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冠状动脉64-MDCTA扫描行左心功能检查的可行性研究报告

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冠状动脉64一MDCrA扫描行左心功能检查的可行性研究 硕士研究生刘志 导师杨学华教授 郑州大学第一附属医院放射科 河南郑州450052 摘要 目的 采用常规冠状动脉64一MDCI,A扫描方式,探讨64一MDCT左心功能检测时 左心室舒张末期和收缩末期所对应的期相,同时测量左心室功能各项指标,并 与超声心动图结果比较,评价为行冠状动脉64一MDCTA扫描的可疑冠心病患者 同时进行64一MDCT左心功能检测的可行性与准确性 材料与方法 随机收集2009年8月至2010年9月在郑州大学第一附属医院CT室行冠状 动脉64一MDCTA扫描成功者100例,年龄为57士12(32一83)岁,男60例,女 40例,所有的受检者均有64一MDCTA检查结束后3日(72小时)内的超声心动 图心功能检查结果冠状动脉64一MDcTA扫描采用后门控心电扫描方式Timing bohis法,扫描范围覆盖整个心脏,图像后处理采用回顾性心电重建技术,将原 始图像重建为间隔为5%!O%一95%共20个期相的全心动周期薄层图像,调入随 64一MDCT机配置的后处理工作站,采用自动心功能分析软件,计算出各个期相 的左心室容积及左心室功能的各项指标,并将所测得的左心室功能各项指标与 超声心动图结果比较,同时进行统计学分析 结果 100例受检者中95例左心室舒张末期为O%期相,5例为95%期相;27例左 心室收缩末期为35%期相,56例为40%期相,17例为45%期相;0%期相位于摘要 心电图QRs的主波波峰区,35%期期相位于T波中部,40%期相位于T波末处 64一MDCT心功能检测得到的左心室舒张末期容积(EDV)为151.76士31.33ml (89.20ml一306.0Oml),收缩末期容积(ESV)为55.09士16.70ml(25.30ml一105.70 ml),每搏输出量(SV)为96.0壮20.26ml(29.80ml一200.30ml),射血分数(EF) 为64.11士6.04%(50.20%一78.20%);超声心动图心功能检测得到的EDv值为 113.39士30.04ml(67.00ml一223.00ml),ESV值为41.34士13.SOtnl(ZI.00ml一87.00 ml),SV值为71.43士19.2Oml(33.00ml一125.00ml),EF值为64.15士5.40% (51.00%一79.00%) 64一MDcT心功能检测结果(EDv!ESv!Sv!EF)与超声心动图比具有较 强的相关性,相关系数分别为0.818!0.745!0.706!0.647;64一MDCT心功能检 测所得到的EDV!ESV及SV值均高于超声心动图,但是EF值二者无明显差异 结论 64一MDCT左心功能检查左心室舒张末期为O%期相,收缩末期为35%一45% 期相,大部分为35%或40%期相;采用常规冠状动脉64一MDCTA扫描所获得的 心功能检查结果准确!可信,可以在不增加射线量和对比剂用量的前提下,为 行冠状动脉血管成像扫描的受检者同时额外提供准确可信左心室功能信息 关键词心功能左心室x线计算机体层成像超声Abstract Feasibilityresearchofleftventricularfunctiontestusingthe scanningmodeofcoronary64一MDCrLA Postgradute:LiuZhi Tutor:Prof.!乞119Xuehua RadiologyDePartment, TheFirstAffiliatedHosPitalofZhengzhouUniversity Zhengzhou,China,450052 AbstraCt Objeetive TOinvestigatethePhasescorresPondingtoleftventricularend一diastoleor end一systoleforleftventrieularfunctiontestof64rowdeteetorssPiralCT(64一MDCT) byusingECG一gated64一MDCTangiograPhyandtoevaluatethefeasibilityand aecuraeyof64一MDCTleftventrieularfunetionexaminationbyeomParingeardiae funetionmeasuredfrom64一MDCTwithwhatofehoeardiograPhy(ZDE). MethodS 100cases(agerange32一83years,mean57士12years;40females,60males)were randomlyeolleetedfromAugust2009toSePtember2010inFirstAffiliatedHosPital ofZhengzhouUniversitywithsusPectedeoronaryheartdieaseandnofailureofleft ventricularsystolicfunctioninelinieal.AllPatientsweresueeessfullyunderwent ECG一gated64一MDCTeoronaryangiographyandeardiacehoeardiographytest.The bothexaminationsofindividualPatientmustbeeomPletedwithin3days. ThewayofECG一gated64一MDCTeoronaryangiograPhywastimingbolus.The Scanningc0VerdWholeheart.AftertheseanningcomPlated厂丁wentyseries(0%一95% Phases,5%interval)ofthinimageswerereeonstruetedalloverthefullcardiaeeyele fromtheoriginalimagesandtransferredtothePost一Proeessingworkstaion.Then,the 111 刁Abstraet leftvenirieularvolumneofeachPhaseandfunetioncaleulatedbyautomaticcardiae funetionanalysissoftware.Alldatawereanal邓edbystatistiealteehniques.Theresults ofleftventrieularfunetionmeasuredby64一MDCTwereeomParedwith eehocardiography. ReSUltS ThePhasetoleftventricularend一diastolewaso%in95casesand95%ins eases.ThePhasetoleftventrieularend一systolewas35%in27eases,40%in56eases and45%in17eases.0%PhasewasloeatedatthePeakofECG一QRSwave35%Phase wasinthemiddleTwaveo%PhasewasloeatedattheendofTwave. Theleftventrieularend一diastolievolume(EDV)measuredby64一MDCTwas 151.76士31.33ml(89.2Oml一306.00ml),leftend一systolicvolume(ESV)was55.09士16,70 ml(25.30ml一IOS.7Oml),strokevolume(SV)was96.04土20.26ml(29.SOml一ZOO.3Oml), ejeetionfraetion(EF)was64.11士6.04%(50.20%一78.20%).TheleftEDVmeasuredby echocardiograPhywas113.39士3o.04ml(67.O0ml一223.00ml),ESVwas41.34士13.80 ml(21.OOml一87.OOml),SVwas71.43士19.2Oinl(33.001111一125.OOml),EFwas64.15士 5.40%(51.00%一79.00%). Theletventrieulaifunctionmeasuredby64一MDCTwasstronglyrelatedto echocardiograPhy,thecorrelationcoeffieientsofEDV,ESV,SVaxldEFwere0.818, 0.745,0.706,0647.EDV,ESVandEFobtainedby64一MDCTwerehigherthan eehocardiograPhy,butEFwasnoaPPreciablediffereneebetweenthetwomethods. Conclusion ThePhasetoleftventricularend一diastoleobtaindebyECG一gated64一MDCT coronaryangiographywaso%andthePhasetoleftventrieularend一systolewas 35%一45%,esPeeially35%and40%Phase.Theresultsof64一MDCTeardiaefunetion examinationwereaeeurateandcredible.Thetestdidn.tincreaseX一rayexPosureand dosageofeontrasttocoronary64一MDCTA. KeywordsheartfunctionleftventrieularCTultrasonogaphy IV目录 报告部分 缩略语表........................................................................... 冠状动脉64一MDCTA扫描行左心功能检查的可行性研究 月J舀.............................................................................................................. 材料与方法...................................................................................................... 结果.............................................................................................................. 讨论.............................................................................................................. 附图............................................................................................................17 结论............................................................................................................23