心脏CT检查对肥厚型心肌病合并冠心病患者的诊断价值  被引量:9

The diagnostic value of cardiac CT in the diagnosis of coronary artery disease combined with hypertrophic cardiomyopathy

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作  者:马晓海[1,2] 赵蕾[1,2] 范占明[1,2] 葛海龙[1,3] 张臣[1,2] 李宁[1,2] 

机构地区:[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管疾病研究所医学影像科,100029 [3]北京市心肺血管疾病研究所干部保健科,100029

出  处:《心肺血管病杂志》2014年第5期624-627,共4页Journal of Cardiovascular and Pulmonary Diseases

基  金:国家自然科学基金(81101173);北京市高层次卫生技术人才培养计划(2013-3-005)

摘  要:目的:评估心脏CT检查在诊断肥厚性心肌病(hypertrophic cardiomyopathy,HCM)可疑合并冠心病患者中的价值。方法:60例患者入组本研究。心脏CT检查包括冠状动脉CT血管造影(CT angiography,CCTA)和延迟强化检查。以冠状动脉造影(coronary angiography,CA)和心脏磁共振检查(cardiovascular magnetic resonance,CMR)作为参考标准,分别检测CCTA和延迟强化检查在评估冠状动脉狭窄程度、左心室舒张末期室壁厚度、心功能和心肌纤维化的诊断准确性。结果:与CA比较,CCTA在检测冠状动脉狭窄程度方面的敏感性、特异性、阳性预测值及阴性预测值分别为100%、94.4%、92.3%及100%。在检测左心室舒张末期室壁厚度、心功能指标方面,CT与CMR有较好的相关性,但CT略低估以上指标。CMR延迟强化图像的对比噪声比优于CT(P<0.01);CT测量的局灶性心肌纤维化范围与CMR结果相关性较好(P<0.01)。结论:心脏CT一站式检查能够提供冠状动脉狭窄程度、心室形态、心功能及心肌活性方面的信息,有助于肥厚性心肌病可疑合并冠心病患者的鉴别诊断。Objective:To evaluate the value of cardiac computed tomography CT in the diagnosis of coronary artery disease( CAD) combined with hypertrophic cardiomyopathy( HCM). Methods: Sixty patients were enrolled. The cardiac CT examination included coronary CT angiography( CCTA) and delayed enhancement CT. The performance of CT in the coronary artery evaluation was assessed in comparison with coronary angiography( CA). The left ventricle( LV) wall thickness,functional indices and myocardial delayed enhancement( MDE) were identified in both magnetic resonance( MR) and CT images separately. Results: Compared with CA,CCTA had a sensitivity,specificity,positive and negative predictive value of 100%( 24 /24),94. 4%( 34 /36),92. 3%( 24 /26) and 100%( 34 /34),respectively. The LV wall thickness and functional indices measured with CT were correlated with MR( P〈0.01) but CT results underestimated these parameters.MDE MR images had better contrast-to-noise ratio than CT images [( 11. 3 ± 3. 9) % vs.( 6. 0 ± 0. 9) %( P 0. 001) ]. The volume of focal MDE determined with CT was significantly correlated with MR( r = 0. 98,P〈0.01). Conclusion: For patients with HCM who have likelihood of CAD,this comprehensive cardiac CT protocol can be helpful for ruling out coronary stenosis and providing information of morphology,function and tissue characterization of LV myocardium.

关 键 词:计算机断层成像 磁共振成像 肥厚性心肌病 冠状动脉粥样硬化性心脏病 

分 类 号:R54[医药卫生—心血管疾病]

 

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