前瞻性心电门控640层容积CT冠状动脉搭桥术后评价  

Evaluation of coronary artery bypass grafts patency using electrocardiogram（ECG）-triggered volume scan by 640-slice CT

作　　者：李国英[1] 孙纲[1] 丁娟[1] 

机构地区：[1]济南军区总医院医学影像科,山东济南250031

出　　处：《实用放射学杂志》2015年第3期379-383,共5页Journal of Practical Radiology

基　　金：山东省自然科学基金青年基金项目（ZR2012HQ007）。

摘　　要：目的：探讨前瞻性心电门控640层容积CT冠状动脉成像对冠状动脉搭桥术后桥血管评价及临床应用价值。方法对28例冠状动脉搭桥术后患者行前瞻性心电门控640层容积CT冠状动脉容积扫描,对原始数据进行重建后行容积再现（VR）、多平面重组（MPR）及曲面重建（CPR）,评价图像的质量及辐射剂量,并与 1 8例螺旋扫描病例对照；以常规选择性冠状动脉造影为标准,评价冠状动脉CT容积成像判断桥血管通畅性的准确性。结果冠状动脉CT容积扫描及螺旋扫描图像优质率分别为85.51%及81.82%,2组图像总体质量无明显差异；但是容积扫描方式较螺旋扫描平均辐射剂量降低61.99%；以常规选择性冠状动脉造影为标准,6 4 0层容积CT冠状动脉成像诊断冠状动脉搭桥术后桥血管狭窄的敏感度、特异度、阳性预测值、阴性预测值及准确度分别为86.67%、95.24%、92.86%、90.91%,91.67%,对桥血管闭塞判断的敏感度、特异度、阳性预测值、阴性预测值及准确度均为100%。结论前瞻性心电门控6 4 0层容积CT冠状动脉成像可以准确评价冠状动脉搭桥术后桥血管的通畅性,且可降低患者的辐射剂量。Objective To explore the clinical value of prospective electrocardiogram（ECG）-triggered volume scan by 640-slice CT for the assessment of coronary artery bypass grafts patency.Methods 28 patients after coronary artery bypass surgery underwent prospective volume scan by 640-slice CT.Raw data were reconstructed and volume rendering（VR）,multiplanar reformation（MPR） and curved planar reformation（CPR）were generated .The image quality of grafts and radiation dose were evaluated and compared with those of 18 patients examined with helical scan mode;The accuracy of 640-slice volume CT angiography in the assessment of grafts patency was determined with conventional selective coronary angiography as the reference standard.Results The ratio of good image in coronary artery volume scan group and spiral CT scan group were 85.51% and 81.82% respectively.There were no signifi-cant differences in overall image quality between two groups.The mean effective radiation dose of the volume scan group was signifi-cantly lower than spiral CT scan group （4.85 and 12.76 mSv）,with a reduction of radiation dose of 61.99%.With conventional se-lective coronary angiography as the reference standard,the sensitivity,specificity,positive predictive value ,negative prediction value and accuracy of 640-slice volume CT angiography for detecting grafts stenosis were 86.67%,95.24%,92.86%,90.91%,91.67%. For detecting grafts occlusion,the sensitivity,specificity,positive predictive value,negative prediction value and accuracy were all 100% .Conclusion Coronary artery bypass grafts patency can be assessed accurately using electrocardiogram（ECG）-triggered vol-ume scan by 640-slice CT and the radiation dose of the patient can be significantly reduced.

关 键 词：冠状动脉搭桥术 血管造影术 计算机体层摄影术 辐射剂量 

分 类 号：R622.4[医药卫生—整形外科] R814.43[医药卫生—外科学]