二代双源CT的MinDose技术与超声心动图在主动脉瓣病变术前评估中的对比研究

【摘要】 背景 准确评价冠状动脉、主动脉瓣环直径(aortic valve annulus diameter,AVAD)以及左心射血分数(left ventricular effective fraction,LVEF)对于主动脉置换手术策略的制定具有非常重要的意义。本研究中探讨双源CT的低辐射剂量MinDose技术在主动脉瓣置换术前的临床应用价值。方法 回顾性分析40例欲行换瓣治疗的主动脉瓣病变病人，所有病人均接受双源CT以及超声心动图检查。经胸超声采用二维及四维方法获取病人左室射血分数。所有病人于舒张末期测量主动脉瓣环直径。对照组为33 名非主动脉瓣狭窄成年人，DSCT检查采用常规回顾性心电门控扫描。结果 40例病人MD-DSCT 检查评价冠状动脉均获得良好效果，所有CT成像能够清晰显示瓣叶钙化、脱垂等形态学改变。所有病人的LVEF-MinDose-DSCT与LVEF-2D-TTE有较强的相关性(r=0.87,P<0.01)，与LVEF-4D-TTE有更强的相关性(r=0.90,P<0.01)。AVVD-MinDose-DSCT与AVVD-2D-TTE有较强的相关性(r=0.90, P<0.01)。与标准后门控对照组相比，有效辐射剂量能明显减低63.54%。 结论 MinDose-DSCT可以于术前一站式评价主动脉瓣狭窄病人的冠状动脉病变、AVVD以及LVEF。

Comparison of low-dose sequence of dual-source CT and echocardiography for preoperative evaluation of aortic valve disease

Abstract Keywords: radiation dose; coronary CT angiography; dual-source CT; cardiac function; aortic valve annulus diameters Background Accurate evaluation of coronary artery, aortic valve annulus diameter (AVAD) and cardiac function in patients with aortic valve disease is of great significance for surgical strategy. In this study we explored the preoperative evaluation of low-dose sequence (MinDose sequence) scan of dual-source CT (DSCT) for those patients. Methods Forty patients suspected for aortic valve disease (experimental group) underwent MinDose sequence of DSCT to observe coronary artery, aortic valve annulus diameters (AVAD) and left ventricular ejection fraction (LVEF). Another 33 subjects suspected for coronary artery disease (control group) underwent conventional retrospective ECG-gated sequence of DSCT. Two-dimensional transthoracic echocardiography (2D-TTE) and four-dimensional transthoracic echocardiography (4D-TTE) were applied in the experimental group to measure AVAD and LVEF and compared with MinDose-DSCT. Results There was a strong correlation between LVEF measured by 2D-TTE and MinDose-DSCT (r=0.87, P<0.01), as well as between 4D-TTE and MinDose-DSCT (r=0.90, P<0.01). AVAD measured by MinDose-DSCT was in good agreement with corresponding measurements by 2D-TTE (r=0.90, P<0.01). The effective dose in the experimental group was 63.54% lower than that in the control group. Conclusions MinDose sequence of DSCT with a low radiation dose serving as a one-stop preoperative evaluation makes effective assessment of the coronary artery, AVAD and LVEF for patients with aortic valve disease.