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目的探讨双源CT(dual-source CT,DSCT)前瞻性心电门控“一站式”低剂量扫描方案在低心率患者冠状动脉成像及左心室功能分析中的应用价值。方法 33例临床怀疑或确诊为冠心病的患者1周内同时行冠状动脉DSCT和超声心动图检查。入组条件:心律规则且心率≤70次/分。DSCT采用管电流调制,前瞻性心电触发序列扫描,扫描窗宽为30%～80%R-R间期,全电流采集时相为70%R-R间期,其余时相使用全电流的20%。冠状动脉依据美国心脏学会冠状动脉16分段法,图像质量用4级法进行评估,1～3级图像为可评估,能用于影像诊断,4级为不可评估。采用手动矫正Simpson法计算DSCT所测得的左心室射血分数(LVEF),并以超声心动图测得的LVEF值为对照进行配对t检验和Pearson相关性检验。结果 30例患者顺利完成检查及左心室功能分析,1例心脏扫描失败,2例左心室功能分析失败。平均辐射剂量为(3.08±0.40)mSv。共评价冠状动脉409段,其中可用于诊断的节段占96.82%。双侧配对t检验结果显示DSCT与超声心动图测得的LVEF值差别无统计学意义(P=0.14),且有很高的相关性(r=0.74)。结论 DSCT前瞻性心电触发序列扫描低剂量“一站式”心脏检查方法可以用于低心率患者的冠状动脉成像和左心室功能分析。冠状动脉图像质量较好,左心室功能分析结果可靠,平均辐射剂量较低。
Objective To investigate the value of dual-source CT (DSCT) prospective electrocardiographic gating “one-stop” low-dose scanning in the analysis of coronary artery imaging and left ventricular function in patients with low heart rate. Methods Thirty-three patients suspected or diagnosed as having coronary heart disease underwent coronary DSCT and echocardiography simultaneously within one week. Inclusion conditions: heart rate rules and heart rate ≤ 70 beats / min. DSCT uses tube current modulation and prospective ECG-triggered serial scans with a scan window width of 30% -80% R-R interval, a full-current acquisition phase of 70% R-R interval, and the rest of the phases using 20% of full current. Coronary Artery According to the American Heart Association Coronary 16 Segmentation Method, the image quality was evaluated by the 4-step method. The 1 ~ 3 images were evaluable and could be used for imaging diagnosis. The 4 grades were not evaluable. The left ventricular ejection fraction (LVEF) measured by DSCT was calculated by manual correction Simpson method. The paired t-test and Pearson correlation test were performed using the LVEF values measured by echocardiography as controls. Results 30 patients successfully completed the examination and analysis of left ventricular function, one case of cardiac failure, two cases of failure of left ventricular function analysis. The average radiation dose was (3.08 ± 0.40) mSv. A total of 409 coronary arteries were evaluated, of which 96.82% were useful for diagnosis. Bilateral paired t-test results showed that DSCT and echocardiography measured LVEF values were not statistically different (P = 0.14), and there is a high correlation (r = 0.74). Conclusions DSCT prospective ECG-triggered low-dose “one-stop” cardiac scan can be used for coronary angiography and left ventricular function analysis in patients with low heart rate. Coronary artery image quality is good, reliable left ventricular function analysis, the average radiation dose is low.