负荷动态CT-MPI联合CCTA诊断冠心病的价值分析  

Analysis of the value of stress dynamic CT-MPI combined with CCTA in the diagnosis of coronary atherosclerotic heart disease

作　　者：唐文才 黄菁慧 李传资 聂忠仕[1] 王绥煌[1] TANG Wen-cai;HUANG Jing-hui;LI Chuan-zi;NIE Zhong-shi;WANG Sui-huang(Department of Radiology,the Second Aflliated Hospital of Hainan Medical University,Haikou 570311,China)

机构地区：[1]海南医学院第二附属医院放射科,海口570311

出　　处：《中国医学前沿杂志（电子版）》2018年第7期100-103,共4页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：海南省自然科学基金(2015812173)

摘　　要：目的以单光子发射计算机断层成像(single positron emission computer tomography,SPECT)核素心肌灌注成像(myocardial perfusion imaging,MPI)结果作为参考标准,评价负荷动态CT-MPI联合冠状动脉CT血管造影(coronary CT angiography,CCTA)在冠心病诊断中的应用价值。方法选取2015年1月至2016年12月本院收治的疑似冠心病行CCTA检查的40例患者为研究对象。定性分析CT-MPI结果并测量17段心肌节段的灌注量化指标,包括心肌血流量(myocardial blood flow,MBF)、心肌血容量(myocardial blood volume,MBV)、达峰时间(time to peak,TTP)。以SPECT-MPI结果作为参考标准将所有心肌节段分为灌注正常组和灌注异常组,比较两组间MBF、MBV、TTP的差异;评价CT-MPI诊断心肌缺血的效果。结果灌注正常组心肌节段MBF、MBV均显著大于灌注异常组(P_均<0.05),TTP显著短于灌注异常组(P<0.05);将SPECT-MPI结果作为参照,负荷动态CT-MPI诊断心肌缺血分别在患者、血管、节段三个水平上均具有较高的敏感度,其准确率分别为77.5%、85.0%及91.9%;CT-MPI与SPECT-MPI诊断心肌缺血的一致性检验结果表明,患者、血管、节段三个水平上Kappa值分别为0.600、0.775及0.868,且均具有显著差异(P_均<0.05)。结论负荷动态CT-MPI对冠心病心肌缺血具有良好的诊断效果,CT-MPI联合CCTA评价冠状动脉狭窄及心肌血流灌注具有显著优势,能够更好地识别导致缺血的狭窄病变,有良好的临床应用前景。Objective To analyze the clinical value of stress dynamic CT myocardial perfusion imaging（CT-MPI） combined with coronary CT angiography（CCTA） in the diagnosis of coronary atherosclerotic heart disease（CHD） by using SPECT myocardia perfusion imaging（MPI） as a reference standard. Method 40 cases of patients with suspected CHD examined by CCTA in our hospital from January 2015 to December 2016 were selected as research objects. The CT-MPI results were analyzed qualitatively, and the perfusion quantitative indexes of 17 segments such as myocardial blood flow（MBF）, myocardial blood volume（MBV） and time to peak（TTP） were measured. According to the results of SPECT-MPI, all the myocardial segments were divided into two groups, namely the perfusion normal group and the perfusion abnormal group. The differences of MBF, MBV and TTP between the two groups were compared, and the efficacy of CT-MPI in the diagnosis of myocardial ischemia was evaluated. Result The levels of MBF and MBV in perfusion normal group were significantly higher than those in perfusion abnormal group（Pall〈0.05）, but TTP in perfusion normal group was significantly shorter than that in perfusion abnormal group（Pall〈0.05）. The results of SPECT-MPI were used as reference standard, the stress dynamic CT-MPI diagnosing myocardial ischemia was more sensitive at three levels： patients, vessels and segments and the accuracy rate was 77.5%, 85.0% and 91.9% respectively. Moreover, the consistency test of CT-MPI and SPECT-MPI in the diagnosis of myocardial ischemia showed that Kappa in patients, vessels and segments were 0.600, 0.775 and 0.868 respectively, and they were all statistically significant（Pall〈0.05）. Conclusion Stress dynamic CT-MPI have great effects on the diagnosis of myocardial ischemia in CHD, CCTA combined with CT-MPI can make a one-stop evaluation of coronary artery stenosis and myocardial perfusion, which have remarkable advantages and can make better identify on the cause of ischemic stenosis, it

关 键 词：负荷动态CT心肌灌注成像 冠状动脉CT血管造影 冠心病 诊断 

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