多层螺旋CT血管成像胸部三联检查在急性胸痛诊断中的临床应用

目的 探讨多层螺旋CT血管成像胸部三联检查在急性胸痛诊断中的临床价值.方法 对50例以临床急性胸痛为首发症状的患者行64层或双源CT心胸联合血管造影检查.对冠状动脉、肺动脉和主动脉进行曲面重建（CMPR）、最大密度投影（MIP）、容积再现技术（VRT）等图像重组,评价成像质量能否满足临床需求.结果 共检出冠状动脉狭窄≥50％ 15例（其中2例并发急性心肌梗死）;急性肺动脉栓塞12例,主动脉夹层4例（其中伴有冠状动脉多发斑块并管腔狭窄1例）.冠状动脉显影图像质量优的节段占82.1％（495/603例）,图像质量良占10.4％（62/603例）,图像质量差占7.5％（46/603例）;肺动脉及主动脉增强后CT均值≥200HU;平均扫描时间为（8±1.0）s,总对比剂用量为80～100ml.结论 多层螺旋CT三联检查能在8秒左右一次完成检查,能同时对冠状动脉、肺动脉、主动脉等疾病作出正确诊断,在急性胸痛病因诊断中具有很高的临床应用价值.

Clinical application of multi-slice spiral CT angiography based thoracic triple examination on acute chest pain diagnosis

Objective To approach the clinical significance of multi-slice spiral CT angiography-based thoracic tri- ple examination to acute chest pain diagnosis. Methods 64-slice CT or DSCT （Double-source CT） angiography-based thoracic triple examination was conducted for 50 cases with clinical acute chest pains as an initial symptom. Image recon- struction technologies including CMPR （Curved Multi-planar Reconstruction）, MIP （Maximum Intensity Projection） and VRT （Volume Rendering Technique） were adopted for the coronary artery, pulmonary artery and aorta to assess the ima- ging quality. Results 15 cases were diagnosed as coronary artery stenosis including 2 cases with acute myocardial infarc- tion as a combination. 12 cases were diagnosed with acute pulmonary embolism and 4 cases were diagnosed with aortic dissection including 1 case with multiple atherosclerotic plaques and narrow lumens as a combination. 495 out of 603 coro- nary artery imaging segments had excellent image quality. The value of the enhance CT scan of the pulmonary artery and aorta averaged 200HU or higher. The average scanning time was 8s± 1.0s, and the total dosage of contrast agent was 80-100mL. Conclusion Multi-slice spiral CT angiography-based thoracic triple examination can be finished in around 8s in a one-off effort to make a correct diagnosis of diseases of the coronary artery, pulmonary artery and aorta.