256层CT单个心动周期冠状动脉成像在高心率患者中应用的可行性研究  

Feasibility study of coronary CT angiography in single cardiac cycle in patients with high heart rate using 256-row detector CT

作　　者：梁俊福[1] 王辉[1] 徐磊[1] 范占明[1] 晏子旭[1] 杨琳[1] 

机构地区：[1]首都医科大学附属北京安贞医院医学影像科,100029

出　　处：《中华放射学杂志》2017年第2期108-113,共6页Chinese Journal of Radiology

摘　　要：目的探讨256层CT对高心率患者单个心动周期冠状动脉成像的可行性，并评价图像质量及辐射剂量。方法2015年10月至11月连续收集92例心率≥80次／min（bpm）疑似冠心病患者，应用256层CT以前瞻性心电门控技术单个心动周期扫描结合冠状动脉追踪冻结（SSF）技术行冠状动脉cT成像，根据扫描的实时心率分成3组，A组（80～89bpm）56例、B组（90～99bpm）20例和C组（≥100bpm）16例。对其中74例患者应用SSF技术前后图像进行对比。最终由2名有心血管CT诊断经验的医师以双盲法对3组冠状动脉成像，按照国际心脏CT协会冠状动脉18分段以4分法进行评价，并比较各组的辐射剂量。3组间的年龄、体质量指数、心率以及辐射剂量的比较应用单因素方差分析或多样本秩和检验，冠状动脉可评价节段数百分比差异性的比较应用卡方检验。标准重建和SSF技术重建冠状动脉节段的图像质量等级评分采用两样本配对设计比较的秩和检验。用Kappa分析评价不同观察者冠状动脉图像质量评分的一致性。结果1065个冠状动脉节段中，98．97％（1054／1065）能够满足诊断的图像质量要求。A、B、C3组图像质量可诊断率分别为98．64％（651／660）、99．57％（232／233）、99．42％（171／172），差异无统计学意义（χ^2=1．274，P=0．563）。应用SSF技术后重建图像质量等级明显提高，并能增加可诊断血管节段数，图像可诊断率由90．29％（772／855）提高到99．44％（881／886）（χ^2=68．811，P〈0．05），差异具有统计学意义。A、B、C3组有效辐射剂量中位数分别为2．03、1．93、2．37mSv，3组有效辐射剂量差异无统计学意义（χ^2=2．412，P〉0．05）。结论256层CT在高心率患者单个心动周期完成冠状动脉成像检查具有可行性，能以较低的辐射剂量获得诊断所需图像质量。SSF技术能显著提高图像质量。Objective To investigate the feasibility of coronary CT angiography in single cardiac cycle and to analyze the image quality and radiation dose in patients with high heart rate（HR） using 256-row detector CT. Methods Ninety-two consecutive patients between October and November 2015 who were suspected coronary artery disease underwent coronary CT angiography （CCTA） were enrolled, which was performed with a 256-row detector CT （Revolution CT, GE Healthcare） using prospective ECG-triggered volume CCTA within a single cardiac cycle with snapshot freeze （SSF） technique. The patients were grouped by HR during CT scans： group A （80-89 bpm, n=56）, group B （90-99 bpm, n=20）, and group C （≥100 bpm, n=16）. Image quality was compared before and after using SSF technique reconstructions in seventy-four patients. The image quality of coronary artery was evaluated blindly by 2 experienced radiologists using a four-point scale based on the 18-segment model according to the Society of Cardiovascular Computed Tomography guidelines. The differences in age, body mass index, heart rate and CT dose index volume, effective dose（ED） among the three groups were compared by using ANOVA analysis or Kruskal-Wallis test, the image quality and interpretability using χ^2 test. Comparisons of image quality between standard and SSF were performed with paired Wilcoxon rank sum test. Kappa coefficient was used to test inter-observer agreement. Results A total of 1 065 coronary artery segments, 98.97% （1 054/1 065） met the requirements for diagnosis. No significant difference was found （χ^2=1.274, P=0.563） for the diagnostic image quality of coronary artery segments among the 3 groups with 98.64% （651/660）, 99.57% （232/233）, 99.42% （171/172）, respectively. Significant difference （χ^2=68.811, P〈0.05） was found for diagnostic image quality before and after using SSF with increase from 90.29% （772/855） to 99.44% （881/ 886）. Image quality was improved with the use of SSF reconstruc

关 键 词：心率 冠状血管 体层摄影 X线计算机 辐射剂量 

分 类 号：R541.4[医药卫生—心血管疾病] R816.2[医药卫生—内科学]