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目的:探讨双源CT(dual-source CT,DSCT)适应性序列扫描技术在低剂量冠状动脉成像(CTCA)中的应用价值。方法:285例疑诊冠心病患者,将心率>70次/min且心律规整者随机分成实验组(145例)和对照组(140例),实验组行前瞻性门控适应性序列扫描,对照组行常规回顾性心电门控螺旋扫描,实验组和对照组中分别有33例、32例2周内行常规冠状动脉造影(CCA)。用χ2检验比较两组CTCA对冠状动脉的可评价率,用两独立样本t检验比较两组患者冠脉图像质量评分及患者接受的有效辐射剂量,用Kappa检验评价两组CTCA与CCA检查对冠状动脉狭窄度评估的一致性,应用两独立样本t检验比较两组患者有效辐射剂量。结果:实验组和对照组参与评价的冠状动脉节段可评价率分别为98.4%(1 787/1 816)、98.1%(1 717/1 750),差异无统计学意义(χ2=0.14,P=0.706);两组图像质量评分分别为(4.42±0.64)分、(4.41±0.65)分,差异无统计学意义(t=0.38,P=0.710);两组CTCA与CCA诊断冠状动脉狭窄度的一致性检验结果分别是Kappa=0.829和0.845,两组对诊断冠状动脉狭窄度的一致性均具有统计学意义;实验组和对照组患者接受的有效辐射剂量分别是(4.60±0.98)和(12.60±1.90)mSv,两组间差异有统计学意义(t=44.8,P=0.000)。结论:心率>70次/min且心律规整者采用适应性序列扫描,既能保证诊断所需的图像质量,对冠状动脉狭窄度具有较高的诊断正确性,又能显著降低辐射剂量。
Objective: To investigate the value of dual-source CT (DSCT) adaptive sequence scanning in low-dose coronary angiography (CTCA). Methods: 285 patients with suspected coronary heart disease were randomly divided into experimental group (145 cases) and control group (140 cases) with heart rate> 70 beats / min. The prospective gated adaptive sequence scan The patients underwent routine retrospective electrocardiographic gated helical scanning. There were 33 cases in the experimental group and control group respectively, and 32 cases underwent routine coronary angiography (CCA) within 2 weeks. The χ2 test was used to compare the evaluable rates of CTCA on the coronary arteries. Two independent samples t-test were used to compare the coronary artery image quality score and the effective radiation dose received by the two groups. Kappa test was used to evaluate the coronary artery Arterial stenosis assessment of the consistency of two independent samples t test was used to compare the two groups of patients effective radiation dose. Results: The evaluable rates of coronary segments in the experimental group and the control group were 98.4% (1 787/1 816) and 98.1% (1 717/1 750), respectively, with no significant difference (χ2 = 0.14, P = 0.706). The image quality scores of the two groups were (4.42 ± 0.64) points and (4.41 ± 0.65) points respectively, with no significant difference (t = 0.38, P = 0.710) Degree of consistency test results were Kappa = 0.829 and 0.845, the two groups for the consistency of diagnosis of coronary artery stenosis were statistically significant; experimental group and control group received effective radiation dose were (4.60 ± 0.98) and (12.60 ± 1.90) mSv, the difference between the two groups was statistically significant (t = 44.8, P = 0.000). Conclusion: Heart rate> 70 beats / min and cardiac rhythm adaptive sequence scan can not only ensure the quality of the images needed for diagnosis, but also have a high diagnostic accuracy for coronary stenosis and significantly reduce the radiation dose.