“一站式”CT心肌灌注成像在评估冠状动脉重度狭窄患者中的应用价值

刘科伶; 彭婉琳; 徐旭; 罗婷; 张金戈; 胡斯娴; 刁凯悦; 李磊; 夏春潮; 李真林

“一站式”CT心肌灌注成像在评估冠状动脉重度狭窄患者中的应用价值

The Application Value of One-stop CT Myocardial Perfusion Imaging in the Evaluation of Patients with Severe Coronary Artery Stenosis

摘要

摘要:
目的对比“一站式”CT心肌灌注成像(CT-MPI)与心脏磁共振(CMR)MPI的一致性，探讨其在评估冠状动脉重度狭窄患者中的应用价值。
方法前瞻性选取50例我院心内科经冠状动脉造影证实冠脉一支或多支狭窄程度≥90%、欲行冠脉支架植入术的患者，于术前一周内行“一站式”CT-MPI检查，其中22例同时行CMR检查。采用后处理软件Ziostation2获取灌注缺损心肌、正常心肌的灌注参数并比较，包括血流量(BF)、血容量(BV)、达峰时间(TTP)及平均通过时间(MTT)。采用Pearson相关分析比较CT和CMR缺损/正常心肌相对灌注参数(rBF、rBV、rTTP、rMTT)相关性。采用Bland-Altman法分析CT及CMR左心功能参数一致性。
结果与正常心肌相比，灌注缺损心肌BV、BF下降，而MTT、TTP延长(P均＜0.05)。CT和CMR测得rBV、rBF、rMTT及rTTP呈中到高度正相关(r分别为0.685、0.641、0.871、0.733，P均＜0.05)。Bland-Altman分析发现，22个点中，有21个点均位于一致限范围内，两种检查方式左心功能参数一致性较好。“一站式”CT-MPI扫描有效剂量为3.5(P₂₅~P₇₅，3.3~3.8) mSv。
结论 “一站式”CT-MPI能一次扫描同时获得冠脉解剖、心肌灌注和左心功能信息，测得的心脏参数与CMR一致，可用作冠状动脉重度狭窄患者病情评估的选择方案。

Abstract:
Obstract Purpose "One-stop" CT myocardial perfusion imaging (CT-MPI) was compared with cardiac magnetic resonance(CMR) to investigate its application value in evaluating patients with severe coronary artery stenosis.
Methods Fifty patients with coronary artery stenosis≥90% of at least one major coronary arteries comfirmed by coronary angiography (CAG) in the department of cardiology in our hospital, who referred for coronary artery stent implantation were prospectively enrolled. All the patients underwent "One-stop" CT-MPI within a week before surgery, among which 22 patients underwent CMR examination simultaneously. The postprocessing software Ziostation2 was used to obatin and compare the perfusion parameters of patients with normal and perfusion defect myocardium, including blood flow (BF), blood volume (BV), peak time (TTP), and mean transit time (MTT). Pearson correlation analysis was used to compare the correlation of relative perfusion parameters (defect/normal myocardium) between CT and CMR. Bland-Altman analysis was used to analyze the consistency between CT and CMR in left ventricular (LV) function parameters measurements.
Results Compared with normal myocardium, BV and BF of perfusion defect myocardium were significantly decreased, while MTT and TTP were significantly prolonged (all P < 0.05). The rBV, rBF, rMTT and rTTP were medium to high positive correlated between CT and CMR (r=0.685, 0.641, 0.871, 0.733, respectively, all P < 0.05). Bland-Altman analysis showed that 95% (21/22) points were within the 95% limits of agreement (LoA), suggesting the LV function parameters measurements between two methods were highly consistent.
Conclusion "One-stop" CT-MPI can simultaneously obtain the information about coronary anatomy, myocardial perfusion and LV function. It is of great value in the evaluation of patients with severe coronary artery stenosis, with shorter scan time and less contraindications compared with CMR.

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