东芝320排CT扫描容积成像在左心耳封堵术中的临床应用价值  

Application of CT scan volumetric imaging in percutaneous transcatheter left atrial appendage occlusion

作　　者：王子荣[1] 杨栋[2] 张邢炜[2] 陈晓飞 丁建平[1] WANG Zirong;YANG Dong;ZHANG Xingwei;CHEN Xiaofei;DING Jianping(Department of Medical Imaging,Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China)

机构地区：[1]杭州师范大学附属医院医学影像科,310015 [2]杭州师范大学附属医院心内科,310015

出　　处：《浙江医学》2020年第18期1949-1953,I0005,共6页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2020KY712);杭州市科技发展计划项目(20170533B45);杭州市卫生科技计划重大项目(2017ZD02)。

摘　　要：目的使用东芝320排CT扫描容积成像技术重建心房颤动患者左心耳并进行测量,探究经皮左心耳封堵术中临床应用价值。方法选取非瓣膜性心房颤动患者60例,回顾性心电门控CT扫描患者30例(A组),前瞻性心电门控CT扫描患者30例(B组),使用GE ADW4.6后处理工作站重建左心耳3D结构,并使用空间向量测量左心耳开口的长度,选择放置适当尺寸的左心耳封堵器,分析测量参数与左心耳封堵器之间的相关性。结果A组外测法左心耳开口最长径和内测法左心耳开口最长径与封堵器直径均呈正相关(r=0.91、0.82,均P<0.001);B组外测法左心耳开口最长径和内测法左心耳开口最长径与封堵器直径均呈正相关(r=0.77、0.73,均P<0.001)。结论回顾性心电门控CT扫描及前瞻性心电门控CT扫描测量数据均与封堵器直径相关,且回顾性扫描相关度更高。东芝320排CT扫描容积成像技术重建左心耳及测量,为经皮左心耳封堵术提供重要数据,为术后随访提供可靠依据。Objective To apply CT scan volumetric imaging in percutaneous left atrial appendage occlusion.Methods Sixty patients with non-valvular atrial fibrillation aged 44-86 years undergoing percutaneous left atrial appendage occlusion were randomly divided into two groups:30 patients underwent a retrospective electrocardiogram-gated CT scan(group A),and 30 patients underwent a prospective electrocardiogram-gated CT scan(group B)using Toshiba 320-row CT scanner.The left atrial appendage stereostructure was reconstructed by GE's ADW4.6 post-processing workstation,and the left atrial appendage opening was measured with space vectors.The long and short diameters were compared with intraoperative transesophageal echocardiography(TEE).A left atrial appendage occluder of appropriate size was selected and placed.The correlation between each parameter and the size of the left atrial appendage occluder was analyzed.TEE or CT volume imaging was performed at 3 and 12 month follow-ups.Results In group A the atrial appendage occluder was correlated with the external measurement and the internal measurement of the longest diameter of the left atrial appendage opening(r=0.91,0.82,P<0.001),and the effective radiation dose was 13.96±1.92 mSv.In group B the atrial appendage occluder was correlated with the external measurement and the internal measurement of the longest diameter of the left atrial appendage opening,respectively(r=0.77,0.73,P<0.001),and the effective radiation dose was 3.96±1.14 mSv.At 3 and 12 months after operation,no leakage of blood flow was observed by TEE or CT volume imaging,and only 2 cases had minimal(≤2.5 mm)left atrial appendage device marginal shunt.Conclusion Both retrospective and prospective scanning measurements by CT scan volumetric imaging are correlated with the diameter of the occluder,and the retrospective scanning method is more relevant,but the radiation dose is higher than the prospective scanning method.This technique facilitates percutaneous left atrial appendage occlusion and also provides a

关 键 词：CT扫描 容积成像 心房颤动 左心耳 封堵器 

分 类 号：R541.75[医药卫生—心血管疾病] R816.2[医药卫生—内科学]