第二代双源CT双能量心肌灌注成像对心肌梗死的诊断价值  被引量:8

Diagnostic accuracy of the second generation dual-source dual-energy CT myocardial perfusion imaging in patients with suspicious myocardial infarction

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作  者:韩瑞娟[1] 孙凯[1,2] 李坤成[3] 赵瑞平[1] 李文欢[3] 白栓成[4] 王君艳[5] 李洪宇[1] 卢耀军[1] 

机构地区:[1]内蒙古包头市中心医院转化医学中心,014040 [2]内蒙古包头市中心医院医学影像研究所,014040 [3]首都医科大学宣武医院放射科,北京100020 [4]内蒙古包头市中心医院麻醉科,014040 [5]内蒙古包头市中心医院ICU,014040

出  处:《中华诊断学电子杂志》2015年第3期17-21,共5页Chinese Journal of Diagnostics(Electronic Edition)

摘  要:目的探讨第二代双源CT双能量心肌灌注成像对心肌梗死的诊断价值。方法 40例30 d内有综合随访资料(冠状动脉造影证实、实验室检查肌钙蛋白Ⅰ增高、心电图有动态演变等资料)的可疑心肌梗死患者为研究对象。采用第二代双源CT双能量扫描模式,对可疑心肌梗死患者进行一站式心肌灌注及冠状动脉成像。以冠状动脉造影和临床资料为金标准,计算第二代双源CT双能量心肌灌注诊断心肌梗死的敏感度、特异度、阳性预测值和阴性预测值,评价冠状动脉各段图像质量及有效射线剂量。采用SPSS 19软件进行统计分析,冠状动脉CT血管造影射线剂量采用x±s表示,不同观察者间的一致性检验采用Cohen's Kappa分析。结果第二代双源CT双能量心肌灌注诊断心肌梗死的敏感度、特异度、阳性预测值、阴性预测值分别为95.0%、97.0%、86.4%和98.9%。1例患者出现断层伪影,右冠状动脉、回旋支显影差,中远段血管不可评估;另1例患者由于心率变异性较大,造成右冠状动脉中远段有运动伪影,其余患者成像质量均良好。第二代双源CT的平均有效射线剂量为(6.1±1.5)mSv。结论第二代双源CT双能量一站式心肌灌注碘图,结合冠状动脉CT血管造影检测心肌梗死的准确性高,有效射线剂量低。Objectives To evaluate the diagnostic accuracy of the second generation dual-source dual-energy CT myocardial peffusion imaging in patients with suspicious myocardial infarction. Methods Fifty-six patients underwent dual-source dual-energy myocardial peffusion imaging, of which forty patients had follow-up results [ confirmed by catheter coronary angiography,cardiac troponin I elevation and Electrocardiogram (ECG) changes and evolution of acute myocardial infarction] within 30 days.Catheter coronary angiography and clinical data served as the standard of references. The sensitivity, specificity and positive and negative predictive values of the second generation dual-source dual-energy CT myocardial perfusion in the detection of myocardial infarction were evaluated.The coronary image quality and radiation dose were evaluated. Results Diagnostic accuracy: the sensitivity, specificity and positive and negative predictive values were 95.0%, 97.0%, 86.4% and 98.9%, respectively.Coronary image quality:one patient with non-diagnostic images was due to motion artifacts occurred at the right coronary artery and left circumflex artery; another patient's vessels were unassessable due to the motion artifacts induced by high heart rate variability;the other patients' image quality were good.Radiation dose : the average effective radiation dose was ( 6.1 ±1.5 ) mSv. Conclusion One-step dual-source dual-energy CT myocardial perfusion scan combined with coronary CTA provide high diagnostic accuracy for detecting myocardial infarction with lower radiation exposure in patients with suspicious myocardial infarction.

关 键 词:体层摄影术 X线计算机 心肌灌注显像 心肌梗死 诊断 

分 类 号:R542.22[医药卫生—心血管疾病] R816.2[医药卫生—内科学]

 

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