128层CT对心肌梗死综合评估及预后判断的价值

目的:探讨MSCT对急性心肌梗死介入治疗早期综合评估及6个月左心室重构的预测价值。方法:选择36例急性心肌梗死介入治疗患者,均于介入治疗后1周及6个月行MSCT和经胸超声心动图检查,并根据MSCT延迟扫描将患者分为A、B、C组,分析不同组别的图像特点。结果:36例患者中,早期扫描检出早期灌注缺损(early defect,ED)34例,经冠脉造影证实32例,30例表现为心内膜下,2例为透壁性,ED区域CT值(45.32±15.32)HU,明显低于正常心肌。延迟扫描检出孤立性心内膜下晚期增强(late enhancement,LE)18例,心内膜下残余灌注缺损(residual defect,RD)和心外膜下LE 4例,单纯心内膜下RD 12例;LE区域CT值(105.85±16.23)HU,明显高于正常心肌;RD区域CT值(39.24±8.36)HU,明显低于正常心肌。A组ST回落程度(63.2±7.1)%明显高于B、C组,C组(44.3±3.5)%明显高于B组;B组CT梗死容积(13.2±4.1)%明显高于A、C组;B组左心室舒张末容积(41.2±7.2)mm3明显高于A、C组。结论:介入治疗后急性心肌梗死患者MSCT双期扫描图像表现出不同的强化方式,具有一定的特征性,对急性心肌梗死6个月左心室重构有较好的预测价值。

The application analysis and prognostic value of 128 slices spiral CT in comprehensive evaluation of myocardial infarction

Objective：To analyze comprehensive evaluation of MSCT in acute myocardial infarction, and intervention 6 months predictive value of left ventricular remodeling. Methods： 36 cases of acute myocardial infarction patients with interventional therapy were recorded one week and 6 months after the interventional treatment,accepted MSCT scanning and the thoracic echocardiography. According to the MSCT scanning delay phase divided the patients into A,B,C groups, and image characteristics between different groups were analyzed. Results：In 36 patients,early scanning detection of early perfusion defect （ED） showed in 34 cases, 32 cases were confirmed by coronary angiography,in which 30 cases were subendocardial, 2 cases were transmural, ED area CT value （45.32±15.32）HU significantly lower than the normal myocardium. Delay scanning detected isolated subendocardial late enhancement （LE） in 18 cases,residual perfusion defect （RD） under the endocardium and epieardium LE in 4 cases,pure subendocardial RD in 12 cases. LE regional CT value （105.85±16.23） HU was significantly higher than the normal myocardium,RD area CT value （39.24±8.36）HU was significantly lower than the normal myoeardium. ST down degree （63. 2±7.1） % was significantly higher in group A than group B and C;group C was significantly higher than group B （44.3±3.5） . CT infarction volume （13.2±4.1）% significantly higher in Group B than that of group A and C. Left ventricular diastolic diameter （41.2±7.2） mm of group B were significantly higher than group A and C. Conclusion： After interventional treatment in patients with acute myocardial infarction,double phase MSCT scanning images show enhancement in different ways, with a certain characteristic. It has good predictive value to left ventricular remodeling six months after acute myocardial infarction.