CT测量左心室心肌应变的可重复性及与超声对照的一致性研究  

The reproducibility of left ventricular strain measured by CT and its agreement with speckle tracking echocardiography

作　　者：马亚南[1] 孟庆超 王涵 任心爽 于易通 安云强 吕滨[1] Ma Yanan;Meng Qingchao;Wang Han;Ren Xinshuang;Yu Yitong;An Yunqiang;Lyu Bin(Department of Medical Imaging,Fuwai Hospital,National Center for Cardiovascular Disease,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037,China;Department of Ultrasonic Imaging Center,Fuwai Hospital,National Center for Cardiovascular Disease,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院放射影像科,100037 [2]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院超声影像中心,100037

出　　处：《中华放射学杂志》2021年第11期1147-1152,共6页Chinese Journal of Radiology

基　　金：国家重点研发计划(2016YFC1300400)。

摘　　要：目的探讨CT特征追踪技术(CT-FT)评估左心室整体心肌应变的可重复性,及与斑点追踪超声心动图(STE)测量结果的相关性和一致性。方法前瞻性纳入2019年11月阜外医院门诊因疑诊冠心病在1周内完成全心动周期冠状动脉CTA(CCTA)和经胸超声心动图检查的患者30例。使用CT-FT、STE技术分别分析CT及超声图像的左心室容积和心肌应变,包括舒张末期容积(EDV)、收缩末期容积(ESV)、射血分数(EF)、整体纵向应变(GLS)、整体径向应变(GRS)和整体周向应变(GCS),其中GLS包括心内膜下整体纵向应变(EndoGLS)和心肌整体纵向应变(MyoGLS),GCS包括心内膜下整体周向应变(EndoGCS)和心肌整体周向应变(MyoGCS)。采用ICC评估CT-FT测量参数的观察者内和观察者间的一致性;采用配对样本t检验比较CT-FT与STE不同模式间测量参数的差异,Pearson相关系数分析CT-FT、STE测量结果的相关性,Bland-Altman法分析CT-FT、STE测量结果的一致性。结果CT-FT测量的EDV、ESV、EF、EndoGLS、MyoGLS、GRS、EndoGCS和MyoGCS,观察者内和观察者间测量结果一致性较好(ICC为0.775~0.964,P均<0.001)。CT-FT和STE测量的EF分别为(60.27±8.70)%和(61.22±5.64)%,差异无统计学意义(t=-0.777,P=0.443)。CT-FT测量的EndoGLS、MyoGLS、GRS和MyoGCS分别为(-20.47±4.01)%、(-18.06±3.75)%、(73.90±20.58)%和(-18.48±3.65)%;STE测量的EndoGLS、MyoGLS、GRS和MyoGCS分别为(-18.97±3.33)%、(-16.49±2.60)%、(18.56±3.06)%和(-20.26±4.45)%,差异均具有统计学意义(t值分别为-2.367、-2.945、12.161、2.459,P均<0.05),而CT-FT和STE测量的EndoGCS分别为(-27.78±6.66)%和(-29.18±7.24)%,差异无统计学意义(t=1.246,P=0.223)。两种成像模式测量的EndoGLS、MyoGLS、GRS、EndoGCS、MyoGCS呈中等-强相关,r值分别为0.566、0.629、0.509、0.606、0.539(P均<0.05)。CT-FT与STE测量的EndoGLS、MyoGLS、GRS、EndoGCS、MyoGCS的差值分别为-1.5%、-1.6%、55.3%、1.4%、1.8%、95%一致性界限分别为-8.3%~Objective To investigate the reproducibility of left ventricular strain assessed by CT feature tracking(CT-FT)and its correlation and agreement with speckle tracking echocardiography(STE).Methods Thirty outpatients with suspected coronary heart disease who underwent whole cardiac cycle coronary CTA and transthoracic echocardiography within one week were prospectively enrolled in November 2019.Left ventricular volume and strain parameters were measured by CT-FT and STE,including left ventricular end-diastolic volume(EDV),end-systolic volume(ESV),ejection fraction(EF),global longitudinal strain(GLS),global radial strain(GRS),and global circumferential strain(GCS).GLS included endocardial global longitudinal strain(EndoGLS)and myocardial global longitudinal strain(MyoGLS),GCS included endocardial global circumferential strain(EndoGCS)and myocardial global circumferential strain(MyoGCS).ICC was used to evaluate intra-and inter-observer differences in strain measured by CT-FT.The differences of measurements between CT-FT and STE were compared by paired-samples t test.Pearson correlation coefficient was used to analyze the correlation between CT-FT and STE measurements.Agreement between measurements of two modalities was assessed by Bland-Altman analysis.Results There was a good consistency in EDV,ESV,EF,EndoGLS,MyoGLS,GRS,EndoGCS and MyoGCS measured by CT-FT between intra-and inter-observer(ICC was 0.775-0.964,P<0.001).There was no significant difference in EF measured by CT-FT and STE[(60.27±8.70)%and(61.22±5.64)%,P=0.443].EndoGLS,MyoGLS,GRS and MyoGCS measured by CT-FT were(-20.47±4.01)%,(-18.06±3.75)%,(73.90±20.58)%and(-18.48±3.65)%,respectively,while the strain measured by STE were(-18.97±3.33)%,(-16.49±2.60)%,(18.56±3.06)%and(-20.26±4.45)%,respectively.The differences were statistically significant between CT-FT and STE(t=-2.367,-2.945,12.161,2.459,P<0.05).The EndoGCS measured by CT-FT and STE were(-27.78±6.66)%and(-29.18±7.24)%,respectively,with no statistical significance(P=0.223).The correlation co

关 键 词：体层摄影术 X线计算机 特征追踪 心肌应变 斑点追踪超声心动图 

分 类 号：R540.45[医药卫生—心血管疾病] R816.2[医药卫生—内科学]