64层CT心电门控血管造影对急性肺栓塞右室功能的评价

目的：评价64层CT心电门控肺动脉造影（CTPA）对急性肺栓塞右室功能的价值。方法：回顾性分析64层CT心电门控CTPA且影像质量良好的患者共45例,所有患者均同时进行了常规CTPA。对常规CTPA患者,测量横断位、四腔心左右室最大短轴内径。对心电门控CTPA患者,测量舒张末期和收缩末期心室最大内径,并计算左、右室舒张末期和收缩末期容积。然后对阳性组与阴性组之间右心功能各组参数进行独立样本t检验,并对中央型、周围型及阴性组之间参数进行方差分析或非参数检验。结果：45例患者中,阳性30例,其中中央型20例、周围型10例。对于阴性组与阳性组,右室收缩末期容积（P=0.02）、每搏输出量（P=0.015）及射血分数（P=0.01）在两组之间的差异有统计学意义,右室/左室（RV/LV）收缩末期容积比在两组之间有统计学差异（P=0.005）。对于中央型、周围型与阴性组,右室每搏输出量、射血分数在中央型与阴性组之间以及周围型与阴性组之间均有统计学差异（P〈0.05或P〈0.01）。RV/LV容积比在中央型与阴性组之间,以及收缩末期中央型与周围型之间均有统计学差异（P〈0.05）。右室内径及RV/LV内径比在阴性与阳性组之间无统计学差异,但RV/LV内径比在中央型与阴性组之间（P〈0.05）或周围型之间（P〈0.01）有统计学差异。结论：64层CT心电门控肺动脉造影对评价右室功能有一定的价值。

Evaluation of right ventricular function with ECG-gated 64-slice CT: preliminary findings in acute pulmonary embolism

Objective：To retrospectively evaluate the right ventricular function in patients with suspected acute pulmonary embolism（PE） by ECG-gated 64-slice computed tomography angiography （CTA）. Methods：Forty-five adult patients underwent ECG-gated 64-slice CTA after non-gated 64-slice CTA to assess the right ventricular function. The axial and reformatted four-chamber ventricular diameters were measured for both the non-gated CT and the ECG-gated CT in end-diastole and end-systole. Furthermore,the right ventricular end-diastolic and end-systolic volumes were measured on ECG-gated 64-slice CT scans. An independent samples t test was performed to compare the mean value of different groups. An analysis of variance post hoc test was performed to find whether the values of the variables varied among groups. Results：Thirty patients of acute PE were detected in the 45 patients. According to location,there were 20 patients of central PE and 10 of peripheral PE. The RV end-systolic volume was larger （P=0.02）,stroke volume （P=0.015） and ejection fraction （P=0.01） were lower in patients with PE. Furthermore,the RV/LV volume ratios at end systole was significantly different between PE and those without PE （P=0.005）. The ECG-gated RV stroke volume and ejection fraction showed significant differences between patients without PE and those with central or peripheral PE. All ECG-gated RV/LV ratio measurements （except RV/LV volume ratios at end systole between central PE and peripheral PE） and RV/LV dimension ratios obtained on the non-gated angulated four-chamber views showed significant differences between patients with central PE and those without or with peripheral PE. Conclusion：Retrospective ECG-gated 64-slice CTA facilitates detection of right ventricular dysfunction.