本文選題：冠狀動(dòng)脈CT血管成像　切入點(diǎn)：首過灌注　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:在冠狀動(dòng)脈 CT 成像(coronary computed tomography angiograph,CCTA)上對(duì)三支冠狀動(dòng)脈正�；蜉p度狹窄患者的相應(yīng)供血區(qū)心肌CT密度值進(jìn)行測量,評(píng)價(jià)其碘對(duì)比劑首次通過時(shí)的心肌強(qiáng)化程度;對(duì)單支冠狀動(dòng)脈重度以上狹窄患者,測量單支冠狀動(dòng)脈重度狹窄、亞閉塞和閉塞的相應(yīng)供血區(qū)CT密度值,初步評(píng)價(jià)其碘對(duì)比劑首次通過的心肌強(qiáng)化程度在三者之間的差異性。材料與方法:對(duì)2012年1月～2016年8月期間因懷疑冠心病在我院先后接受冠狀動(dòng)脈 CT 成像(coronary computed tomography angiograph,CCTA)和導(dǎo)管法冠狀動(dòng)脈造影檢查的524例患者行回顧性分析。男365例,女159例,年齡28～92(65.82±8.96)歲。兩種檢查的間隔時(shí)間為1～25(6.32±4.11)天。524例患者中,導(dǎo)管法冠狀動(dòng)脈造影顯示三支冠狀動(dòng)脈正�；蜉p度狹窄(50%)的患者76例;導(dǎo)管法冠狀動(dòng)脈造影顯示單支冠狀動(dòng)脈(其余兩支冠狀動(dòng)脈正常或輕度狹窄)重度以上狹窄(≥75%)的患者448例,其中冠狀動(dòng)脈重度狹窄患者154例,冠狀動(dòng)脈亞閉塞患者146例,冠狀動(dòng)脈閉塞患者148例。使用二代雙源CT行CCTA檢查,機(jī)架旋轉(zhuǎn)時(shí)間:0.28 s/r;探測器準(zhǔn)直:2×64×0.6 mm,Z軸飛焦點(diǎn)技術(shù)采集:2× 128×0.6 mm;管電壓:120kV～140kV,管電流:330mAs～400mAs;重建時(shí)間分辨率:75ms;層厚:0.75mm,層間隔:0.7mm;顯示野:250～270mm;矩陣:512×512;圖像重建算法:濾波反投影(filtered back projection,FBP),圖像重建的卷積核值:B26f;根據(jù)患者自身情況,采用回顧性心電門控螺旋掃描方式(Retrospective ECG-gated spiral mode)或前瞻性心電觸發(fā)適應(yīng)性序列掃描方式(Prospective-ECG triggered sequential scan mode)。采用歐利奇高壓注射器,在肘正中靜脈置入18G套管針,經(jīng)套管針以5～6ml/s的流率注入50～60ml對(duì)比劑碘海醇(300mgI/ml),隨后以同樣速率注射0.9%生理鹽水30～50 ml,采用碘造影劑示蹤法,將感興趣區(qū)(region of interest,ROI)設(shè)在升主動(dòng)脈約氣管分叉水平層面并監(jiān)測其CT值,觸發(fā)閾值為100HU,達(dá)到閾值后延遲6S自動(dòng)開始心臟掃描。選取最佳重建時(shí)相的原始橫斷面CT圖像和用于圖像后處理、評(píng)價(jià)冠狀動(dòng)脈狹窄程度和測量左室心肌密度。分析CCTA圖像,運(yùn)用多平面重組(multiple planar reformation,MPR)技術(shù)以左心室長軸為基準(zhǔn),獲得垂直左室長軸的水平短軸切面,按照美國心臟協(xié)會(huì)(AHA)在水平短軸上將左室心肌分為17心肌節(jié)段,繪制"牛眼圖",選取心肌節(jié)段中心測量3次取平均值,分別測量和計(jì)算三支冠狀動(dòng)脈正常或輕度狹窄患者和單支冠狀動(dòng)脈重度以上狹窄患者相應(yīng)供血區(qū)的左心室各節(jié)段心肌CT密度值及其校正值,進(jìn)行統(tǒng)計(jì)學(xué)分析,評(píng)價(jià)正�；蜉p度狹窄患者碘對(duì)比劑首次通過時(shí)左心室心肌強(qiáng)化程度和冠狀動(dòng)脈重度狹窄、亞閉塞和閉塞患者碘對(duì)比劑首次通過的心肌強(qiáng)化程度在三者之間的差異性。結(jié)果:①三支冠狀動(dòng)脈正�；蜉p度狹窄患者左心室各節(jié)段心肌CT密度值及其校正值分別為:心尖段(96.24±0.57)HU和(0.304±0.003);中段(96.81±0.41)HU和(0.313±0.002)H;基底段(97.19±0.27)HU 和(0.327±0.002),心尖段平均CT密度值及其校正值與中段和基底段比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05),中段與基底段平均CT密度值及其校正值比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。冠狀動(dòng)脈正�；蜉p度狹窄患者三支冠狀動(dòng)脈相應(yīng)供血區(qū)心肌CT密度值及其校正值分別為:左前降支(96.71±3.67)HU和(0.322±0.012),左回旋支(96.58±3.84)HU和(0.322±0.009),右冠狀動(dòng)脈(96.63±4.01)HU和(0.322±0.010),三支冠狀動(dòng)脈相應(yīng)供血區(qū)心肌平均CT密度值及校正值比較無統(tǒng)計(jì)學(xué)意義(P0.05)。②單支冠狀動(dòng)脈重度以上狹窄患者的三支冠狀動(dòng)脈相應(yīng)供血區(qū)心肌CT密度值及其校正值比較:病變支與同組內(nèi)非病變支相應(yīng)供血區(qū)左心室心肌平均CT密度值及其校正值比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。單支冠狀動(dòng)脈重度以上狹窄相應(yīng)供血區(qū)左室心肌CT密度值及其校正值比較:左前降支、左回旋支和右冠狀動(dòng)脈重度狹窄組與亞閉塞組和閉塞組的心肌平均CT密度值及其校正值比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05);而亞閉塞組與閉塞組的心肌平均CT密度值比較差異無統(tǒng)計(jì)學(xué)意義(P0.05),但兩組心肌平均校正值比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1)在CCTA圖像上測得并代表心肌強(qiáng)化程度的左心室心肌CT密度值能夠間接提示碘對(duì)比劑首次通過時(shí)的心肌血流灌注情況。2)在三支冠狀動(dòng)脈正�；蜉p度狹窄患者,三支冠狀動(dòng)脈相應(yīng)供血區(qū)心肌CT密度值無顯著性差異;在單支冠狀動(dòng)脈重度以上狹窄患者,其狹窄程度越重,相應(yīng)供血區(qū)心肌CT密度值越低,提示碘對(duì)比劑首次通過時(shí)的心肌血流灌注越少。
