CT管腔内密度衰减梯度联合无创血流储备分数对心肌缺血性损伤的诊断价值  

Diagnostic Value of Myocardial Ischemic Injury by Transluminal Attenuation Gradient Combined with Non⁃Invasive Fraction Flow Reserve in CT

作　　者：汤林梦 刘峰 董婷宇 庞智英 杨飞[2] 朱月香[2] 李娇娇[2] 崔书君[2] TANG Linmeng;LIU Feng;DONG Tingyu(Graduate School,The Hebei Northern University,Zhangjiakou,Hebei Province 075000,P.R.China)

机构地区：[1]河北北方学院研究生学院,张家口075000 [2]河北北方学院附属第一医院医学影像科,张家口075061

出　　处：《临床放射学杂志》2023年第4期585-590,共6页Journal of Clinical Radiology

基　　金：河北省政府资助临床医学人才培养项目[编号:冀卫办科教(2021)9号];张家口市重点研发计划项目(编号:2021030D);张家口市级科技项目(编号:1921131H)。

摘　　要：目的探讨并比较CT管腔内密度衰减梯度(TAG)、无创血流储备分数(FFR)及两者联合对心肌缺血性损伤的诊断效能。方法回顾性纳入2019年1月至2020年7月来本院就诊同时行冠状动脉CT血管造影(CCTA)和冠状动脉造影(ICA)检查,临床资料完整的73例患者,共114支病变血管(心肌缺血性损伤组49支,无心肌缺血性损伤组65支);对比两组患者临床资料与影像学特征的差异,包括基线资料、病变血管数量、病变血管位置、CT-FFR值、TAG值,并建立TAG、CT-FFR及两者联合诊断心肌缺血性损伤模型。结果心肌缺血性损伤组累及单支血管数量明显低于无心肌缺血损伤组,而同时累及三支血管数量明显高于后者(P<0.05)。在血管水平上,心肌缺血性损伤组不论是单支还是总体血管的CT-FFR和TAG值均明显小于无心肌缺血性损伤组(P<0.01)。在诊断效能上,CT-FFR诊断特异度明显优于TAG(87.7%vs.67.7%,P<0.017),TAG联合CT-FFR诊断特异度高于TAG(86.2%vs.67.7%,P<0.017);重要的是,两者联合诊断心肌缺血性损伤曲线下面积(AUC)明显优于TAG(0.889 vs.0788,P<0.017)。结论CT-FFR对心肌缺血损伤的诊断效能良好,TAG联合CT-FFR对心肌缺血性损伤有更高的AUC和特异度,与单独TAG相比有更高的诊断效能,有助于临床诊断心肌缺血病变。Objective To explore the diagnostic efficacy of intracavitary density attenuation gradient(TAG),non⁃inva⁃sive fraction flow reserve(CT⁃FFR)and their combination in myocardial ischemic injury.Methods CCTA and ICA ex⁃aminations were performed in 73 patients with complete clinical data from January 2019 to July 2020,with a total of 114 dis⁃eased vessels(49 in myocardial ischemic injury group and 65 in non⁃myocardial ischemic injury group).The differences of clinical data and imaging features between the two groups were compared,including baseline data,number of diseased ves⁃sels,location of diseased vessels,CT⁃FFR value and TAG value,and the model of combined diagnosis of myocardial ische⁃mic injury by TAG and CT⁃FFR was established.Results The number of single vessel involved in myocardial ischemic injury group was significantly lower than that in non⁃myocardial ischemic injury group,while the number of three vessels in⁃volved in myocardial ischemic injury group was significantly higher than that in the latter group(P<0.05).At the vascular level,the CT⁃FFR and TAG values of both single vessel and total vessel in the myocardial ischemic injury group were signif⁃icantly lower than those in the non⁃myocardial ischemic injury group(P<0.01).In terms of diagnostic efficiency,the diag⁃nostic specificity of CT⁃FFR was significantly better than that of TAG(87.7%vs.67.7%,P<0.017),and the diagnostic specificity of TAG combined with CT⁃FFR was higher than that of TAG(86.2%vs.67.7%,P<0.017).And the combi⁃nation of the two is significantly better than TAG in the diagnosis of myocardial ischemic injury(0.889 vs.0.788,P<0.017).Conclusion The diagnostic efficacy of CT⁃FFR in myocardial ischemic injury is still good.TAG combined with CT⁃FFR has higher AUC and specificity in myocardial ischemic injury,and has higher diagnostic efficacy than TAG alone,which is helpful for clinical diagnosis of myocardial ischemic injury.

关 键 词：冠心病 心肌缺血 管腔内密度衰减梯度 血流储备分数 体层摄影术 X线计算机 

分 类 号：R541.4[医药卫生—心血管疾病] R816.2[医药卫生—内科学]