双源CT多时相前瞻性冠状动脉成像应用于窦性心动过速患者的探讨  

Application of Dual-Source CT Multi-Phase Coronary Angiography with Prospective ECG-triggering Technique in Patients with Sinus Tachycardia

作　　者：谭四平[1] 沈比先[1] 谢培益[1] 陈丽兴[1] 薛水培[1] 贾飞鸽[1] 汪春荣[1] 

机构地区：[1]广东医学院附属南山医院影像科,深圳518052

出　　处：《临床放射学杂志》2015年第3期380-384,共5页Journal of Clinical Radiology

摘　　要：目的探讨多时相前瞻性冠状动脉CTA显示窦性心动过速患者各支冠状动脉的最佳时相,以提高前瞻性冠状动脉CTA在窦性心动过速患者中的应用价值。方法应用Flex Padding技术对46例临床怀疑冠心病的窦性心动过速患者行多时相前瞻性冠状动脉CTA检查。数据采集中心时相设为40%,以相对时相40%重组图像后,在180~320 ms间期内再以10 ms的间隔重组15个绝对时相。选择显示各支冠状动脉的最佳时相并进行后处理。分析直径≥1.5 mm的冠状动脉节段的图像质量（1~4分）,比较单时相和多时相重组的图像质量,并记录辐射剂量。结果 46例窦性心动过速患者的右冠状动脉（RCA）、左前降支（LAD）、左回旋支（LCX）最佳重组时相不一致。71.7%的RCA最佳重组时相位于280~300 ms;52.2%的LAD最佳重组时相位于210~230 ms,82.6%的LAD最佳重组时相位于200~250 ms;63.1%的LCX最佳重组时相位于240~260 ms。40%的单时相重组图像质量评分平均为2.81±0.62,合格率为57.6%;经过多时相重组后,图像质量评分平均达到3.57±0.55,合格图像达到92.6%。单时相与多时相重组的RCA、LAD、LCX图像质量评分存在统计学差异（P〈0.05）。平均有效辐射剂量（ED）为（2.46±0.55）m Sv。结论窦性心动过速患者RCA、LAD、LCX的最佳重组时相不一定相同,单时相重组难以获得满意的图像,多时相重组可以提高窦性心动过速患者前瞻性冠状动脉CTA的图像质量,同时显著降低辐射剂量。Objective To investigate the optimal reconstruction phase of multi-phase coronary CT angiography with prospective ECG-triggering technique in order to improve its diagnostic value for patients with sinus tachycardia.Methods A total of 46 patients with sinus tachycardia and suspected coronary artery disease underwent multi-phase coronary CT angiography by using Flex Padding technique.The phase was set to 40% on data collection center; the images were reconstructed using the relative phase of 40%,then 15 absolute phases within the period of 180ms- 320 ms with an intervals of 10 ms were reconstructed.The optimal phase for displaying each branch of coronary artery was determined,and the results were processed using post-processing software.The image quality of ？ 1.5mm coronary segments was evaluated with scoring（ 1- 4 point）.The image quality and radiation dose of single-phase reformation were compared with those of multi-phase reformation.Results The optimal reconstruction phases of right coronary artery（ RCA）,left anterior descending artery（ LAD）,left circumflex artery（ LCX） were inconsistent with sinus tachycardia in all 46 patients.The optimal reconstruction phases of RCA,LAD and LCX were within the time of 280- 300ms（ 71.7%）,210- 230ms（ 52.2%） and 240-260ms（ 63.1%） respectively in all patients.The mean single-phase image quality score was 2.81 ± 0.62 when 40%phase reconstruction was used; the qualified image rate（ 3- 4 points） was 57.6%.When multi-phase reconstruction technique was used,the mean image quality score was up to 3.57 ± 0.55 and the qualified image rate was up to 92.6%（ 3-4 points）.The differences in the mean image quality scores of RCA,LAD and LCX between the single-phase reconstruction and the multi-phase reconstruction were statistically significant（ P 〈 0.05）.The mean effective radiation dose（ ED）was（ 2.46 ± 0.55） m Sv.Conclusion The optimal reconstruction phases of RCA,LAD and LCX in patients with sinus tachycardia are not necessarily the sa

关 键 词：体层摄影术 X线计算机 冠状动脉血管造影术 前瞻性心电门控 窦性心动过速 

分 类 号：R541.7[医药卫生—心血管疾病] R816.2[医药卫生—内科学]