双源 CT 大螺距前瞻性双次扫描模式在冠心病诊断中的价值  

High- pitch dual- source CT in prospectively electrocardiogram- triggered spiral double scanning mode for diagnosing coronary artery patency

作　　者：杨晓波[1,2] 杨俊杰[1] 田峰[1] 周迎[1] 汪奇[1] 张华巍[1] 杜洛山[3] 陈韵岱[1] 

机构地区：[1]解放军总医院心内科 [2]解放军总医院南开大学医学院,天津300071 [3]解放军总医院放射科,北京100853

出　　处：《南方医科大学学报》2013年第11期1605-1610,共6页Journal of Southern Medical University

基　　金：国家科技部支撑计划(2009BAI86B04)~~

摘　　要：摘要：目的评价双源cT大螺距前瞻眭心电门控双次扫描模式（DoubleFlash）显示冠状动脉的图像质量、诊断冠状动脉狭窄的准确性及辐射剂量。方法人选采用DoubleFlash模式CT冠状动脉成像（CTCA）和冠状动脉造影（cAG）检查的患者，根据检查时心率不同，将患者分为A组（心率〈65次/min）和B组（65次，min≤心率〈80次／min），评价两组冠状动脉各段图像质量（1-4分）；以CAG结果为金标准，分别基于患者和血管评价该扫描模式诊断冠状动脉狭窄的敏感度、特异度、阳性预测值、阴性预测值和准确度；并评价患者辐射剂量。结果114例患者共显示冠状动脉1725个节段（A组933段、B组792段）：（1）图像质量：A组采用DoubleFlash模式两次扫描综合显示可诊断的血管节段百分比为98．5％，而B组为97．3％，差异无统计学意义（PtO．82）；两组血管的图像质量总体评分差异无统计学意义（P〉0．05）；（2）准确性评价：基于患者水平分析，A组DoubleFlash模式两次扫描综合显示有意义的冠状动脉狭窄的敏感度、特异度、阳性预测值、阴性预测值和准确度分别为100％、90．5％、95．4％、100％和96．7％，而B组为100％、88．5％、94．5％、100％和96．2％，两组比较无统计学差异（P〉O．05）；（3）辐射剂量：平均有效辐射剂量为1．63±0．52msv。结论双源CTDoubleFlash模式具有临床可行性，尤其对于65次／min≤心率〈80次，min的患者，在较低的辐射剂量条件下，可保证较好的图像质量和诊断冠状动脉狭窄准确性。Objective To assess the image quality, diagnostic accuracy and effective radiation dose of prospectively ECG- triggered high-pitch spiral double scanning （Double Flash） mode of computed tomography coronary angiography （CTCA） using dual-source CT for the diagnosis of significant coronary stenoses. Methods Patients underwent both CTCA in Double Flash mode and conventional coronary angiography （CAG） and were divided into two groups according to heart rate （HR）, namely group A with HR 〈65/min （62 cases） and group B with HR between 65 and 80/min （52 cases）. All the coronary segments were evaluated by two blinded and independent observers for image quality on a four-point scale and for the presence of significant coronary stenoses （defined as a diameter narrowing exceeding 50%）. CAG served as the reference standard for analyzing the diagnostic accuracy of Double Flash mode images on the level of both patients and vessels. Radiation dose values were calculated using the dose-length product. Results A total of 114 patients were enrolled and 1725 vessel segments were displayed. In terms of image quality, the diagnosable segments accounted for 98.5% （919/933） in group A and 97.3% （770/792） in group B. In the per-patient analysis, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 100%, 90.5%, 88.2%, 100% and 96.7% in group A and were 100%, 88.5%, 94.5%, 100% and 96.2% in group B, respectively. The mean effective radiation dose was 1.63~0.52 mSv. Conclusion Double Flash spiral protocol of dual-source CTCA can acquire good image quality and yield high diagnostic accuracy for assessment of coronary artery stenoses at a low radiation dose in patients with HR between 65 and 80/min.

关 键 词：冠状动脉狭窄 体层摄影术 X线计算机 冠状动脉造影术 

分 类 号：R541.4[医药卫生—心血管疾病]