上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

双能量心脏成像在中、重度肾功能不全患者中的初步应用

曹立秀，潘自来，张 欢，杨文杰，陈克敏，严福华   

  1. 上海交通大学 医学院附属瑞金医院放射科， 上海 200025
  • 出版日期:2013-07-28 发布日期:2013-08-22
  • 通讯作者: 潘自来, 电子信箱: zilaipanlilly@yahoo.com。
  • 作者简介:曹立秀（1986—），女，硕士生; 电子信箱: shanzibing@126.com。

Application of dual energy heart imaging in patients with moderate to severe renal insufficiency

CAO Li-xiu, PAN Zi-lai, ZHANG Huan, YANG Wen-jie, CHEN Ke-min, YAN Fu-hua   

  1. Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
  • Online:2013-07-28 Published:2013-08-22

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摘要：

目的 探讨双能量心脏成像一次性综合评价中、重度肾功能不全患者冠状动脉病变、首过心肌灌注和左心室心功能的价值。方法 回顾性分析20例临床明确诊断为中、重度肾功能不全患者心电门控双能量冠状动脉动脉增强扫描（DECT-helical）的结果，评价冠状动脉狭窄、心肌灌注和心功能情况，并综合分析三者之间的相关性；同时比较双源CT （DSCT）与心脏超声分析左心功能参数的一致性。结果 共分析20例中、重度肾功能不全患者的248个冠状动脉节段，其中14例患者有不同程度冠状动脉病变，累及60个冠状动脉节段，患者以多支病变伴管腔轻度狭窄为主；分析340个心肌节段的灌注情况，有15例患者存在灌注异常，共涉及72个心肌节段，比较灌注异常、灌注稀疏区域与正常心肌的碘值，两两间比较差异均有统计学意义（P<0.01）；左心室心功能异常者为12例，其中9例有左心室全心功能异常，11例有左心室局部室壁运动异常，共涉及61个心肌节段；DSCT与心脏超声评估左心室舒张末期容积、收缩末期容积、每搏输出量和射血分数均有良好的一致性。结论 心率合适的情况下利用DECT-helical模式一次增强扫描评估中、重度肾功能不全患者的冠状动脉形态学改变、首过心肌灌注和左心室心功能情况，可对冠心病做出综合性诊断。

关键词: 慢性肾功能不全, 冠状动脉病变, 首过心肌灌注, 左心室心功能, 双能量CT

Abstract:

Objective To investigate the application of dual energy heart imaging in evaluation of coronary artery, first-past myocardial perfusion and left ventricular cardiac function in patients with moderate to severe renal insufficiency. Methods The results of dual energy CT-helical (DECT-helical) in 20 patients confirmed as moderate to severe renal insufficiency were retrospectively analysed, the coronary artery stenosis, myocardial perfusion imaging and cardiac function were evaluated, and the correlation among the three items was explored. Besides, the consistency of heart function analysed by dual-source CT (DSCT) and echocardiogram was determined. Results A total of 248 coronary segments in 20 patients with moderate to severe renal insufficiency were analysed, among whom 14 had different degrees of pathological changes, involving 60 coronary segments, and most patients had multi-vessel lesion with mild stenosis of the lumen. A total of 340 segments of myocardial perfusion were analysed, and 15 patients had perfusion defects, involving 72 myocardial segments. There were significant differences in the iodine values among defective perfusion region, sparse perfusion region and normal myocardium (P<0.01). Twelve patients had abnormal left ventricular cardiac function, among whom 9 had whole cardiac anomalies and 11 had regional wall movement abnormalities, which involved 61 myocardial segments. The consistency of end-diastolic volume, end-systolic volume, stroke volume and ejection fraction between DSCT and echocardiogram was favorable. Conclusion DECT-helical can evaluate the morphology of coronary artery, first-past myocardial perfusion and left ventricular cardiac function in patients with moderate to severe renal insufficiency with appropriate heart rate, and can comprehensively make diagnosis of cardiovascular disease.

Key words: chronic renal insufficiency, coronary artery disease, first-pass myocardial perfusion, left ventricular cardiac function, dual energy CT