CAJ | 학술논문

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。
목적：탐토제이대쌍원CT쌍능량심기관주성상대심기경사적진단개치。방법40례30 d내유종합수방자료（관상동맥조영증실、실험실검사기개단백I증고、심전도유동태연변등자료）적가의심기경사환자위연구대상。채용제이대쌍원CT쌍능량소묘모식，대가의심기경사환자진행일참식심기관주급관상동맥성상。이관상동맥조영화림상자료위금표준，계산제이대쌍원CT쌍능량심기관주진단심기경사적민감도、특이도、양성예측치화음성예측치，평개관상동맥각단도상질량급유효사선제량。채용SPSS 19연건진행통계분석，관상동맥CT혈관조영사선제량채용x ± s표시，불동관찰자간적일치성검험채용Cohen′s Kappa분석。결과제이대쌍원CT쌍능량심기관주진단심기경사적민감도、특이도、양성예측치、음성예측치분별위95．0％、97．0％、86．4％화98．9％。1례환자출현단층위영，우관상동맥、회선지현영차，중원단혈관불가평고；령1례환자유우심솔변이성교대，조성우관상동맥중원단유운동위영，기여환자성상질량균량호。제이대쌍원CT적평균유효사선제량위（6．1±1．5） mSv。결론제이대쌍원CT쌍능량일참식심기관주전도，결합관상동맥CT혈관조영검측심기경사적준학성고，유효사선제량저。
Objectives To evaluate the diagnostic accuracy of the second generation dual?source dual?energy CT myocardial perfusion imaging in patients with suspicious myocardial infarction. Methods Fifty?six patients underwent dual?source dual?energy myocardial perfusion imaging, of which forty patients had follow?up results [confirmed by catheter coronary angiography,cardiac troponin I elevation and Electrocardiogram (ECG) changes and evolution of acute myocardial infarction] within 30 days.Catheter coronary angiography and clinical data served as the standard of references. The sensitivity, specificity and positive and negative predictive values of the second generation dual?source dual?energy CT myocardial perfusion in the detection of myocardial infarction were evaluated.The coronary image quality and radiation dose were evaluated. Results Diagnostic accuracy:the sensitivity, specificity and positive and negative predictive values were 95. 0%, 97.0%,86.4% and 98.9%,respectively.Coronary image quality:one patient with non?diagnostic images was due to motion artifacts occurred at the right coronary artery and left circumflex artery;another patient′s vessels were unassessable due to the motion artifacts induced by high heart rate variability;the other patients′image quality were good.Radiation dose:the average effective radiation dose was (6.1±1.5)mSv.Conclusion One?step dual?source dual?energy CT myocardial perfusion scan combined with coronary CTA provide high diagnostic accuracy for detecting myocardial infarction with lower radiation exposure in patients with suspicious myocardial infarction.