多层螺旋CT心肌灌注对缺血性心脏病的应用价值

目的探讨MSCT心肌灌注在缺血性心脏病(IHD)诊断与治疗中的应用价值。方法选取35例CAG和(或)支架植入术后IHD患者行MSCT心肌灌注扫描,分别测量并比较正常心肌与缺血心肌的CT值、血流量(BF)、血容量(BV)、峰值时间(MTP)、平均通过时间(MTT)及时间-密度曲线(TDC)。结果 35例患者MSCT心肌灌注扫描均可显示低灌注区,与CAG、SPECT及ECG提示心肌缺血区域相对应。首过灌注图像上缺血心肌CT值为(90.28±7.29)HU,正常心肌CT值为(141.05±9.54)HU;缺血心肌BF、BV减低,MTP、MTT延迟,与正常心肌的差异均具有统计学意义(P均<0.05)。34例正常心肌TDC呈稍快上升继而平缓下降;20例缺血心肌TDC呈缓慢上升,10例近乎水平,5例与正常心肌TDC形态相似。结论 MSCT心肌灌注成像可用于定位及诊断心肌缺血,在缺血性心脏病的诊断及治疗决策中起重要指导作用。

Application of MSCT myocardial perfusion in ischemic heart disease

Objective To observe the application value of MSCT myocardial perfusion in diagnosis and treatment of ischemic heart disease. Methods Totally 35 patients who had underwent CAG and/or stent implantation were enrolled, and MSCT myocardial perfusion was performed in all patients. The mean attenuation, blood flow (BF), blood volume (BV), time to peak (TTP), mean transit time (MTT) and the time-density curve (TDC) were measured respectively, and were compared between normal and ischemic myocardium. Results In 35 patients, the hypoperfusion areas of ischemic myocardium identified by SPECT myocardial perfusion scanning, CAG and ECG also could be detected with MSCT. The mean attenuation of ischemic myocardium and normal myocardium in first pass perfusion were (90.28±7.29)HU and (141.05±9.54)HU, respectively. BF and BV of ischemic myocardium were lower, while TTP and MTT were longer than those of normal myocardium (all P<0.05). TDC of normal myocardium (n=34) appeared as a little fast ascending and slow descending, while of ischemic myocardium in 20 cases appeared as slow ascending, in 10 cases appeared as nearly horizontal straight line, and in 5 cases were similar to that of normal myocardium. Conclusion MSCT myocardial perfusion imaging could be used to diagnose and locate ischemic myocardium. It may play an important role in guiding diagnosis and treatment of IHD.