双能量CT多参数技术评估心力衰竭患者心肌瘢痕的可行性与准确度  

Feasibility and accuracy of dual-energy CT multiparameter technique in evaluating myocardial scar in patients with heart failure

作　　者：郭倩 邵君 蒋佳珅 吴苏蒙 施林生[2] 刘君[2] 王天乐[1] 龚沈初[1] 祁荣兴[1] Guo Qian;Shao Jun;Jiang Jiashen;Wu Sumeng;Shi Linsheng;Liu Jun;Wang Tianle;Gong Shenchu;Qi Rongxing(Department of Radiology,Nantong Municipal First People′s Hospital,the Second Affiliated Hospital of Nantong University,Nantong 226001,China;Department of Cardiology,Nantong Municipal First People′s Hospital,the Second Affiliated Hospital of Nantong University,Nantong 226001,China)

机构地区：[1]南通市第一人民医院南通大学第二附属医院影像科,南通226001 [2]南通市第一人民医院南通大学第二附属医院心内科,南通226001

出　　处：《中华放射学杂志》2023年第4期390-396,共7页Chinese Journal of Radiology

基　　金：2021年江苏省医学会伦琴影像科研专项资金(SYH-3201150-0010);2021年南通市基础科学研究项目(JC2021195);南通市临床医学中心项目(HS2019002)。

摘　　要：目的以基于钆对比剂心脏MR延迟强化(LGE-CMR)为参考标准,探讨心脏双能量CT延迟扫描(LIE-DECT)多参数后处理技术评估心力衰竭(HF)患者心肌瘢痕存在、位置和程度的可靠性。方法前瞻性收集2019年11月至2021年11月于南通大学第二附属医院2周内行心脏LIE-DECT和LGE-CMR检查的HF患者39例,所有入组HF患者LIE-DECT使用多参数后处理技术重建40 keV单能谱(Mono+)图、碘图和电子云密度/等效原子系数(Rho/Z)图,分别在左心室短轴位图上评估左心室心肌LIE位置及累及程度,并且与LGE-CMR进行对照。DECT多参数技术检测LIE观察者内和观察者间的一致性、DECT多参数技术检测LIE存在及位置与CMR的一致性采用Cohen′s Kappa一致性检验,并计算DECT多参数技术诊断心肌瘢痕的诊断效能。DECT多参数技术测量的瘢痕累及程度与CMR的一致性采用Bland-Altman一致性检验。结果39例患者CMR共检测出32例患者147个节段存在LGE,心内膜下型37个、透壁型19个、心肌中层型74个、心外膜下型17个。40 keV Mono+图、碘图和Rho/Z图观察者内一致性的Kappa值分别0.878、0.930和0.835(P均<0.001),观察者间一致性Kappa值分别为0.838、0.892和0.808(P均<0.001)。40 keV Mono+图、碘图、Rho/Z图检测的LIE均与CMR有较好的一致性,Kappa值分别达0.903、0.883和0.810(P均<0.001)。基于患者,40 keV Mono+图、碘图和Rho/Z图诊断心肌瘢痕准确度为92.3%(36/39)、92.3%(36/39)和82.1%(32/39);基于心肌节段,40 keV Mono+图、碘图和Rho/Z图诊断心肌瘢痕的准确度性分别为96.1%(492/512)、95.3%(488/512)和92.6%(474/512)。Bland-Altman分析显示40 keV Mono+图、碘图和Rho/Z图所测量瘢痕累及程度与CMR间的偏倚-2.03%、-2.21%和-2.65%,95%一致性界限为-12.20%~8.14%、-12.69%~8.28%和-14.85%~9.58%。结论LIE-DECT多参数技术能够很好地检测HF患者的心肌瘢痕,与LGE-CMR有很好的一致性。Objective To evaluate the reliability of cardiac late iodine enhancement dual-energy CT(LIE-DECT)multiparameter post-processing technique for evaluating the presence,location,and extent of cardiac scars in patients with heart failure(HF),using cardiac MR(CMR)late gadolinium enhancement(LGE)as a reference standard.Methods Thirty-nine HF patients who underwent cardiac LIE-DECT and LGE-CMR examinations in the Second Affiliated Hospital of Nantong University from November 2019 to November 2021 were prospectively collected,all enrolled HF patients underwent LIE-DECT post-processing to reconstruct monoenergetic plus(Mono+)map(40 keV),iodine map and Rho/Z map,to evaluate the enhancement degree,location and extent of left ventricular myocardial LIE on the left ventricular short-axis map,respectively,and compared with LGE-CMR.Cohen′s Kappa test was used to assess the intra-and inter-observer consistency of LIE by DECT multiparameter technique and the consistency of LIE presence and location by DECT multiparameter technique and by CMR.The diagnostic efficacy of DECT multiparameter technique in diagnosing myocardial scar was calculated.Results Of the 39 patients included,32 patients were detected by CMR with LGE in 147 segments,including 37 subendocardial patterns,19 transmural patterns,74 mid-wall patterns,and 17 epicardial patterns.The intra-observer consistency Kappa values of 40 keV Mono+map,iodine map and Rho/Z map were 0.878,0.930 and 0.835(P all<0.001),respectively.The inter-observer consistency Kappa values were 0.838,0.892 and 0.808(P all<0.001),respectively.The LIE of 40 keV Mono+map,iodine map and Rho/Z map were in good agreement with CMR,Kappa values were 0.903,0.883 and 0.810(P all<0.001),respectively.For the per-patient analysis,the accuracies of 40 keV Mono+map,iodine map and Rho/Z map were 92.3%(36/39),92.3%(36/39)and 82.1%(32/39),respectively.For the segment-based analysis,the accuracies of 40 keV Mono+map,iodine map and Rho/Z map accuracy were 96.1%(492/512),95.3%(488/512)and 92.6%(474/512),respectively.

关 键 词：体层摄影术 X线计算机 磁共振成像 心肌延迟强化 

分 类 号：R541.6[医药卫生—心血管疾病] R816.2[医药卫生—内科学]