64层螺旋CT冠状动脉CTA显示心肌低灌注现象的分析

目的分析64层螺旋CT冠状动脉CTA的图像，总结显示心肌低强化现象的情况，并通过综合评价心肌强化情况与CTA冠状动脉血管图像，判断冠状动脉狭窄对于心肌血供影响的情况。方法回顾性分析2009年1月～2012年12月．在太原市中心医院进行64层螺旋CT冠状动脉CTA检查并行冠状动脉血管造影检查的39例临床可疑冠心病患者的CTA图像．心肌图像按17段分段法重建，对强化后的心肌密度进行测量，并记录CT值，以低于临近节段心肌密度30hu为低强化区域。结合冠状动脉血管造影检查结果，对于发现的冠状动脉狭窄段相对应的供血区心肌密度与相邻正常节段心肌密度进行两组均数分析。综合分析冠状动脉CTA血管及心肌图像．判断冠状动脉狭窄对心肌灌注造成的影响。结果39例患者均在1周内接受了冠状动脉CTA及血管造影检查。冠状动脉血管造影显示有意义的冠状动脉狭窄63段。39例患者的CT图像，经过重建，共得到663段心肌图像。其中1段心肌图像测量出脂肪密度，干扰低强化现象的分析，排除在外，其他662段心肌图像共显示低强化心肌87段。提示心肌灌注不足，其中71段显示为心内膜下低强化区，16段显示为透壁低强化区，低强化区平均CT值为（66．0±32．1）hu。其他各段心肌未见明显低强化区，CT值最低（95．2±25．8）hu，最高（122．1±26．6）hu，平均CT值为（108．18±8．83）hu。经过两组均数比较，t=5．150，P〈0．001，低强化区与正常强化区心肌CT值之间差异有统计学意义。结论在进行64层螺旋CT冠状动脉CTA检查过程中，综合评价冠状动脉血管及心肌强化CT图像，可以在一定程度上反映心肌血供情况，为临床治疗提供更多诊疗信息。

Analysis of myocardial hypoperfusion phenomenon with images of 64- slice CT coronary CTA

Objective To analyze the myocardial hypoperfusion phenomenon with images of 64-slice spiral CT coro- nary CTA, to evaluate coronary stenosis and influence for myocardial blood supply after evaluating both myocardial en- hancement and CTA coronary vascular images comprehensively. Methods Thirty-nine patients with clinical suspected coronary heart disease （CHD） whose 64-slice CT coronary CTA examination parallel coronary artery angiography were reviewed retrospectively in Taiyuan Centre Hospital from Jan. 2009 to Dec. 2012. The patients＇ myocardial images were reconstructed at 17-segment segmentation style, the CT value for strengthening the cardiac muscle density was measured and recorded. The CT values of hypoperfusional region below the near segment 30 hu. The means of my- ocardial CT value of coronary stenosis segment and adjacent normal segment were compared. Evaluated myocardial en- hancement and CTA coronary vascular image comprehensively to determine the degree of coronary stenosis and influ- ence for myocardial blood supply. Results Thirty-nine patients who were imaged by coronary CTA and angiography within a week showed 63 segments of significant coronary stenosis were revealed by coronary angiography. In a total 663 segment CT myocardial images, i segment was excluded for fat interference, in the other 662 segments of the my- ocardial images, 87 hyperperfusional regions were found; 71 were subendocardial, 16 were transmural, the average CT value was （66.0±32.1） hu. The CT value of the normal myocardium were from minimum （95.2±25.8） hu to maximum （122.1±26.6） hu, the average CT value was （108.18±8.83） hu.There were statistical differences between two groups by two groups mean comparison, t=5.150, P 〈 0.001. Conclusion The comprehensive evaluation of coronary vascular and myocardial enhanced CT image in 64-slice CT coronary CTA inspection processes can reflect myocardial blood supply to a certain extent, and provide more efficient information for clinical treatment.