负荷动态CT心肌灌注结合冠状动脉CT血管成像对冠心病心肌缺血的诊断价值  

Stress dynamic CT myocardial perfusion imaging combined with coronary CT angiography for the detection of ischemic coronary artery disease

作　　者：高扬[1] 王成英[2] 周艳丽[2] 侯志辉[1] 尹卫华[1] 李震南[1] 孙凯[3] 吕滨[1] Gao Yang Wang Chengying Zhou Yanli Hou Zhihui Yin Weihua Li Zhennan Sun Kai Lyu Bin(Department of Medical Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院放射影像科,100037 [2]内蒙古科技大学包头医学院包头市中心医院核医学科 [3]内蒙古科技大学包头医学院包头市中心医院影像科

出　　处：《中华放射学杂志》2017年第4期246-250,共5页Chinese Journal of Radiology

基　　金：国家自然科学基金（81271571）;北京市科技计划“首都特色”专项（Z121107001012118）

摘　　要：目的 评价负荷动态CT心肌灌注成像（CT-MPI）联合冠状动脉CT血管成像（CCTA）诊断冠心病心肌缺血的价值.方法 2015年9月至2016年11月前瞻性对CCTA明确诊断为冠心病的30例患者行负荷动态CT-MPI扫描,并于1周内行核素心肌灌注显像检查.定性分析CT-MPI结果,并测量前降支、右冠状动脉、回旋支共17段心肌节段的灌注量化指标,包括心肌血流量（MBF）、心肌血容量（MBV）和达峰时间（TTP）.以单光子发射计算机断层成像术（SPECT）-MPI结果为参照标准将所有心肌节段分为灌注正常组和灌注异常组,采用两独立样本t检验比较两组间MBF、MBV和TTP差异,采用ROC曲线评价CCTA、CT-MPI及两者联合诊断心肌缺血的效能.结果 研究共纳入30例患者.灌注异常组MBF、MBV分别为（79.3±18.0）ml·100 ml^-1·min^-1和（8.9±2.9）ml/100 ml,显著低于灌注正常组的（135.1±35.2）ml·100 ml^-1·min^-1和（13.8±8.9）ml/100 ml,差异具有统计学意义（t值分别为0.302、0.866,P〈0.01）;而灌注异常组的TTP为（13.9±2.5）s,显著高于灌注正常组[（9.1±2.1）s],差异具有统计学意义（t=0.024,P〈0.01）.节段水平上,CT-MPI诊断心肌缺血的敏感度、特异度分别为91.3%（147/161）、84.6%（281/332）.血管水平上,CCTA〉70%狭窄预测心肌缺血的ROC曲线下面积为0.635（95%CI：0.517-0.753）,CT-MPI的曲线下面积为0.709（95%CI：0.599-0.819）,而CCTA〉70%联合CT-MPI的曲线下面积为0.837（95%CI：0.749-0.925）.结论 负荷动态CT-MPI对冠心病心肌缺血有较好的诊断效能,CT-MPI联合CCTA一站式评价冠状动脉狭窄和心肌血流灌注能更好地识别导致缺血的狭窄病变.Objective To assess effects of stress dynamic CT myocardial perfusion imaging （CT-MPI） combined with coronary CT angiography （CCTA） on the diagnosis of myocardial perfusion defects in coronary artery disease （CAD）. Methods Patients with CAD diagnosed by CCTA underwent ATP stress CT-MPI examination. Single-photon emission computed tomography （SPECT） myocardial perfusion imaging （SPECT-MPI） was performed within one week and set as the reference standard. CT-MPI results were qualitatively analyzed, and myocardial blood flow （MBF）, myocardial blood volume （MBV） as well as time to peak （TTP） were quantified according to CT-MPI. Effects of CCTA, CT-MPI, and CT-MPI combined with CCTA on predicting myocardial perfusion defects were assessed in comparison with NMPI. Results Thirty patients [（54.8±8.4）years] were enrolled in our study, 20 were men （68%）. MBF [（79.3±18.0） versus （135.1± 35.2） ml·100 ml^-1·min^-1] and MBV [（8.9±2.9） versus （13.8±8.9） ml/100 ml] were significantly decreased in hypoperfused segments compared with normal segments, while TTP was increased in hypoperfused segments [（13.9 ± 2.5）s] compared with normal segments [（9.1 ± 2.1）s] （t=0.302, 0.866 and 0.024 respectively, all P values〈0.01）. The sensitivity, specificity of CT-MPI for identifying segments with perfusion defects were 91.3%（147/161）, 84.6%（281/332）, respectively. On a per-vessel basis, the area under the receiver operating characteristic curve for predicting myocardial perfusion defects were 0.635（95%CI：0.517—0.753） for CCTA, 0.709（95%CI：0.599—0.819）for CT-MPI, and 0.837（95%CI：0.749—0.925）for CT-MPI combined with CCTA, respectively. Conclusions The performance of stress dynamic CT-MPI in the diagnosis of myocardial perfusion defects in CAD was good. One-stop examination of CT-MPI combined with CCTA improves the diagnostic accuracy for identifying flow-obstructing stenosis.

关 键 词：心肌缺血 体层摄影术 X线计算机 心肌灌注显像 冠状动脉狭窄 

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