重建技术及上胸部补充扫描对冠状动脉CT血管造影发现心外病灶的价值  

Clinical value of reconstruction technique and supplementary upper chest scan in detecting extra-cardiac lesions by coronary computed tomography angiography

作　　者：郭满涛 范晓娥 刘哲 刘小龙 齐敏[2] GUO Mantao;FAN Xiaoe;LIU Zhe;LIU Xiaolong;QI Min(Department of medical image,Xianyang Hospital of Yan'an University,Xianyang,Shaanxi 712000,China;Department of CT,Shaanxi Provincial People's Hospital,Xi'an,Shaanxi 710068,China)

机构地区：[1]延安大学咸阳医院影像科,陕西咸阳712000 [2]陕西省人民医院CT室,陕西西安710068

出　　处：《安徽医药》2022年第4期680-684,共5页Anhui Medical and Pharmaceutical Journal

基　　金：陕西省重点研发计划项目(2017SF-023)。

摘　　要：目的 观察冠状动脉CT血管造影(CCTA)检查后,大视野重建技术及上胸部补充扫描对心外病变检测中的临床价值。方法选取2014年2月至2018年3月陕西省人民医院收治的230例因可疑冠状动脉粥样硬化性心脏病(冠心病)行CCTA的病人,并且病人在行CCTA同时行补充上胸部CT检查。对CCTA图像进行大视野重建,而后将心外病灶分类,观察发现心外病灶分类情况;比较年龄<60岁组及年龄≥60岁组在大视野重建及补充上胸部CT扫描后心外病灶检出情况。结果 201例(201/230,87.39%)病人检出心外病灶293处,其中Ⅰ类病灶16处,Ⅱ类病灶51处,Ⅲ类病灶68处,Ⅳ类病灶158处;在发现的心外病灶数目中年龄≥60岁组占69.28%(203/293)高于<60岁组的30.72%(90/293);因发现Ⅰ类及Ⅱ类病灶而改变诊疗方案者共计62例,其中年龄<60岁组中20.38%的病人(21/103)改变了诊疗方案,≥60岁组中32.28%的病人(41/127)改变了诊疗方案,差异有统计学意义(P<0.05)。结论CCTA检查中大视野重建联合上胸部补充扫描则能基本覆盖胸部整个扫描范围,更能有效发现心外病灶,特别是在年龄较大的病人中,避免再次胸部扫描给病人带来的辐射剂量及检查费用的增加,部分地改变了胸痛病人的诊疗方案,值得推广。Objective To explore the clinical application value of large FOV reconstruction technique and supplementary upper chest scan in the detection of extra-cardiac lesions after coronary computed tomography angiography (CCTA).Methods A total of 230 suspected CAD patients who received CCTA and a supplementary scan of the upper chest in Shaanxi Provincial People’s Hospital from February 2014 to March 2018 were enrolled in this study.The CCTA images were performed by the large FOV (including the entire thorax) reconstruction technique,and then the extracardiac lesions were classified,and the classification of extracardiac lesions was observed.The difference of extracardiac lesions detected in<60 year old group and≥60 year old group after large FOV reconstruction technique and supplementary upper chest scan according to age groups.Results 230 cases of extra-cardiac lesions were found in 201patients (201/230,87.39%%),among them,16 were type I lesions,51 were typeⅡlesions,68 were typeⅢlesions and 158 were type IV lesions.In the number of extra-cardiac lesions,69.28%(203/293) in the age group≥60 years old was higher than 30.72%(90/293)in the age group<60 years old.There were 62 patients who changed the treatment plan due to the discovery of typeⅠandⅡlesions.Among them,20.38%of patients (21/103) in the age group<60 changed the diagnosis and treatment plan,and 32.28%of patients (41/127) in the age group≥60 changed the diagnosis and treatment plan.The difference was statistically significant (P<0.05).Conclusion Large FOV reconstruction technique and supplementary upper chest scan can basically cover the whole chest scanning range and detect more incidental extra-cardiac lesions in CCTA examination,especially in older patients,it can also avoid the radiation dose received by patients undergoing chest CT examination again and partially change the diagnosis and treatment plan for patients with chest pain,which is worthy of further promotion and application.

关 键 词：胸痛 计算机体层摄影血管造影术 心外病变 冠状动脉 补充扫描 

分 类 号：R541.4[医药卫生—心血管疾病]