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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x±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。
Objective To investigate the diagnostic value of second generation dual-source CT dual-energy myocardial perfusion imaging in myocardial infarction. Methods 40 patients with suspicious myocardial infarction within 30 days were enrolled in this study. They were confirmed by coronary angiography, elevated troponin I in laboratory and dynamic changes of electrocardiogram. The second-generation dual-source CT dual-energy scanning mode was used to perform one-stop myocardial perfusion and coronary angiography in patients with suspected myocardial infarction. Using coronary angiography and clinical data as the gold standard, the sensitivity, specificity, positive predictive value and negative predictive value of the second generation dual-source CT dual-energy myocardial perfusion in myocardial infarction were calculated to evaluate the image quality of the coronary arteries and the effective radiation dose. SPSS 19 software for statistical analysis, coronary CT angiography ray dose x ± s said consistency between different observers using Cohen’s Kappa analysis. Results The sensitivity, specificity, positive predictive value and negative predictive value were 95.0%, 97.0%, 86.4% and 98.9% for the second generation dual-source CT dual-energy myocardial perfusion in diagnosis of myocardial infarction. One patient showed tomographic artifacts, the right coronary artery and circumflex were poorly differentiated, and the vessels in the middle and distal segments were not evaluated. The other patient had motion artifacts in the middle and distal segments of the right coronary artery due to large heart rate variability. The imaging quality of the remaining patients good. The average effective radiation dose of the second-generation dual-source CT was (6.1 ± 1.5) mSv. Conclusion The second generation dual-source CT dual-energy one-shot myocardial perfusion iodine map, combined with coronary angiography in the detection of myocardial infarction with high accuracy, low effective radiation dose.