双源CT新扫描模式在冠状动脉支架置入术后随访中的应用价值  

Value of prospectively electrocardiography-triggered high-pitch computed tomography in the follow-up of patients with previous coronary stent implantation

作　　者：周迎[1] 汪奇[1] 田峰[1] 杨俊杰[1] 杨霞[1] 董静[1] 杨晓波[1] 何柏[1] 陈韵岱[1] 

机构地区：[1]解放军总医院心内科,北京100853

出　　处：《中华心血管病杂志》2012年第11期933-938,共6页Chinese Journal of Cardiology

摘　　要：目的探讨双源CT大螺距前瞻性心电触发采集模式（新扫描模式）在冠状动脉支架置入术后随访中的应用价值。方法入选行CT冠状动脉成像检查的心率〈75次／min、窦性心律且节律整齐、体质量〈100kg的冠状动脉支架术后患者96例。根据双源CT扫描模式的不同，采用信封随机分组法将患者分为A组（采用前瞻性心电门控模式，共50例）和B组（采用大螺距前瞻性心电触发采集模式，共46例）。采用4分法对图像质量进行评价（1分=图像质量极好，2分=图像质量好，3分=图像质量一般，4分=图像质量差），并记录两组患者整个扫描过程中的总有效剂量值及总剂量长度乘积，以及CT冠状动脉成像增强扫描过程中的有效剂量值、剂量长度乘积及CT容积剂量指数。结果两组患者冠状动脉共置入支架157枚，其中A组78枚，图像质量评分为（1．3±0．6）分；B组79枚，图像质量评分为（1．4±0．6）分，两组问图像质量评分差异无统计学意义（P〉0．05）。A和B组整个扫描过程中的总有效剂量值分别为（7．6±1．8）mSv和（1．6±0．3）mSv（P〈0．01），总剂量长度乘积分别为（545．8±131．5）mGy×cm和（111．4±19．8）mGy×cm（P〈0．01）；CT冠状动脉成像增强扫描过程中的有效剂量值分别为（6．7±1．7）mSv和（1．2±0．2）mSy（P〈0．01），剂量长度乘积分别为（480．8±121．9）mGy×cm和（84．24-17．5）mGy×cm（P〈0．01），CT容积剂量指数分别为（35．7±8．6）mGy和（4．5±0．9）mGy（P〈0．01）。结论双源CT大螺距前瞻性心电触发采集模式应用于冠状动脉支架术后随访可行；与前瞻性心电门控模式比较，在保证图像质量的同时，还可显著降低辐射剂量。Objective To explore the value of prospectively ECG-triggered high-pitch spiral mode CT coronary angiography （ CTCA ） in the follow-up of patients with prior coronary stent implantation. Methods According to the different scan modes, ninety-six patients with heart rate below 75 beat per minute, sinus rhythm and weight below 100 kg and previous coronary stent implantation who underwent 128-slice dual-source Flash spiral CT coronary angiography were randomly divided into two groups according to the randomly numbers in the envelopes： group A （the prospective electrocardiography gated group,50 cases） and group B（ the prospectively ECG-triggered high-pitch spiral mode group,46 cases）. The image quality was evaluated with a four-point grading scale （ 1 = excellent,2 = good ,3 = poor,4 = very poor or non-diagnostic）. The total effective dose and the total dose length product between the two groups were recorded respectively. The CTCA enhanced effective dose, dose length product, and the CT volume dosage index（CTDIvol） between the two groups were recorded respectively. Results A total of 157 stents were implanted, there were 78 stents in group A and 79 stents in group B, and the value of the image quality was （ 1.3 ±0. 6） scores in group A and （ 1.4 ±0. 6） scores in group B （ P 〉 0. 05 ）. The total effective dose [（7.6±1.8） mSv vs. （1.6±0.3） mSv] and dose length product [（545.8±131.5 ）mGyxcm vs. （111.4 ±19. 8） mGy x cm]of the entire scan process were significantly higher in group A than in group B （ all P 〈 0.01 ）. The CTCA enhanced effective dose [ （ 6. 7 ±1.7 ） mSv vs. （ 1.2 ±0. 2 ） mSv ], dose length product [ （480. 8 ±121.9 ）mGy × cm vs. （84. 2 ±17.5） mGy × cm] and the CTDIvol [ （35.7 ±8.6）mGy vs. （4. 5 ±0. 9） mGy] of group A were also significantly higher than those in group B （ all P 〈 0. 01 ）. Conclusions It is clinically feasible to use the dual-source Flash spiral CT coronary angiography for the follow-up of the

关 键 词：冠状动脉疾病 支架 体层摄影术 X线计算机 辐射剂量 

分 类 号：R541.4[医药卫生—心血管疾病]