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心肌灌注成像(myocardial perfusion imaging,MPI)是指在团注碘对比剂后心肌组织密度随时间而变化,根据不同的数学模型计算出组织的血流灌注量、血流容积等参数,进行定量评价心肌的灌注程度,是评价心肌微循环和判断心血管疾病预后及不良事件的重要无创性检查方法[1]。
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双源DE-CT-MPI的临床应用目的是在对受检者进行冠状动脉评估的同时也能够对心肌的灌注情况进行评估,并能够与对冠状动脉的诊断评估结合在一起进行观察,有利于医师作出更全面准确的诊断。双源DE-CT-MPI技术利用采集到的双能量心脏扫描数据经过计算得到心肌的灌注情况,在数据采集过程中不需要对心脏进行平扫,只需利用造影剂的射线能量敏感性来进行处理计算。基于正常心肌组织和受损心肌组织对造影剂的摄取差异性,双源DE-CT-MPI检查能够检测出心肌内很小的灌注缺损区,具有很高的灵敏度。
Ruzsics等[9]的初步研究结果显示,与SPECT相比,双源DE-CT-MPI检测心肌缺血的灵敏度、特异度分别为84%、94%;而同时以导管法冠状动脉造影为参照标准,双源DE-CT-MPI诊断≥50%冠状动脉狭窄的灵敏度、特异度分别是98%、88%。彭晋和张龙江[23]研究表明,以组织病理学检查为金标准,双源DE-CT-MPI诊断心肌损伤的灵敏度、特异度、阴性预测值和阳性预测值分别为89.3%、93.5%、78.1%,97.1%;Kappa值为0.79,与组织病理学检查结果的一致性好。Ko等[24]与Weininger等[25]分别进行了负荷双源DE-CT-MPI的研究,灵敏度和特异度可分别达98%、93%和100%、99%,较SPECT诊断准确率有了进一步的提高;Weininger等[25]的临床研究发现,双源DE-CT-MPI诊断冠状动脉疾病的灵敏度达84%,特异度94%,准确率92%,同时Ko等[24]发现,双源DE-CT-MPI对于狭窄程度 > 50%的冠状动脉评估的灵敏度也达到了98%,特异度达88%,准确率达92%。孙凯等[26]建立猪急性心肌梗死的模型研究表明,利用第二代双源DE-CT-MPI的扫描方式可实现“一站式”获得心肌灌注和冠状动脉的图像,进一步提高了心脏CT检测心肌梗死的准确率,有效辐射剂量低。综上所述,双源DE-CT-MPI能够评估冠状动脉的同时评估由于心肌缺血导致的心肌受损情况。国内外学者关于双源DE-CT-MPI的检测性能评价见表 1。
表 1 双源双能量CT对急性心肌梗死及冠心病的检测性能(%)
Table 1. Dual-source and dual energy CT detection performance in monitoring of acute myocardial infarction and coronary heart disease(%)
双源双能量CT心肌灌注成像的研究进展
Progress of dual-energy myocardial perfusion imaging by dual-source computed tomography
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摘要: 近年来,双源双能量CT心肌灌注成像在临床中的应用及研究逐渐增多,能够反映心肌微循环状况,定性及定量地评价心肌血流状态,检测心肌微循环及心肌活性,并且可以在评估冠状动脉的同时评估由于心肌缺血导致的心肌受损情况。其诊断心肌损伤的灵敏度、特异度、阴性预测值和阳性预测值与组织病理学检查的一致性好。相对于其他检查技术,双能量心肌灌注成像能便捷地提供更丰富的临床信息。笔者对双源双能量CT心肌灌注成像的研究进展进行综述。
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关键词:
- 心肌灌注显像 /
- 体层摄影术,X线计算机 /
- 双能量
Abstract: In recent years, dual-energy myocardial perfusion imaging via dual-source CT has been extensively used in clinical diagnoses and research. This technique can reflect the condition of myocardial microcirculation blood flow, qualitatively and quantitatively evaluate myocardial blood flow, identify myocardial microcirculation and myocardial viability, assess myocardial damage caused by myocardial ischemia, and assess the coronary artery. The sensitivity, specificity, negative predictive value, and positive predictive value of the diagnosis of myocardial damage demonstrated good consistency with pathologic tissue examination. Compared with other techniques, dual-energy myocardial perfusion imaging provides more detailed clinical information. This paper reviews the progress of dual-energy myocardial perfusion imaging via dual-source CT in clinical applications.-
Key words:
- Myocardial perfusion imaging /
- Tomography, X-ray computed /
- Dual energy
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表 1 双源双能量CT对急性心肌梗死及冠心病的检测性能(%)
Table 1. Dual-source and dual energy CT detection performance in monitoring of acute myocardial infarction and coronary heart disease(%)
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