双源CT冠状动脉及心肌灌注一站式成像对冠心病的诊断价值  

The diagnostic value of dual source coronary CT angiography combined with dynamic CT myocardial perfusion imaging in coronary artery disease

作　　者：王洁[1] 陈宏伟[1] 方向明[1] 钱萍艳[1] Wang Jie Chen Hongwei Fang Xiangming Qian Pingyan(Department of Medical Imaging, Wuxi People＇s Hospital Affiliated to Nanfing Medical University, Wuxi 214023, China)

机构地区：[1]南京医科大学附属无锡市人民医院医学影像科,214023

出　　处：《中华放射学杂志》2017年第4期251-256,共6页Chinese Journal of Radiology

摘　　要：目的 探讨心脏CT一站式检查[负荷动态CT-心肌灌注成像（MPI）联合冠状动脉CT血管成像（CCTA）]对冠心病的诊断价值.方法 回顾性分析2013年6月至2014年2月30例符合纳入标准的患者行CCTA与负荷动态CT-MPI一站式检查及负荷单光子发射计算机断层成像术（SPECT）-MPI检查,其中16例追加了有创性冠状动脉造影（ICA）检查,各项检查时间间隔小于2周且期间未行相关治疗.CT-MPI及SPECT-MPI结果均采用可视法判断灌注状态,测量CT-MPI上心肌血流量（MBF）值,通过配对t检验（资料符合正态分布）比较灌注正常与异常心肌的MBF值差异.以SPECT-MPI为参考标准,评价CT-MPI对心肌缺血的诊断效能,并采用Kappa检验评价两者的一致性;以SPECT联合ICA为参考标准,分别评价CT-MPI、CT-MPI联合CCTA诊断有血流动力学异常冠心病的诊断效能.结果 CT-MPI检查中,30例中有19例共52个节段显示心肌灌注减低,灌注正常节段MBF值[（117.61±29.82）ml·100 ml^-1·min^-1]与灌注减低节段MBF值[（80.60±22.15）ml·100 ml^-1·min^-1]差异有统计学意义（t=15.764,P〈0.01）.以SPECT为参考,以血管节段为单位,CT-MPI检测心肌缺血的敏感度、特异度为94.12%（32/34）、95.80%（456/476）,两种检查结果的Kappa=0.772（P〈0.01）.对于16例行ICA检查者,CT-MPI检测出15例22个血管支配区有血流动力学异常.以SPECT-MPI联合ICA为参考标准,负荷CT-MPI诊断有动力学异常冠脉狭窄的敏感度、特异度分别为92.31%（12/13）、71.43%（25/35）;CCTA为100%（13/13）、51.43%（18/35）;负荷CT-MPI联合CCTA为92.31%（12/13）、82.86%（29/35）.负荷CT-MPI联合CCTA与参考标准的r=0.690（P〈0.001）.结论 负荷动态CT-MPI可检测心肌灌注的异常,评价心肌的血流动力学改变,联合CCTA可提高检测动力学异常的冠心病的诊断价值,最终实现CT在冠心病检查中的一站式模式.Objective To evaluate the diagnostic value of one-stop cardiac CT （stress dynamic CT-MPI combining with CTA） in CAD. Methods Thirty patients underwent CCTA combined with stress dynamic CT-MPI and stress SPECT-MPI including 16 patients underwent ICA were retrospectively enrolled. All procedures were performed within 2 weeks without related treatment. CT-MPI and SPECT-MPI were evaluated visually and MBF was quantified according to dynamic CT-MPI which was compared through paired t test. The diagnostic value of CT-MPI for myocardial ischemia was evaluated with SPECT-MPI as the reference standard. The consistency between the two techniques was determined by Kappa test. With SPECT combined with ICA as the reference standard, we evaluated the value of CT-MPI and its combination with CCTA in the diagnosis of CAD with hemodynamic stenosis. Results On stress CT-MPI, 19 of 30 patients and 52 segments were evaluated with myocardial perfusion defects. There was a significant difference in MBF values between normal[（117.61±29.82）ml·100 ml^-1·min^-1] and hypoperfused [（80.60±22.15）ml·100 ml - 1 · min - 1] segments （t=15.764,P〈0.001）. With SPECT as reference standard, the sensitivity, specificity were 94.12% （32/34）, 95.80% （456/476） on the vessel basis. The Kappa value of the two examinations was 0.772（P〈0.001）. As for the 16 patients who also underwent ICA, 15 patients with 22 vessel-areas had hemodynamic stenosis on CT-MPI. Compared with SPECT combined with ICA, the sensitivity, specificity for detecting hemodynamic stenosis were 92.31% （12/13）, 71.43% （25/35） for CT-MPI;100%（13/13）, 51.43%（18/35） for CTA and 92.31%（12/13）, 82.86%（29/35） for CT-MPI combined with CTA, respectively. Moderate correlation was observed between the combination of CT-MPI and CCTA and reference standard （r=0.690,P〈0.001）. Conclusion Stress dynamic CT-MPI can detect myocardial perfusion defects and hemodynamic changes and improves the diagnostic ability of functional stenosis of CAD

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]