摘要
目的分析多层螺旋CT(MSCT)冠状动脉CT血管成像(CTA)联合心脏磁共振成像(CMR)对冠心病(CHD)心肌缺血的诊断价值。方法选取2013年7月至2016年11月于重庆三峡中心医院采用128层MSCT行CTA检查的疑似CHD患者60例,均行冠状动脉造影(CAG)检查,并从中选取30例临床确诊为CHD并有1支或1支以上冠状动脉狭窄的患者行CMR。分析128层MSCT CTA对冠状动脉斑块成分的检测情况及诊断CHD的阳性预测值、阴性预测值、灵敏度、特异度和准确度。测量CMR中病变心肌与正常心肌首过灌注时间、首过最大上升斜率,及延迟强化特点。结果本组60例300支冠状动脉中共检出176个斑块,占58.67%,其中钙化斑块128个(72.73%)、脂质斑块25个(14.20%)、纤维斑块23个(13.01%)。以CAG为金标准,得出128层MSCT CTA诊断CHD的灵敏度为100.00%、特异度为83.33%、阳性预测值为93.33%、阴性预测值为100%、准确度为95.00%;对冠状动脉狭窄程度的评估存在高估的现象。在30例患者CMR中,病变心肌较正常心肌具有首过灌注时间延长,最大上升斜率降低及延迟强化信号强度增强的特点,其中54个室壁节段具有心肌首过灌注减低并最大上升斜率也减低的特点。49个心肌节段出现延迟强化,其中22个节段呈透壁性强化;27个节段呈非透壁强化。结论128层MSCT CTA有利于显示冠状动脉血管解剖学方面的病变,而CMR有利于显示心肌病理生理学方面的改变,其两者联合对CHD综合诊断有较高的临床价值。
Objective To analyze the imaging features of multislice spiral CT（MSCT） coronary CT angiography（CTA） and cardiac magnetic resonance（CMR） in myocardial ischemia of coronary heart disease（CHD）. Methods We selected 60 patients with suspected CHD who completed CTA by 128-MSCT and coronary angiography in Chongqing Three Gorges Central Hospital,during Jul. 2013 and Nov. 2016,and coronary angiography（CAG） was performed on all cases.CMR imaging was performed in 30 patients with clinically diagnosed coronary artery disease and 1 or more than 1 stenosis of the coronary arteries. The ability of 128-MSCT CTA to detect coronary plaque components was analyzed,and the positive predictive value,negative predictive value,sensitivity,specificity and accuracy of coronary artery disease were analyzed. The first-pass perfusion time,the first maximal increase slope and the delayed enhancement feature of myocardium and normal myocardium in MR myocardial perfusion imaging were measured. Results Altogether 176 plaques（58. 67%） were found in 300 coronary arteries of the 60 cases,including 128（72. 73%） calcified plaques,25（14. 20%） lipid plaques,and 23（13. 01%） fibrous plaques. The sensitivity,specificity,positive predictive value,negative predictive value and accuracy rate of 128-MSCT CTA in the diagnosis of coronary stenosis were 100%,83. 33%,93. 33%,100. 00%,95. 00% respectively,with CAG as the gold standard. There was overestimation of the degree of coronary stenosis. In 30 patients with CMR,compared with the normal myocardium,the time of first-pass perfusion of the lesions myocardium was prolonged,the maximum rise slope of the lesion myocardium was decreased and the intensity of delayed intensification of the lesion myocardium was enhanced,54 ventricular wall segments showed a decrease in myocardial first-pass perfusion and a decrease in the maximum ascending slope. 49 myocardial segments appeared delayed enhancement,22 segments showed transmural enhancement;27 segments showed non-transmural enhancement. Conclusion 128-MSCT CTA can display the anatomy of coronary artery lesions and CMR imaging can show the pathophysiological changes in the myocardium,and the combination of the two scanning methods has high clinical value in the comprehensive diagnosis of CHD.
作者
罗勇
曾文兵
陈垚
李俊
刘兴华
温云
LUO Yong;ZENG Wenbing;CHEN Yao;LI Jun;LIU Xinghua;WEN Yun(Department of Radiology,Chongqing Three Gorges Central Hospital,Chongqing 404000,Chin)
出处
《医学综述》
2018年第14期2876-2880,共5页
Medical Recapitulate
基金
重庆市万州区科委科研计划项目(201203060)
关键词
冠心病
心肌缺血
体层摄影术
X线计算机
磁共振成像
Coronary heart disease
Myocardial ischemia
Tomography
X-ray computed
Magnetic resonance imaging
