双能量CT心肌灌注成像助诊冠状动脉迂曲型心肌缺-第三军医大学学报.docVIP

双能量CT心肌灌注成像冠状动脉迂曲与心肌缺血相关性研究 魏淼 王思杭 温家华 刘洋 吕发金* 重庆医科大学附属第一医院放射科 重庆 400016 【摘要】目的：利用双能量CT心肌灌注成像探讨冠状动脉迂曲与心肌缺血的相关性。方法：连续收集98例（男47/女51）心前区不适的患者行双能量CT心肌灌注成像，后处理获得冠状动脉3D重建图、心肌碘分布图和混合能量120kV灰度图，根据冠状动脉情况将98例患者分为迂曲组和非迂曲组，按照AHA的冠脉15段、心肌17段标准分段研究冠状动脉的迂曲程度（角度和数目）和其支配心肌的血流灌注（碘含量和CT值），测量血管起止点之间的直线长度与实际血管曲线长度，计算迂曲指数（TI=L曲/L直），统计迂曲指数与碘含量的相关性，结合24小时动态心电图、超声心动图、SPECT核素心肌显像和冠脉造影综合分析无狭窄的冠状动脉迂曲与心肌缺血是否相关。结果：迂曲组58例，非迂曲组40例，迂曲组中女性占55.17%，伴发心绞痛者96.55%，S-T段异常者82.76%，左室心功能下降者72.41%，与非迂曲组间差异有统计学意义（p0.05）；迂曲组共有502段迂曲血管，迂曲合并狭窄占6.77%，无狭窄的迂曲血管占93.23%，左前降支及对角支占60.96%，回旋支占23.51%，右冠状动脉占15.54%；迂曲组的迂曲数目1104个，平均迂曲弧度（109.08±20.9）°；迂曲组的平均迂曲指数（TI=1.51±0.14）大于非迂曲组（TI=1.21±0.04），无狭窄的迂曲血管支配的心肌平均碘含量和平均CT值（-1.04±0.38mg/ml，63.84±7.92HU）均低于非迂曲组（4.52±0.21mg/ml，98.55±6.41HU），两组间迂曲指数、碘含量、CT值差异均有统计学意义（p=0.000）；冠脉迂曲指数与支配心肌的碘含量呈明显负相关（R=-0.863,p=0.000）。结论：冠脉迂曲常见于女性，好发于左前降支，较少合并狭窄；无狭窄的冠状动脉迂曲程度与心肌缺血呈明显负相关。 【关键字】双能量CT心肌灌注成像；冠状动脉迂曲；心肌缺血 【中图分类号】R814.42 【文献标识】 The Correlation Study of Coronary Tortuosity and Myocardial Ischemia with Dual-energy CT Myocardial Perfusion Imaging WEI Miao, WANG-Sihang, WEN-Jiahua, LIU Yang, LV-Fajin* Department of Radiology,the First Affiliated Hospital of Chongqing Medical University,Chongqing, China,400016 【Abstract】Objective:To investigate the correlation between coronary tortuosity and myocardial ischemia by dual-energy CT myocardial perfusion imaging.Methods:98 patients（male 47/female 51）who complained about precordial distress were carried out dual-energy CT myocardial perfusion imaging continuously.3D images of coronary artery、iodine distribution map of myocardium and grey-scale map of polychromatic energy 120kV were reconstructed.98 patients were divided into tortuous and non-toutuous group.Tortuosity of coronary arteries (angle and number) and blood perfusion of myocardium (iodine concentration and CT value) were studied at 15 coronary artery segments and 17 myocardical segments by AHA criterion.The straight lengths(LS) and actual curve length of coronary artery(LT) from start to