双源CT对正常人群心内膜下首过灌注分布和时相性变化的初步研究  

Qualitative Assessment of Normal Myocardial Perfusion in Cardiac Cycle with Dual Source CT Scanning

作　　者：喻杰[1] 刁楠[1] 陈艳[1] 韩萍[1] 史河水[1] 周国锋[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院放射科,武汉430022

出　　处：《临床放射学杂志》2014年第9期1331-1334,共4页Journal of Clinical Radiology

基　　金：高等学校博士学科点专项科研基金项目(编号:20090142110047)

摘　　要：目的使用双源CT（DSCT）研究正常人群心内膜下区静息首过心肌灌注的节段分布和时相变化,探讨其定性评估心肌血流灌注的价值并为进一步评价缺血性心脏病提供参考。方法随机选取符合正常组入选标准的45例体检者DSCT冠状动脉成像资料,其中男25例,女20例,平均（62±10.5）岁。采用回顾性心电门控、非离子型对比剂行DSCT冠状动脉成像,观察以5%间隔重组的0～100%RR间期的图像,选择最佳收缩期和最佳舒张期作为评价时相,使用TVA（Time volume analysis）软件自动测量17个心肌节段心内膜下区心肌首过灌注。17个节段的心肌首过灌注强化值的比较采用随机区组方差分析。每个节段收缩期和舒张期心肌首过灌注值的比较采用配对t检验。结果 45例744个心肌节段进行了测量,除心底的少数节段和心尖外,绝大部分节段舒张期首过强化高于收缩期,并有极显著统计学意义（P≤0.001）。节段分布显示前壁、下壁和心尖的首过强化较低,而室间隔壁和左室侧壁则相对较高,差异具有显著统计学意义（P≤0.01）。结论 DSCT具有较高时间分辨率,一定程度上反映心肌首过灌注的时相变化特征和心肌节段的分布特点,有助于基于常规冠状动脉CTA检查的临床实践中认识和发现心肌缺血。Objective To investigate first-pass myocardial perfusion in normal coronary segments during the cardiac cy- cle using contrast-enhanced dual-source CT （DSCT） scanning. Methods A total of 45 health screening individuals were enrolled in this study. The patients included 25 males and 20 females with a mean age of 62± 10.5 years old and had no coronary artery disease. Dual-source CT coronary angiography was performed in all patients. Images of left ventricle in opti- mal diastole and systole phase were reconstructed. According to 17-segment method, CT values of each segment in sub-en- docardial area were automatically measured, which were used as estimation of myocardial perfusion. The variation among segments and during cardiac cycle was analyzed by using t test. Results A total of 744 segments in 45 cases were meas- ured. Systolic perfusion score was significantly lower than diastolic perfusion score for each segment （P ≤0. 001 ） except several basal segments and cardiac apex. The sub-endoeardial perfusion score in anterior, inferior and apex was lower than that in septal and lateral segments either in diastole phase or systole phase （P≤0.01）. Conclusion DSCT can be used to qualitatively evaluate the sub-endocardial perfusion pattern at both systolic and diastolic phases, which is very helpful in detecting cardiac ischemia.

关 键 词：体层摄影术 X线计算机 心肌灌注 时相变化 

分 类 号：R816.2[医药卫生—放射医学]