双能量心脏CT多模态成像结合细胞外容积分数评估陈旧性心肌梗塞的可行性研究  

Study on the feasibility of dual-energy cardiac CT multimodal imaging combined with extracellular volume fraction in assessing OMI

作　　者：刘烁[1] 敬文波 刘艳[2] LIU Shuo;JING Wen-bo;LIU Yan(Center of Radiological Imaging,Xinjiang Uiger Municipal People’s Hospital,Urumqi 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院放射影像中心,新疆乌鲁木齐830001 [2]新疆医科大学附属肿瘤医院影像科,新疆乌鲁木齐830001

出　　处：《中国医学装备》2022年第10期37-43,共7页China Medical Equipment

摘　　要：目的:对比研究双能量心脏CT及延迟增强扫描结合基于CT衰减值的细胞外容积分数与锝99(^(99)Tc^(m))-甲氧基异丁基异腈(^(99)Tc^(m)-MIBI)心肌灌注显像,探讨双能量心脏CT一站式评价陈旧性心肌梗塞的可行性。方法:选取34例在医院行冠状动脉CT血管成像的陈旧性心肌梗塞(OMI)患者,与^(99)Tc^(m)-MIBI心肌灌注显像相应的心肌节段进行对照,观察常规CT图像、能谱图像及细胞外容积分数等,采用受试者工作特征(ROC)曲线下面积(AUC)评价陈旧性心肌梗塞的诊断效能。结果:在34例陈旧性心肌梗塞患者的578个心肌节段中,^(99)Tc^(m)-MIBI心肌灌注显影固定性缺损节段共230个,在双能量CT(DECT)能谱图像中电子云密度与等效原子序数(Rho/Z)值诊断效能相对较高,AUC为0.856,而常规CT图像诊断效能最低;延迟期增强扫描后的基于CT衰减值的细胞外容积分数诊断效能最高,AUC为0.878,约登指数为0.735,最佳分界点30.70%时其灵敏度、特异度、阳性预测值及阴性预测值分别为87.5%、86.0%、85.3%和87.8%。结论:双能量心脏CT多模态成像结合细胞外容积分数,可以提高OMI的诊断效能,有助于心肌血供的一站式评估。Objective:To investigate the feasibility of one-stop evaluation of dual-energy cardiac computed tomography(CT) on the old myocardial infarction(OMI) by comparing and studying dual-energy cardiac CT and delayed contrast-enhanced scan combined with extracellular volume fraction based on CT pad value and heart muscle perfusion imaging with technetium 99 m(^(99)Tc^(m))-methoxyisobutylisonitrile(99 ^(99)Tc^(m)m-MIBI).Methods:A total of 34 patients with OMI who underwent coronary CT angiography in hospital were collected,and the results were compared with the corresponding cardiac segments of^(99)Tc^(m)-MIBI myocardial perfusion imaging.Conventional CT images,energy spectral images and extracellular volume fraction were observed.And the area under curve(AUC) of receiver operating characteristic(ROC) curve was used to evaluate the diagnostic efficacy on OMI.Results:In 578 cardiac segments of34 OMI patients,230 segments were fixed defect segments as^(99)Tc^(m)-MIBI myocardial perfusion imaging.The diagnostic efficiency of electron cloud density and equivalent atomic number(Rho/Z) value was relatively high in dual-energy CT(DECT) spectral images,and the AUC of that was 0.856.However,the diagnostic efficiency of routine CT image was lowest.The diagnostic efficiency of extracellular volume fraction based on CT pad value after enhancement scan during delay period was highest,and AUC was approximate 0.878,and Youden index was 0.735.In addition,the sensitivity,specificity,positive predictive value and negative predictive value were 87.5%,86.0%,85.3% and 87.8% at the 30.70% of the best cut-off point,respectively.Conclusion:Dual-energy cardiac CT multimodal imaging combined with extracellular volume fraction can improve the diagnostic efficiency of OMI and help to one-stop assessment on the supply of myocardial blood.

关 键 词：双能量CT 细胞外容积分数 陈旧性心肌梗塞(OMI) 单光子发射型电子计算机断层扫描(SPECT) 心肌灌注显像 

分 类 号：R816.2[医药卫生—放射医学]