CAJ | 학술논문

目的：评价双源CT大螺距前瞻性心电门控双次扫描模式（Double Flash）显示冠状动脉的图像质量、诊断冠状动脉狭窄的准确性及辐射剂量。方法入选采用Double Flash模式CT冠状动脉成像（CTCA）和冠状动脉造影（CAG）检查的患者，根据检查时心率不同，将患者分为A组（心率<65次/min）和B组（65次/min≤心率<80次/min），评价两组冠状动脉各段图像质量（1~4分）；以CAG结果为金标准，分别基于患者和血管评价该扫描模式诊断冠状动脉狭窄的敏感度、特异度、阳性预测值、阴性预测值和准确度；并评价患者辐射剂量。结果114例患者共显示冠状动脉1725个节段（A组933段、B组792段）：（1）图像质量：A组采用Double Flash模式两次扫描综合显示可诊断的血管节段百分比为98.5%，而B组为97.3%，差异无统计学意义（P=0.82）；两组血管的图像质量总体评分差异无统计学意义（P>0.05）；（2）准确性评价：基于患者水平分析，A组Double Flash模式两次扫描综合显示有意义的冠状动脉狭窄的敏感度、特异度、阳性预测值、阴性预测值和准确度分别为100%、90.5%、95.4%、100%和96.7%，而B组为100%、88.5%、94.5%、100%和96.2%，两组比较无统计学差异（P>0.05）；（3）辐射剂量：平均有效辐射剂量为1.63±0.52 msv。结论双源CT Double Flash模式具有临床可行性，尤其对于65次/min≤心率<80次/min的患者，在较低的辐射剂量条件下，可保证较好的图像质量和诊断冠状动脉狭窄准确性。
목적：평개쌍원CT대라거전첨성심전문공쌍차소묘모식（Double Flash）현시관상동맥적도상질량、진단관상동맥협착적준학성급복사제량。방법입선채용Double Flash모식CT관상동맥성상（CTCA）화관상동맥조영（CAG）검사적환자，근거검사시심솔불동，장환자분위A조（심솔<65차/min）화B조（65차/min≤심솔<80차/min），평개량조관상동맥각단도상질량（1~4분）；이CAG결과위금표준，분별기우환자화혈관평개해소묘모식진단관상동맥협착적민감도、특이도、양성예측치、음성예측치화준학도；병평개환자복사제량。결과114례환자공현시관상동맥1725개절단（A조933단、B조792단）：（1）도상질량：A조채용Double Flash모식량차소묘종합현시가진단적혈관절단백분비위98.5%，이B조위97.3%，차이무통계학의의（P=0.82）；량조혈관적도상질량총체평분차이무통계학의의（P>0.05）；（2）준학성평개：기우환자수평분석，A조Double Flash모식량차소묘종합현시유의의적관상동맥협착적민감도、특이도、양성예측치、음성예측치화준학도분별위100%、90.5%、95.4%、100%화96.7%，이B조위100%、88.5%、94.5%、100%화96.2%，량조비교무통계학차이（P>0.05）；（3）복사제량：평균유효복사제량위1.63±0.52 msv。결론쌍원CT Double Flash모식구유림상가행성，우기대우65차/min≤심솔<80차/min적환자，재교저적복사제량조건하，가보증교호적도상질량화진단관상동맥협착준학성。
Objective To assess the image quality, diagnostic accuracy and effective radiation dose of prospectively ECG-triggered high-pitch spiral double scanning (Double Flash) mode of computed tomography coronary angiography (CTCA) using dual-source CT for the diagnosis of significant coronary stenoses. Methods Patients underwent both CTCA in Double Flash mode and conventional coronary angiography (CAG) and were divided into two groups according to heart rate (HR), namely group A with HR <65/min (62 cases) and group B with HR between 65 and 80/min (52 cases). All the coronary segments were evaluated by two blinded and independent observers for image quality on a four-point scale and for the presence of significant coronary stenoses (defined as a diameter narrowing exceeding 50%). CAG served as the reference standard for analyzing the diagnostic accuracy of Double Flash mode images on the level of both patients and vessels. Radiation dose values were calculated using the dose-length product. Results A total of 114 patients were enrolled and 1725 vessel segments were displayed. In terms of image quality, the diagnosable segments accounted for 98.5%(919/933) in group A and 97.3% (770/792) in group B. In the per-patient analysis, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 100%, 90.5%, 88.2%, 100%and 96.7%in group A and were 100%, 88.5%, 94.5%, 100%and 96.2%in group B, respectively. The mean effective radiation dose was 1.63±0.52 mSv. Conclusion Double Flash spiral protocol of dual-source CTCA can acquire good image quality and yield high diagnostic accuracy for assessment of coronary artery stenoses at a low radiation dose in patients with HR between 65 and 80/min.