显示冠脉病变的敏感性、特异性、准确率、阳性预测值和阴性预测值。结果①两组患者一般情况比较差异无统计学意义。②两组不可诊断节段基于血管节段评价分别为1．52％和1．74％，基于患者评价分别为7．5％和6．7％，差异均无统计学意义（P=0．345，P=0．812）。两组图像质量评分均数分别为1．064±0．306和1．084±0．327，差异无统计学意义（P=0．063）。A组平均图像噪声19±27（21．4±4．5）HU，CNR6．4-25．3（12．1±4．2）：B组分别为19±28（20．9±4.3）HU和7．1-28．2（13．8±5．1），两组比较差异无统计学意义。③心率变异性：A组图像质量评分3分的病例平均心率变异性明显小于B组。④与CCA比较，两组患者评价冠状动脉狭窄的敏感性、特异性差异均无统计学意义。⑤射线剂量：A组平均有效射线剂量显著低于B组[（1．04±0．16）mSv比（7．05±1．05）mSv，P=0．001]。结论高心率患者（心率〉65次／min）采用Flash双源CT大螺距前瞻性心电门控螺旋扫描在RR间期20％±30％成像，图像质量、准确性与回顾性心电门控扫描接近，而有效射线剂量显著减低。心率变异性对高心率患者FlashSpiral模式扫描图像质量的影响较大。Objective To investigate the image quality, diagnostic accuracy and radiation doses of prospectively ECG-triggered spiral acquisition mode（Flash Spiral mode）coronary computed tomography angiography （CCTA） using high-pitch dual-source CT in patients with high heart rates, compared with retrospectively ECG- gated spiral acquisition mode（Spiral mode） and catheter coronary angiography（CCA）. Methods Two hundred and sixty-eight consecutive patients with mean HR〉65 beats per minute （bpm） were prospectively included in this study. The patients were divided into two groups. Collection in group A （134 patients） was performed CTCA usingflash mode setting at 20%-30% of the R-R interval, while group B （134 patients ） used retrospectively ECG-gat- ed spiral acquisition mode to acquire data. Among them, there were 47 cases in group A （as group A1） and 45 cases in group B （as group B1 ） were underwent CCA. The general characteristics, image quality scores, the image noise, contrast-to-noise ratio （CNR） and effective radiation dose between two groups were assessed. Considered CCA as the standard of reference, the sensitivity, specificity, positive predictive value and negative predictive val- ue of two groups were calculated. Results （1）There were no significant differences in general characteristics between the two groups （all P〉0.05）. （2）The non-diagnostic coronary artery segments were no significant differences between group A and group B （segment-based analysis 1.52% vs 1.74%, P=0.345, patients-based analysis 7.5% vs 6.7%, P=0.812）. There were no significant differences in the image quality scores [ 1.064±0.306 （group A） vs 1.084±0.327 （group B）, P=0.063±. The average image noise was 19-27 ±range （21.4±4.5）HU] and CNR was 6.4-25.3（range： 12.1±4.2） in group A, and the corresponding numbers were 19-28[range： （20.9_±4.3）HU] and 7.1-28.2 （range： 13.8±5.1） in group B. There were no significant differences in image noise or CNR between

关 键 词：大螺距双源CT 前瞻性心电门控螺旋扫描 冠状动脉成像 高心率 

分 类 号：R814.42[医药卫生—影像医学与核医学]