心率过快、心律不齐及起搏器置入患者的电子束CT冠状动脉成像

目的 总结不宜或不能行多层螺旋CT（MSCT）冠状动脉检查的心率过快、心律不齐、起搏器置入患者应用新代电子束CT（EBCT）行无创冠状动脉成像的初步经验。方法 患者36例，其中心率过快（／〉90次／min）20例、心律不齐11例、起搏器置入术后16层MSCT不能触发扫描4例、扫描中心率骤升16层MSCT检查失败1例。以EBCT行冠状动脉成像检查：静脉法增强扫描、前置心电门控数据采集、容积再现（VR）、最大密度投影（MIP）、曲面重组（CPR）、电影方式（cine）重组，以MIP图像评价冠状动脉管腔，以VR图像5级记分评价图像质量。结果 全部患者均成功获得冠状动脉影像。冠状动脉各主支总显示率80.0％，其中左主干、前降支、右冠状动脉显示率100％，回旋支94.3％。结论 新代EBCT能够完成心率过快、心律不齐和起搏器置入术后患者的无创冠状动脉检查，并可取得满意的结果。

Electron-beam CT coronary angiography in the patients with high heart rate arrhythmia or pacemaker

Objective To report the clinical applicability of coronary angiography for patients with high heart rate, arrhythmia or cardiac pacing using the new-generation of electron-beam CT(e-Speed). Methods EBCT (GE e-Speed) coronary angiography was performed in 36 cases(male 27 , female 9, mean age 58 ),including the heart rate more than 90 bpm in 20 patients, frequent ectopic beats in 11 cases, implantation of cardiac pacemaker in 4 patients and the unacceptable MSCT image quality due to variability of interscan heart rate (from 82 bpm to 104 bpm) in 1 case. After volume data set was acquired using spiral mode with prospective ECG-gating ,the reconstructions of MIP ,CPR, VR and Cine were performed. The VR quality was evaluated using a five-point scale. Results The quality of coronary imaging in all of 36 cases were acceptable. The total visualization rate of coronary artery branches was 80.0%. Left main , left anterior artery and right coronary artery were visualized in all patients and in 94.3% of all cases circumflex artery were visible. Conclusion EBCT (e-Speed) is applicable in noninvasive coronary angiography for patients with high heart rate,arrhythmia or implanted cardiac pacemaker, and this examination can obtain satisfied diagnosis.