[Abstract]:Objective: coronary artery CT imaging (coronary computed tomography angiograph, CCTA) was used to measure the values of corresponding blood supply to the myocardium CT density of three coronary artery stenosis in patients with normal or mild, evaluate the iodine contrast enhancement degree by the first of myocardial; single coronary artery stenosis in patients with severe, severe single measurement coronary artery stenosis, occlusion and occlusion of the corresponding sub supply area CT density differences between the three of the preliminary evaluation of iodine contrast agent for the first time by the myocardial enhancement degree. Materials and methods: from January 2012 to August 2016 in our hospital during the period of suspected coronary heart disease underwent coronary artery imaging (CT coronary computed tomography angiograph, CCTA analysis of 524 cases) and catheter coronary angiography review. Male 365 cases, female 159 cases, age 28~92 (65.82 + 8.96) years old. Among the two kinds of inspection Every time is 1~25 days (6.32 + 4.11).524 patients, catheter coronary angiography showed three coronary artery normal or mild stenosis (50%) of 76 cases of patients; catheter coronary angiography showed single vessel coronary artery (the other two normal coronary artery stenosis or mild and severe stenosis (more than 75%) 448) patients with severe coronary artery stenosis in patients with coronary artery occlusion in 154 cases, and 146 patients with coronary artery occlusion in 148 cases. The use of the two generation dual source CT CCTA, rotation time: 0.28 s/r: 2; detector collimating * 64 * 0.6 mm, Z axis flying focus technology acquisition: 2 * 128 * 0.6 mm; tube voltage: 120kV ~ 140kV, tube current: 330mAs ~ 400mAs; the reconstruction time resolution: 75ms; thickness: 0.75mm, interval: 0.7mm; display field: 250 ~ 270mm; matrix: 512 * 512; image reconstruction algorithm: filter back projection (filtered back, projection, FBP) that image reconstruction Convolution kernel value: B26f; according to the patient's own situation, using retrospective ECG gated spiral scan mode (Retrospective ECG-gated spiral mode) or prospective ECG triggering adaptive sequence scan mode (Prospective-ECG triggered sequential scan mode). The odd Orly high-pressure injector in 18G venous trocar through median cubital trocar, in 5 ~ 6ml/s the flow rate of the injected 50 ~ 60ml contrast agent iohexol (300mgI/ml), then at the same rate injection of 0.9% saline 30~50 ml, using iodine contrast agent tracer method, will be a region of interest (region of, interest, ROI) in ascending aorta around the tracheal bifurcation level and monitor the CT value, triggering threshold is 100HU, achieve after the threshold delay 6S automatic start heart scan. Select the best reconstruction phase and the original cross-sectional CT images for image postprocessing, evaluate the degree of coronary artery stenosis and left ventricular measurements Muscle density. CCTA image analysis, using multi planar reconstruction (multiple planar reformation, MPR) in the left ventricular long axis as a benchmark, obtained level short axis view of left ventricular long axis vertical, according to the American Heart Association (AHA) in the left ventricular short axis will be divided into 17 segments, draw the "bull's-eye map" selected, myocardial segment center measuring 3 times the average, the left ventricular myocardium CT density were measured and calculated three coronary artery stenosis in patients with normal or mild and single coronary artery stenosis in patients with severe blood supply area value and the corresponding correction value, statistical analysis, evaluation of normal or mild stenosis in patients with iodine contrast for the first time through the agent of left ventricular myocardium enhancement degree and severe coronary artery stenosis, occlusion and occlusion in patients with mild iodine contrast agent for the first time by the difference in myocardial enhancement degree between the three. Results: the three branch of coronary artery 鑴夋甯告垨杞誨害鐙獎(jiǎng)鎮(zhèn)ｈ，

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