低剂量动态CT心肌灌注成像对急性心肌梗死患者微循环梗阻的诊断价值  

The value of low-dose dynamic CT myocardial perfusion imaging for microvascular obstruction in patients with acute myocardial infarction

作　　者：杨茗茗 陆靖[1] 张佳胤[1] 李跃华[1] YANG Mingming;LU Jing;ZHANG Jiayin;LI Yuehua(Department of Radiology,Shanghai Sixth People's Hospital,Shanghai 200030,China)

机构地区：[1]上海市第六人民医院放射科,上海200030

出　　处：《实用放射学杂志》2021年第2期229-234,共6页Journal of Practical Radiology

基　　金：国家自然科学基金项目(81671673);上海市重中之重医学影像重点学科项目(2017ZZ02005).

摘　　要：目的探讨动态CT心肌灌注成像(CT-MPI)的定量参数对急性心肌梗死(AMI)和微循环梗阻(MVO)的诊断价值.方法本研究将成功接受再血管化治疗后1周内的患者作为研究对象.所有患者均行心脏MRI和CT-MPI检查.结果最终本研究纳入25例患者的425个心肌节段.存在MVO的心肌节段的心肌血流量(MBF)显著低于无MVO节段和参考节段.根据受试者工作特征(ROC)曲线分析,以延迟钆增强(LGE)作为参考标准,在诊断AMI是否存在MVO的所有定量参数中,MBF具有最大的曲线下面积(AUC)(AUC=0.955和0.998;P<0.001).基于MBF评估鉴别MVO的诊断准确性为99.5%,优于其他定量参数和延迟碘增强(LIE).MBF和LGE评价的AMI面积和MVO面积之间有良好的相关性(r=0.97和0.975;P<0.001).结论MBF在诊断患者是否存在AMI和MVO时,准确性高,优于CT-MPI的其他定量参数和LIE,MBF还可以较精确地估算AMI和MVO的面积.Objective To investigate the quantitative parameters of dynamic CT myocardial perfusion imaging(CT-MPI)for the diagnosis of acute myocardial infarction(AMI)and microvascular obstruction(MVO).Methods Patients with AMI who sucessfully received reperfusion treatment within one week were selected as research subjects in this study.All patients underwent cardiac MRI and CT MPL.Results 425 myocardial segments from 25 patients were included in the study.The myocardial blood flow(MBF)of myocardial segments with MVO was sgnficantly lower than that of myocardial sgments without MVO sqgments and refcrence sgments.According to receiver operating characteristic(ROC)curve analysis,late gadolinium enhancement(LGE)was taken as a reference standard.MBF had the largest area under the curve(AUC)among all quantitative parameters for diagnosing AMI with or without MVO(AUC=0.955 and 0.998;P<0.001).The diagnostie accuracy of MBF-based asessmnent for ienifying MV0 was 99.5%,which was better than other quantitative parameters and late iodine enhancenen(LIE).The good crrelation betwen the AMI area and MVO arca an be asssed by MBF and LGE(r=0.97 and 0.975;P<0.001).Conclusion MBF has high accuracy in diagnosing AMI and MVO,which is superior to other quantitative parameters and LIE of CT-MPI,and MBF can accurately estimate the area of AMI and MVO.

关 键 词：急性心肌梗死 微循环梗阻 心肌血流量 心肌灌注成像 

分 类 号：R542.22[医药卫生—心血管疾病] R814.42[医药卫生—内科学]