个性化低剂量冠状动脉成像诊断冠心病:CTA与DSA对照分析  

Coronary artery angiography with individualized low radiation dose in diagnosing of coronary heart disease: comparative analysis between CTA and DSA

作　　者：王刚[1] 张镇滔[1] 郑晓林[1] 张玉兰[1] 蔡庆文[1] 梁满球[1] 袁焕初[1] 李德维[1] 陈炤庭 邓磊[1] 

机构地区：[1]东莞市人民医院放射科,广东东莞523000

出　　处：《中国临床医学影像杂志》2014年第7期477-481,共5页Journal of China Clinic Medical Imaging

基　　金：2011年东莞市科技计划项目(编号201110515001079)

摘　　要：目的：探讨256层CT冠状动脉成像个性化低剂量扫描的可行性;与DSA冠脉造影对比,探讨CTA诊断冠心病的价值.方法：156例患者分为4组：A组78例为前瞻性门控扫描,心率＜80次/min,其中36例行冠脉DSA造影检查;B组78例为回顾性门控扫描,其中60例行DSA检查,根据体质量指数（BMI）再分为3组,B1组（BMI＜ 18 kg/m2） 25例、B2组（BMI 18～25 kg/m2）25例、B3组（BMI＞25 kg/m2）28例.应用Philips 256 iCT,管电压120 kV,管电流A组992 mA,B1组500 mA、B2组580 mA、B3组660 mA.扫描完毕后计算有效辐射剂量（ED）.采用主观评分（4分法）和客观噪声测量2种方法评价图像质量.比较组间心率、ED、噪声及图像评分的差异,P＜0.05认为有统计学意义.结果：A组与B组间心率、ED之间差异有统计学意义（P＜0.05）,其中组间ED平均值相差7.45 mSv,相比较B组,A组ED平均降低50.41％.A、B两组间BMI、图像噪声和评分差异没有统计学意义（P＞0.05）.B1～B3组间比较,图像质量评分、心率差异没有统计学意义,组间两两比较,ED差异有统计学意义,噪声B1组与B2组、B1与B3组间差异有统计学意义,B2与B3组间差异没有统计学意义.CTA诊断冠心病（与DSA比较）,A组的敏感性91.19％,特异性95.64％,准确性94.23％,Kappa值0.87;B组敏感性96.11％,特异性98.06％,准确性97.65％,Kappa值0.93.结论：冠状动脉CTA检查可以通过心率、BMI、管电流等因素对检查者进行分类,在保证图像质量、诊断准确率的前提下,达到个性化基础上有效减低辐射剂量的目的.Objective：To investigate the feasibility of individualized low radiation dose scanning of 256-slice CT in coronary artery imaging.Compared with DSA coronary angiography,to study the value of CTA in the diagnosis of coronary heart disease.Methods：156 patients were divided into 4 groups：78 cases in group A were prospectively ECG-gated scan,heart rate 〈80 bpm,including 36 cases of coronary DSA angiography; 78 cases in group B were retrospectively ECG-gated scan,including 60 cases of coronary DSA angiography.According to BMI,78 cases in group B were divided into 3 groups：25 cases in group B1（BMI〈18 kg/m2）,25 cases in group B2（BMI 18～25 kg/m2）,28 cases in group B3（BMI〉25 kg/m2）.To scan with Philips 256-slice iCT of 120 kV and tube current with 992 mA in group A,500 mA in group B1,580 mA in group B2,660 mA in group B3.Calculating the effective radiation dose （ED） after the scan.To evaluate image quality with subjective score（4 points） and objective measure of noise （SD）.To analyse the differences of heart rate,ED,noise and image score between the two groups with SPSS 13.0 software.Results：Between group A and group B,there were statistically significant differences in heart rate and ED （P〈0.05）,that the mean difference of ED was 7.45 rmSv between the two groups.Compared with group B,the mean ED in group A decreased by 50.41%.Differences between the two groups of BMI,the image SD and score had no statistically significance （P〉0.05）.Among group B1,B2,B3,the difference of image quality score and heart rate had no statistical significance.The difference of ED among the three groups had statistical significance.There was significant difference of noise between group B1 and B2,group B1 and B3,but no significant difference of noise between group B2 and B3.Compared with DSA,the sensitivity,specificity and accuracy in diagnosing coronary heart disease in group A was 91.19%,95.64%.Conclusion：In the coronary artery CTA examination,it may be effectively reduced the individual

关 键 词：冠状动脉疾病 冠状血管造影术 体层摄影术 螺旋计算机 

分 类 号：R543.3[医药卫生—心血管疾病] R814.42[医药卫生—内科学]