应用320排CT评估重度冠状动脉狭窄患者静息态心肌灌注  

Assessment of resting myocardial perfusion in patients with severe coronary artery stenosis using 320-detector CT scan

作　　者：许化致[1] 朱姬莹[1,2] 曹国全[1] 孙厚长[1] 谢福荣[1] 肖方毅[3] 

机构地区：[1]温州医科大学附属第一医院放射科,325000 [2]浙江医学高等专科学校影像系 [3]温州医科大学附属第一医院心内科,325000

出　　处：《浙江医学》2015年第7期554-557,562,共5页Zhejiang Medical Journal

基　　金：温州市科技局科技计划项目(Y20130159)

摘　　要：目的评估重度冠状动脉狭窄患者静息态心肌CT灌注改变。方法以冠状动脉造影(CAG)为参照,选择重度冠状动脉狭窄患者且CAG术前2周内接受320排C丁冠状动脉造影(CTCA)检查,共74例患者作为观察组。应用CTCA的原始数据重建心电图75%R-R间期时相进行灌注分析,自动获得重度冠状动脉狭窄患者16节段心肌平均衰减密度值(AD),并与同期对照组1 18例患者的相应心肌节段进行比较。结果有重度狭窄冠状动脉102支,其中左冠状动脉前降支(LAD)48支,左旋支(LCX)23支,右冠状动脉(RCA)31支。观察组各心肌节段AD值均低于相应对照组,除中间段下间隔壁(t=-1.478,P>0.05)外,两组间AD值差异均有统计学意义(t_(S1-S8,S10-S16)=-2.767、-2.309、-2.347、-3.567、-4.704、-2.947、-3.301、-3.643、-3.170、-3.188、-3.078、-3.589、-2.926、-2 103、-3 426,均P<0.05)。观察组中,LAD供血区各个节段心肌AD值存在差异(F_(LAD)=8.258,P<0.01),而且基底、中间及心尖部间隔壁AD值均高于前壁(均P<0.05)。而LCX、RCA供血区心肌节段间AD值差异无统计学意义(F_(LCX)=1.229,F_(RCA)=2.070,P>0.05)。结论半定量的静息态心肌CT灌注可以反应心肌灌注,重度冠状动脉狭窄患者相应供血区心肌灌注减低,而且左心室前壁灌注低于间隔壁。Objective To assess the resting myocardial perfusion imaging in patients with severe coronary artery steno- sis using 320-detector computed tomography. Methods Seventy four patients with 102 severely stenosed coronary arteries diagnosed by coronal angiography （CAG）, including 48 left anterior descending arteries （LAD）, 23 left circumflex arteries （LCX） and 31 right coronary arteries（RCA） were enrolled in the study. One hundred and eighteen subjects with normal coronary artery served as controls. All subjects underwent 320-detector CT coronary angiography （CTCA）, and myocardial perfusion by 75% R-R electrocardiography （ECG） phase was reconstructed from CTCA raw data and reviewed on the workstation with dedicated myocardial analysis software. The average attenuation density （AD） of 16 myocardial segments recommended by American Heart Association （AHA） automatically was calculated. Results The AD values of myocardial segments in patients with severe coronal artery stenosis were lower than those in normal controls （ tS1-S8,S10-S16=-2.767, -2.309, -2.347, -3.567, -4.704, -2.947, -3.301, -3.643, -3.170, -3.188, -3.078, -3.589, -2.926, -2.103, -3.426, P〈0.05}except $9 （t=-1.478, P 〉0.05）. The AD values of different myocardial segments supplied by LAD artery demonstrated significant density difference （FLAD=8.258, P〈 0.01）, and the AD values of left ventricular septal wall among the base, middle and apical segments were higher than that of anterior wall （P〈0.05）. But there were no significant difference in AD values among the myocardial segments subtended by LCX and RCA arteroes. Conclusion The myocardial ischemia can be reliably detected on rest myocardial perfusion imaging by semi-quantitative assessment.

关 键 词：冠心病 CT冠状动脉造影 灌注成像 容积扫描 

分 类 号：R816.2[医药卫生—放射医学] R543.3[医药卫生—临床医学]