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中华诊断学电子杂志 ›› 2015, Vol. 03 ›› Issue (03) : 173 -178. doi: 10.3877/cma.j.issn.2095-655X.2015.03.005

所属专题： 文献；

影像学诊断研究

第二代双源CT双能量心肌灌注成像对心肌梗死的诊断价值
韩瑞娟1, 孙凯2,†(), 李坤成3, 赵瑞平1, 李文欢3, 白栓成4, 王君艳5, 李洪宇1, 卢耀军1   
  1. 1. 014040　内蒙古包头市中心医院转化医学中心
    2. 014040　内蒙古包头市中心医院转化医学中心；014040　内蒙古包头市中心医院医学影像研究所
    3. 100020　北京，首都医科大学宣武医院放射科
    4. 014040　内蒙古包头市中心医院麻醉科
    5. 014040　内蒙古包头市中心医院ICU
  • 收稿日期:2015-01-16 出版日期:2015-08-26
  • 通信作者: 孙凯

Diagnostic accuracy of the second generation dual-source dual-energy CT myocardial perfusion imaging in patients with suspicious myocardial infarction

Ruijuan Han1, Kai Sun2,†(), Kuncheng Li3, Ruiping Zhao1, Wenhuan Li3, Shuancheng Bai4, Junyan Wang5, Hongyu Li1, Yaojun Lu1   

  1. 1. Department of Translational Medicine Center, Central Hospital of Baotou, Baotou 014040, China
    2. Department of Translational Medicine Center, Central Hospital of Baotou, Baotou 014040, China;Department of Medical Imaging Research Institute, Central Hospital of Baotou, Baotou 014040, China
    3. Department of Imaging, Xuanwu Hospital, Beijing 100020, China
    4. Department of Anesthesiology, Central Hospital of Baotou, Baotou 014040, China
    5. Department of ICU, Central Hospital of Baotou, Baotou 014040, China
  • Received:2015-01-16 Published:2015-08-26
  • Corresponding author: Kai Sun
  • About author:
    Corresponding author: Sun Kai, Email:
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引用本文：

韩瑞娟, 孙凯, 李坤成, 赵瑞平, 李文欢, 白栓成, 王君艳, 李洪宇, 卢耀军. 第二代双源CT双能量心肌灌注成像对心肌梗死的诊断价值[J/OL]. 中华诊断学电子杂志, 2015, 03(03): 173-178.

Ruijuan Han, Kai Sun, Kuncheng Li, Ruiping Zhao, Wenhuan Li, Shuancheng Bai, Junyan Wang, Hongyu Li, Yaojun Lu. Diagnostic accuracy of the second generation dual-source dual-energy CT myocardial perfusion imaging in patients with suspicious myocardial infarction[J/OL]. Chinese Journal of Diagnostics(Electronic Edition), 2015, 03(03): 173-178.

目的

探讨第二代双源CT双能量心肌灌注成像对心肌梗死的诊断价值。

方法

40例30 d内有综合随访资料(冠状动脉造影证实、实验室检查肌钙蛋白I增高、心电图有动态演变等资料)的可疑心肌梗死患者为研究对象。采用第二代双源CT双能量扫描模式，对可疑心肌梗死患者进行一站式心肌灌注及冠状动脉成像。以冠状动脉造影和临床资料为金标准，计算第二代双源CT双能量心肌灌注诊断心肌梗死的敏感度、特异度、阳性预测值和阴性预测值，评价冠状动脉各段图像质量及有效射线剂量。采用SPSS 19软件进行统计分析，冠状动脉CT血管造影射线剂量采用±s表示，不同观察者间的一致性检验采用Cohen′s Kappa分析。

结果

第二代双源CT双能量心肌灌注诊断心肌梗死的敏感度、特异度、阳性预测值、阴性预测值分别为95.0%、97.0%、86.4%和98.9%。1例患者出现断层伪影，右冠状动脉、回旋支显影差，中远段血管不可评估；另1例患者由于心率变异性较大，造成右冠状动脉中远段有运动伪影，其余患者成像质量均良好。第二代双源CT的平均有效射线剂量为(6.1±1.5) mSv。

结论

第二代双源CT双能量一站式心肌灌注碘图，结合冠状动脉CT血管造影检测心肌梗死的准确性高，有效射线剂量低。

关键词: 体层摄影术，X线计算机, 心肌灌注显像, 心肌梗死, 诊断
Objectives

To evaluate the diagnostic accuracy of the second generation dual-source dual-energy CT myocardial perfusion imaging in patients with suspicious myocardial infarction.

Methods

Fifty-six patients underwent dual-source dual-energy myocardial perfusion imaging, of which forty patients had follow-up results [confirmed by catheter coronary angiography, cardiac troponin I elevation and Electrocardiogram (ECG) changes and evolution of acute myocardial infarction] within 30 days.Catheter coronary angiography and clinical data served as the standard of references.The sensitivity, specificity and positive and negative predictive values of the second generation dual-source dual-energy CT myocardial perfusion in the detection of myocardial infarction were evaluated.The coronary image quality and radiation dose were evaluated.

Results

Diagnostic accuracy: the sensitivity, specificity and positive and negative predictive values were 95.0%, 97.0%, 86.4% and 98.9%, respectively.Coronary image quality: one patient with non-diagnostic images was due to motion artifacts occurred at the right coronary artery and left circumflex artery; another patient′s vessels were unassessable due to the motion artifacts induced by high heart rate variability; the other patients′ image quality were good.Radiation dose: the average effective radiation dose was (6.1±1.5)mSv.

Conclusion

One-step dual-source dual-energy CT myocardial perfusion scan combined with coronary CTA provide high diagnostic accuracy for detecting myocardial infarction with lower radiation exposure in patients with suspicious myocardial infarction.

Key words: Tomography, x-ray computed, Myocardial perfusion imaging, Myocardial infarction, Diagnosis
图1 可疑心肌梗死患者冠状动脉造影、冠状动脉CTA、双能量心肌灌注碘图图像
表1 可疑心肌梗死患者冠状动脉CT血管造影图像质量评分分布(例)
冠状动脉节段 1级 2级 3级 4级
RCA ? ? ? ?
1 29 6 3 2
2 25 9 4 2
3 23 9 2 1
4 31 3 1 0
LM ? ? ? ?
5 40 0 0 0
LAD ? ? ? ?
6 39 1 0 0
7 39 1 0 0
8 33 1 0 0
9 33 1 0 0
10 34 0 0 0
CX ? ? ? ?
11 40 0 0 0
12 38 0 0 0
13 34 4 1 1
14 30 0 1 1
15 20 0 0 3
IA ? ? ? ?
16 28 0 0 0
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