基于双层探测器光谱CT碘密度成像定量评估急性ST段抬高型心肌梗死细胞外容积分数  

Quantitative evaluation of extracellular volume fraction after acute ST segment elevation myocardial infarction by iodine density based on spectral detector CT

作　　者：陈冰华 安东敖蕾 何杰 武睿[1] 施若洋 吴崇文 岳婷 范子阳 戴漪思 沈佳璐 丁盈盈[3] 王嵇[1] 卜军[2] 陈杏彪 吴连明[1] 许建荣[1] Chen Binghua;An Dongaolei;He Jie;Wu Rui;Shi Ruoyang;Wu Chongwen;Yue Ting;Fan Ziyang;Dai Yisi;Shen Jialu;Ding Yingying;Wang Ji;Pu Jun;Chen Xingbiao;Wu Lianming;Xu Jianrong(Department of Radiology,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China;Department of Cardiology,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China;Department of Epidemiology,School of Public Health,Key Laboratory of Public Health Safety of Ministry of Education,Fudan University,Shanghai 200032,China;Clinical Science,Philips Healthcare,Shanghai 200070,China)

机构地区：[1]上海交通大学医学院附属仁济医院放射科,200127 [2]上海交通大学医学院附属仁济医院心内科,200127 [3]复旦大学公共卫生学院流行病学教研室公共卫生安全教育部重点实验室,上海200032 [4]飞利浦医疗临床科研部,上海200070

出　　处：《中华放射学杂志》2020年第6期527-533,共7页Chinese Journal of Radiology

基　　金：国家自然科学基金(81873886,81873887)。

摘　　要：目的探讨双层探测器光谱CT碘密度成像定量评价急性ST段抬高型心肌梗死(STEMI)细胞外容积(ECV)分数的可行性。方法回顾性分析2019年1月至10月在上海交通大学医学院附属仁济医院行心脏增强CT及MRI检查的20例STEMI患者的临床和影像资料。心脏增强CT采用双层光谱探测器进行后门控冠状动脉CT血管成像扫描和前门控碘延迟增强扫描。迭代重建和光谱重建获得常规图像和全息光谱图像。通过多平面重建得到与MRI图像相匹配的心脏短轴位图像。基于延迟增强期全息光谱图像数据重建出碘密度图用于心肌CT-ECV的计算。并分别计算基于CT和MRI的梗死心肌、可挽救心肌和远处心肌的ECV。采用Bland-Altman一致性检验和组内相关系数分析(ICC)比较两次测量及不同方法测量的一致性。采用Spearman方法比较CT-ECV和MRI-ECV值的相关性。结果梗死心肌、可挽救心肌和远处心肌CT-ECV值分别为51.21(49.27,53.00)%、38.64(36.17,40.00)%和51.21(49.27,53.00)%,差异具有统计学差异(H=43.17,P<0.01)。梗死心肌CT-ECV值显著高于可挽救心肌和远处心肌CT-ECV值(Z=-24.60、35.40,P均<0.01),但可挽救心肌与远处心肌CT-ECV相比差异无统计学意义(Z=10.80,P=0.15)。梗死心肌、可挽救心肌和远处心肌T1值分别为(1554.85±70.94)、(1443.85±67.28)和(1307.05±91.73)ms,差异具有统计学差异(F=51.35,P<0.01)。梗死心肌T1值高于可挽救心肌和远处心肌T1值(t=-5.07、9.55,P均<0.01),且可挽救心肌显著高于远处心肌T1值(t=5.38,P<0.01)。梗死心肌、可挽救心肌和远处心肌MRI-ECV值分别为55.00(49.27,57.75)%、33.50(29.00,35.00)%和27.00(26.00,29.00)%,差异具有统计学差异(H=47.12,P<0.01)。梗死心肌MRI-ECV显著高于可挽救心肌和远处心肌MRI-ECV值(Z=37.45、-20.30,P均<0.01),且可挽救心肌显著高于远处心肌MRI-ECV值(Z=17.15,P<0.05)。2名医师测量的CT-ECV与MRI-ECV值一致性较好,Bland-Altman分析的偏倚分别�Objective To explore the feasibility of quantitative evaluation of extracellular volume(ECV)fraction in acute ST-segment elevation myocardial infarction(STEMI)by dual-layer spectral detector CT.Methods The clinical and imaging data of 20 patients with STEMI who underwent cardiac contrast-enhanced CT and MRI from January to October 2019 in Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine were retrospectively analyzed.The dual spectral detector was used in the enhanced CT scan of the coronary artery with retrospectively gate and the late iodine enhancement with prospective gate.Conventional image and holographic spectral image were obtained by iterative and spectral reconstruction.The short axis image of the heart matched with MR image was obtained by multiplanar reconstruction.Based on the data of spectral based image,the IDD map was reconstructed for the calculation of myocardial CT-ECV during the late iodine enhancement.ECV of infarcted myocardium,salvageable myocardium and remote myocardium based on CT and MRI were calculated respectively.Bland-Altman consistency test and intra group correlation coefficient analysis(ICC)were used to compare the consistency of two measurements and different methods.The correlation between CT-ECV and MRI-ECV was compared by Spearman method.Results The CT-ECV values of infarcted,salvageable,and remote myocardium were 51.21(49.27,53)%,38.64(36.17,40)%,and 51.21(49.27,53)%,respectively.The difference was statistically significant(H=43.17,P<0.01).The CT-ECV value of infarcted myocardium was significantly higher than that of salvageable myocardium and remote myocardium(Z=-24.60,35.40,P<0.01),but there was no significant difference between salvageable myocardium and remote myocardium(Z=10.80,P=0.15).The T1 values of infarcted myocardium,salvageable myocardium and remote myocardium were(1554.85±70.94),(1443.85±67.28)and(1307.05±91.73)ms respectively,the difference was statistically significant(F=51.35,P<0.01).The T1 value of infarcted myocardium was higher

关 键 词：心肌梗塞 体层摄影术 X线计算机 磁共振成像 

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