CT心肌静态灌注成像中两种参数校正技术对缺血性心肌病诊断效能的研究  

Study on the Diagnostic Efficacy of Two Parameter Calibration Techniques in CT Myocardial Static Perfusion Imaging for Ischemic Cardiomyopathy

作　　者：潘英杰 陈岩 秦斌 张翔 高希法 PAN Yingjie;CHEN Yan;QIN Bin;ZHANG Xiang;GAO Xifa(Department of Radiology,The Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Province Hospital of China Medicine,Nanjing Jiangsu 210029,China)

机构地区：[1]南京中医药大学附属医院/江苏省中医院放射科,江苏南京210029

出　　处：《中国医疗设备》2025年第3期134-139,153,共7页China Medical Devices

基　　金：2023年度国家中医临床研究基地开放课题(JD2023SZ14)。

摘　　要：目的以心脏磁共振(Cardiac Magnetic Resonance,CMR)成像为参照,评估CT静态灌注参数——心肌灌注指数(Myocardial Perfusion Index,MPI)和校正后心肌灌注值(Corrected Myocardial Perfusion,C-MP)对缺血性心肌病的诊断价值及相关性。方法回顾性收集2022年1月至2023年12月期间在我院接受冠状动脉CT血管成像(Coronary CT Angiography,CCTA)并在一周内行静息CMR检查的42例患者数据,将其中21例心肌无异常者作为阈值参照组,其余21例作为实验组。采用美国心脏病学会推荐的17分段法,测量除心尖外的16个节段的心肌衰减密度(Attenuation Density,AD)值,并通过腔内和主动脉平均AD校正,获得MPI与C-MP,再分析其相关性及诊断效能的一致性。结果MPI与C-MP数据差异无统计学意义(P>0.05),且呈正相关分布。以CMR为参照,MPI的敏感度为79.5%,特异性为97.9%,阳性预测值为72.9%,阴性预测值为98.6%,准确度为96.7%;C-MP的敏感度为70.5%,特异性为96.8%,阳性预测值为60.8%,阴性预测值为97.9%,准确度为92.5%。MPI与C-MP对缺血心肌节段的诊断效能与CMR相近(P>0.05)。结论MPI对心肌缺血的诊断效能优于C-MP,可作为CCTA的补充,为临床提供一种便捷的心肌缺血检测手段。Objective To evaluate the diagnostic value and correlation of two CT static perfusion parameters,namely myocardial perfusion index(MPI)and corrected myocardial perfusion(C-MP)for ischemic cardiomyopathy,with cardiac magnetic resonance(CMR)imaging as the reference standard.Methods A total of 42 patients who underwent coronary CT angiography(CCTA)and resting CMR within one week at our hospital from January 2022 to December 2023 were retrospectively enrolled.Among them,21 patients with normal myocardium were included as the threshold reference group,and the remaining 21 patients were assigned to the experimental group.The 17-segment method recommended by the American Heart Association was used to measure the myocardial attenuation density(AD)of 16 segments excluding the apex.MPI and C-MP were obtained by correcting with the average AD of the intracavitary and aortic segments.The correlation and diagnostic performance consistency of MPI and C-MP were analyzed.Results There was no statistically significant difference in the data between MPI and C-MP(P>0.05),and they exhibited a positive correlation.Compared with CMR,the sensitivity of MPI was 79.5%,specificity was 97.9%,positive predictive value was 72.9%,negative predictive value was 98.6%,and accuracy was 96.7%.For C-MP,the sensitivity was 70.5%,specificity was 96.8%,positive predictive value was 60.8%,negative predictive value was 97.9%,and accuracy was 92.5%.The diagnostic efficacy of MPI and C-MP for ischemic myocardial segments was comparable to that of CMR(P>0.05).Conclusion The diagnostic efficacy of MPI for myocardial ischemia is better than that of C-MP.MPI can be used as a supplement to CCTA,providing a convenient method for clinical detection of myocardial ischemia.

关 键 词：冠状动脉疾病 心肌灌注 静态灌注 心脏磁共振成像 心肌灌注指数(MPI) 校正后心肌灌注值(C-MP) CT冠状动脉血管成像(CCTA) 衰减密度(AD) 

分 类 号：R445.2[医药卫生—影像医学与核医学]