动态负荷CT心肌灌注成像与CMR对高血压患者冠状动脉微循环障碍的评估价值  

CT-MPI and CMR evaluation of coronary microcirculatory disorders and related factors in hypertensive patients

作　　者：玉苏甫·肉孜 洪悦[1] 热亚提·阿布拉 李林偲 刘烁[1] YUSUFU Rou-zi;HONG Yue;REYATI Abula;LI Lin-cai;LIU Shuo(Radiography Center,Xinjiang Uygur Autonomous Region 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

出　　处：《中国临床医学影像杂志》2024年第8期557-562,共6页Journal of China Clinic Medical Imaging

基　　金：新疆维吾尔自治区自然科学基金(编号:2022D01C639)。

摘　　要：目的:探讨动态负荷CT心肌灌注成像(CT-MPI)与心脏磁共振成像(CMR)评估高血压患者冠状动脉微循环障碍(CMD)的可行性。方法:纳入我院2022年1月-2023年6月因疑似冠心病收治入院的高血压患者64例,行CT-MPI、CMR、微血管阻力指数(IMR)检查,以IMR>25为CMD标准分为研究组和对照组,对比两组患者CT-MPI、CMR检查参数差异,采用Pearson相关性分析CT-MPI、CMR检查参数与IMR值的相关性,采用回归模型分析CT-MPI结合CMR检查参数预测值与IMR检测结果的一致性,采用ROC曲线分析CT-MPI、CMR及基于回归模型联合评估高血压患者发生CMD的价值。结果:研究组心肌灌注血流量(MBF)、心肌灌注血容量(MBV)、左室射血分数(LVEF)、最大上升斜率(Slopmax)、峰值信号强度(SLpeak)低于对照组,灌注达峰时间(TTP)、左室质量指数(LVMI)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、达峰时间(tpeak)高于对照组,差异有统计学意义(P<0.05);CT-MPI、CMR各指标与IMR值显著相关,有统计学意义(P<0.05);Logistic回归模型预测值与IMR检测结果有良好的一致性,假阳性率3.45%;ROC曲线分析结果显示,MBF、MBV、LVMI、LVEF、LVEDV、SLpeak六个指标敏感度<0.8,有较大的漏诊率;TTP、Slop_(max)、t_(peak)三个指标敏感度和特异性均>0.8有较高评估价值;CT-MPI结合CMR基于Logistic回归预测敏感度=1.00,特异性=0.966,评估价值较高;CT-MPI心肌17节段MBF结果显示,CMD患者负荷态4、5、7、10、15节段MBF值低于静息态,以上节段或是CMD发生主要区域。结论:CT-MPI、CMR可一定程度揭示CMD的存在,CT-MPI结合CMR基于回归模型预测与IMR检测结果有良好一致性,对评估高血压患者CMD有较高价值。Objective:Exploring the feasibility of using dynamic load CT myocardial perfusion imaging(CT-MPI)combined with cardiac magnetic resonance imaging(CMR)to evaluate coronary microcirculation disorders(CMD)in hypertensive patients.Method:Sixty-four hypertensive patients admited to our hospital from January 2022 to June 2023 due to suspected coronary heart disease were included,using CT-MPI,CMR and IMR examinations,divide into study group and control group according to the CMD standard of IMR>25,compare the differences in CT-MPI and CMR examination parameters between two groups of patients,using Pearson correlation analysis to examine the correlation between CT-MPI and CMR parameters and IMR values,using regression models to analyze the consistency between CT-MPI combined with CMR to check parameter predictions and IMR detection results,the value of using ROC curve analysis to evaluate the occurrence of CMD in hypertensive patients us-ing CT-MPI,CMR and regression model-based joint assessment.Result:The MBF,MBV,LVEF,Slopmx and SLpek of the study group were lower than those of the control group,while TTP,LVMI,LVEDV,LVESV and tpeak were higher than those of the control group,with statistical significance(P<0.05).CT-MPI and CMR indicators were significantly correlated with IMR val-ues,with statistical significance(P<0.05).The predicted values of the logistic regression model have good consistency with the IMR detection results,the false positive rate is 3.45%.The ROC curve analysis results show that the sensitivity of six indi-cators,MBF,MBV,LVMI,LVEF,LVEDV and SL_(peak) is less than O.8,indicating a high rate of missed diagnosis.The combi-nation of CT-MPI and CMR based on logistic regression predicts a sensitivity of 1.00 and a specificity of 0.966,indicating high evaluation value.The CT-MPI myocardial 17 segment MBF results showed that the MBF values in the load state 4,5,7,10 and 15 segments of CMD patients were lower than those in the rest state,and these segments may be the main regions of CMD occurrence.Conclusion:

关 键 词：高血压 冠状动脉循环 磁共振成像 体层摄影术 X线计算机 

分 类 号：R543.3[医药卫生—心血管疾病] R544.1[医药卫生—内科学] R445.2[医药卫生—临床医学] R814.42