心脏CT三维容积测量技术评估房间隔缺损在心动周期中的动态变化及对封堵器选择的影响  

Three-dimensional volume rendering for dynamic characteristics of secundum atrial septal defect during various phases of the cardiac cycle and the impact on occluder selection

作　　者：宋会军[1] 李世国[1] 刘琼[1] 金敬琳[1] 杨凯[2] 张旌 徐仲英[1] 潘湘斌[1] 赵世华[2] Song Huijun;Li Shiguo;Liu Qiong;Jin Jinglin;Yang Kai;Zhang Jing;Xu Zhongying;Pan Xiangbin;Zhao Shihua(Center for Structural Heart Disease,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Cardiac MR,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100037,China;Department of Cardiac Surgery,Fuwai Hospital,Chinese Academy of Medical Sciences,Shenzhen 518057,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,阜外医院结构性心脏病中心,北京100037 [2]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院磁共振影像科,北京100037 [3]中国医学科学院,阜外医院深圳医院心外科,深圳518057

出　　处：《中华心血管病杂志》2022年第8期805-810,共6页Chinese Journal of Cardiology

摘　　要：目的探讨继发孔型房间隔缺损(ASD)在心动周期不同时相的动态变化规律及其对封堵器选择的影响。方法本研究为回顾性研究,纳入2016年12月至2019年12月在阜外医院行冠状动脉CT血管成像(CCTA)全心动周期心电门控扫描并成功行介入封堵的ASD患者35例。CCTA影像学数据以5%递增的顺序自0开始依次重建至95%RR间期,合计20个时相。采用CT内镜辅助测量技术(CTVE)观察每个时相的ASD形态,利用CT横断序列辅助测量技术(CTAS)测量出ASD在各时相的横径(D_(a))及上下径(D_(b)),运用等周长转换公式计算其等效圆直径[D_(e),D_(e)=短径+2×(长径-短径)÷3,D_(a)、D_(b)中较大者为长径,较小者为短径]。取75%RR间期时相的数据,将患者分为D_(a(75%RR间期))≥D_(b)(75%RR间期)组和D_(a(75%RR间期))<D_(b(75%RR间期))组。依据术后胸部X线片测量封堵器在左前斜位平片的腰部直径,以校正公式计算得出其校正值(CR-POD_(lao)c)。绘制D_(a)、D_(b)及D_(e)均值随心动周期变化的散点图。分别计算D_(a)、D_(e)在35%及75%RR间期时测值的差值(下文简称改变量)及比值。计算D_(a)(75%RR间期)≥D_(b)(75%RR间期)组和D_(a)(75%RR间期)<D_(b)(75%RR间期)组患者的D_(e)改变量与D_(a)改变量之比,并进行组间比较。采用Pearson相关分析探讨CR-POD_(lao)c与D_(e)(35%RR间期)及D_(e)(75%RR间期)的相关性。结果共纳入35例患者,年龄(42.7±15.0)岁,其中男性10例。D_(a)(75%RR间期)≥D_(b)(75%RR间期)组8例,D_(a)(75%RR间期)<D_(b)(75%RR间期)组27例。散点图显示D_(a)与D_(b)均随心动周期各时相呈规律性变化,D_(a)变化明显,最大值出现在35%~45%RR间期,最小值出现在90%~0 RR间期;D_(b)在10%~90%RR间期无明显改变,在0~10%及90%~0 RR间期先增加后变小。D_(a)的改变量为(6.35±2.46)mm,在35%及75%RR间期时测值的比值为0.77±0.08;D_(e)的改变量为(2.28±1.32)mm,在35%及75%RR间期时测值的比值为0.93±0.05。D_(a)(75%RR间期)≥D_(b)Objective To investigate the dynamic change of the secundum atrial septal defect(ASD)throughout the cardiac cycle,and assess its impact on occluder selection.Methods This study retrospectively analyzed 35 patients with ASD who received electrocardiogram-gated coronary CT angiography(CCTA)throughout the cardiac cycle as well as interventional closure therapy in Fuwai Hospital from D_(e) cember 2016 to D_(e) cember 2019.The raw data were reconstructed into 20 phasic images of RR intervals(RRI)ranging from 0 to 95%in an increment of 5%and transmitted to a workstation for postprocessing.For each phase image,CT virtual endoscopy reconstruction technique(CTVE)was used to provide views of ASD.Axial sequence assisted CT volumetric measurement(CTAS)was used to calculate the maximum dimensions in axial planes(D_(a))and in superior-inferior direction(D_(b)).Using a formula for converting circumference to diameter,the equivalent circle dimensions were calculated(De,De=minor axis+2(major axis-minor axis)/3).Taking the data of 75%RRI phase,the patients were divided into D_(a75%RRI)≥D_(b75%RRI) group and D_(a75%RRI)<D_(b75%RR) group.According to the postoperative chest X-ray,the waist diameter of the occluder in the left anterior oblique plain film was measured,and its correction value(CR-POD_(lao)c)was calculated with the correction formula.Scatter plots of the changes of the mean values of Da,D_(b) and D_(e) with the cardiac cycle were presented.The change and ratio of measured values of D_(a) and D_(e) at 35%and 75%RRI was calculated.The ratio of D_(e) change to D_(a) change in D_(a75%RRI)≥D_(b75%RRI) group and D_(a75%RRI)<D_(b75%RR) group was calculated,respectively,and compared between groups.Pearson correlation analysis was used to explore the correlation between CR-POD_(lao)c and D_(e35%RRI) and D_(e) 75%RRI.Results A total of 35 patients,aged(42.7±15.0)years,including 10 males,were included.Among 35 patients,8 cases were divided into group D_(a75%RRI)≥D_(b75%RRI) and 27 cases into group D_(a75%RRI)<D_(b75%RRI).Bo

关 键 词：房间隔缺损 形态学 心脏CT 成像 三维 心导管插入术 间隔封堵器 

分 类 号：R541.1[医药卫生—心血管疾病]