CAJ | 학술논문

目的探讨心率不低于91次/分(bpm)患者回顾性心电门控双源CT(DSCT)冠状动脉成像R-R间期的最佳重建时相,从扫描时相选择的角度分析前瞻性心电门控(简称前门控)应用的可行性.方法分析232例行回顾性心电门控DSCT冠状动脉成像患者(体质量指数23～25 kg/m2,心率≥91 bpm)的图像,根据扫描过程中患者屏气时心电监控记录到的心率将其分为3组(A～C组),A组83例,心率91～95 bpm,B组68例,心率96～100 bpm,C组81例,心率≥101 bpm.每隔3%重建1个时相,分别由2名医师独立对横断面图像、薄层MIP、CPR、VRT图像质量采用5分法进行综合评估,按照15段分段法,选出每个节段的R-R间期的最佳重建时相及范围.采用Kappa检验,评价2名医师对冠状动脉图像评分的一致性.结果 232例患者中,可评价冠状动脉节段共3343个,其图像最佳重建时相范围集中在81%～61%和51%～31%.3组冠状动脉节段与之相对应的节段数百分比:A组(91～95 bpm,83例的1183个节段)分别为5.49%、94.51%;B组(96-100 bpm,68例986个节段)分别为0.20%、99.80%;C组(≥101 bpm,81例1174个节段)分别为0.17%、99.83%.232例患者的3343个冠状动脉节段中3274个节段(97.94%)最佳重建时相范围集中在以41%为中心的51%～31%R-R间期范围内.2名医师对232例患者的3343个冠状动脉节段图像质量的评分结果得到了较高的一致性(Kappa值=0.883,P<0.05).结论具有稳定的窦性心律,且屏气时平均心率≥91 bpm患者,冠状动脉节段的最佳重建时相集中于以R-R间期41%为中心的51%～31%,从扫描时相选择的角度考虑,可以对稳定高心率(≥91 bpm)患者行前门控横断面扫描,并且预设41%为曝光时间窗,成功把握较大.
목적 탐토심솔불저우91차/분(bpm)환자회고성심전문공쌍원CT(DSCT)관상동맥성상R-R간기적최가중건시상,종소묘시상선택적각도분석전첨성심전문공(간칭전문공)응용적가행성.방법 분석232례행회고성심전문공DSCT관상동맥성상환자(체질량지수23～25 kg/m2,심솔≥91 bpm)적도상,근거소묘과정중환자병기시심전감공기록도적심솔장기분위3조(A～C조),A조83례,심솔91～95 bpm,B조68례,심솔96～100 bpm,C조81례,심솔≥101 bpm.매격3%중건1개시상,분별유2명의사독립대횡단면도상、박층MIP、CPR、VRT도상질량채용5분법진행종합평고,안조15단분단법,선출매개절단적R-R간기적최가중건시상급범위.채용Kappa검험,평개2명의사대관상동맥도상평분적일치성.결과 232례환자중,가평개관상동맥절단공3343개,기도상최가중건시상범위집중재81%～61%화51%～31%.3조관상동맥절단여지상대응적절단수백분비:A조(91～95 bpm,83례적1183개절단)분별위5.49%、94.51%;B조(96-100 bpm,68례986개절단)분별위0.20%、99.80%;C조(≥101 bpm,81례1174개절단)분별위0.17%、99.83%.232례환자적3343개관상동맥절단중3274개절단(97.94%)최가중건시상범위집중재이41%위중심적51%～31%R-R간기범위내.2명의사대232례환자적3343개관상동맥절단도상질량적평분결과득도료교고적일치성(Kappa치=0.883,P<0.05).결론 구유은정적두성심률,차병기시평균심솔≥91 bpm환자,관상동맥절단적최가중건시상집중우이R-R간기41%위중심적51%～31%,종소묘시상선택적각도고필,가이대은정고심솔(≥91 bpm)환자행전문공횡단면소묘,병차예설41%위폭광시간창,성공파악교대.
Objective To explore the optimal reconstruction windows in patients with heart rate (HR) over 91 (beats per minute) bpm, and to explore the feasibility of prospective ECG-gated DSCT coronary angiography.Methods Two hundred and thirty-two patients[body mass index (BMI):23-25 kg/m2, with stable HR, and average HR ≥91 bpm]with suspected or known coronary artery disease underwent retrospective ECG-gated DSCT coronary angiography.They were divided into 3 groups (A-C) according to the average HR of scanning.Images were reconstructed from 29% to 80% of the R-R interval in 3% increments.Two independent readers assessed the overall image quality by a five-point scale and determined the optimal reconstruction windows of each coronary segment and the ranges.Coronary arteries were segmented according to the guideline of the American Heart Association (AHA).The degree of interobserver agreement was determined by Kappa statistics.Results Three thousand three hundred and fortythree segments were considered to have diagnostic image quality in 232 patients.The ranges of optimal reconstruction windows of images were concentrated on 81%-61% and 51%-31%.In group A(91-95 bpm), there were 1183 segments in 83 patients, and the according proportions were 5.49%, 94.51%,respectively; In group B(96-100 bpm), there were 986 segments in 68 patients, and the according proportions were 0.20%, 99.80%, respectively; In group C(≥ 101 bpm), there were 1174 segments in 81 patients, and the according proportions were 0.17%, 99.83%, respectively.The optimal construction windows in 3274 segments out of 3343 segments in 232 patients were concentrated in 41%, ranged from 51%-31%.The image quality assessment in 3343 segments in 232 patients have a high inter-observe agreement (Kappa=0.883,P <0.05).Conclusion The optimal reconstruction windows of patients with stable HR(≥91 bpm) was concentrated in 41%, ranged from 51%-31%.When nothing except the window of data acquisition is considered, the prospective ECC,-gated DSCT coronary angingraphy can be used in patients with stable HR(≥91 bpm).