上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (3): 326-.doi: 10.3969/j.issn.1674-8115.2011.03.018

• 论著（临床研究） • 上一篇    下一篇

多层螺旋CT双期扫描对急性心肌梗死的综合性评估价值

关韶峰1, 方唯一1, 曲新凯1, 叶剑定2, 沈 艳2, 焦 静2, 李若谷1   

  1. 上海交通大学附属胸科医院 1.心内科, 2.放射科, 上海 200030
  • 出版日期:2011-03-28 发布日期:2011-03-29
  • 通讯作者: 方唯一, 电子信箱: fwychest@163.com。
  • 作者简介:关韶峰（1978—）, 男, 主治医师, 博士；电子信箱: gsf@qq.com。
  • 基金资助:

    上海交通大学医学院博士创新基金(BXJ0838)

Value of dual-phase multislice CT in comprehensive assessment of acute myocardial infarction

GUAN Shao-feng1, FANG Wei-yi1, QU Xin-kai1, YE Jian-ding2, SHEN Yan2, JIAO Jing2, LI Ruo-gu1   

  1. 1.Department of Cardiology, 2.Department of Radiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
  • Online:2011-03-28 Published:2011-03-29
  • Supported by:

    Shanghai Jiaotong University School of Medicine Foundation, BXJ0838

PDF (PC)

1620

摘要：

目的 探讨多层螺旋CT（MSCT）对急性心肌梗死(AMI)患者介入治疗后早期的综合性评估价值。方法 以接受经皮冠状动脉介入治疗（PCI）的18例AMI患者作为研究对象，治疗后1周内对所有患者进行双期MSCT扫描检查。分析MSCT图像中早期相灌注缺损（ED）及延迟相晚期增强（LE）和残余缺损（RD）区域和增强特点。将MSCT测量的梗死容积、左心室射血分数（MSCTLVEF）、室壁节段运动情况与血液生化指标血清肌酸激酶（CPK）曲线下面积及超声心电图（TTE）测量的LVEF（TTELVEF）和室壁节段运动情况进行对比分析。结果 早期扫描相检出ED 17例，其判断心肌梗死的敏感性和特异性均为94%。延迟扫描相表现出3种不同的增强特征，分别为孤立性心内膜下LE、心内膜下RD和心外膜下LE以及单纯心内膜下RD。延迟相测得的梗死容积与血清CPK曲线下面积（r=0.840）、MSCTLVEF与TTELVEF（r=0.800）以及TTE与MSCT对室壁节段运动异常的评估结果（r=0.814）均呈显著正相关（均P<0.001）。结论 AMI患者接受PCI治疗后的双期MSCT扫描表现出不同的增强特征。MSCT检查对再灌注后梗死部位和范围的判定具有应用价值。一次MSCT检查尚可了解患者心功能和室壁节段运动情况，且与TTE检查结果高度一致。MSCT可用于对AMI患者进行全方位的综合评估。

关键词: 多层螺旋CT, 影像学, 心肌梗死

Abstract:

Objective To determine the value of multislice CT (MSCT) in early comprehensive assessment of acute myocardial infarction (AMI) after interventional therapy. Methods Eighteen patients with AMI undergoing percutaneous coronary intervention (PCI) were selected. All patients received dual-phase MSCT one week after treatment. The distribution and enhancement patterns of early perfusion defect (ED), late enhancement (LE), and residual perfusion defect (RD) on MSCT images were analysed. The infarction volume, left ventricular ejection fraction (LVEF) and ventricular wall segmental motion determined by MSCT were compared with area under the curve of serum creatine phosphokinase (CPK) and LVEF and ventricular wall segmental motion measured by transthoracic echocardiography (TTE). Results Seventeen cases of ED were detected on early phase of scan, and both the sensitivity and specificity were 94% in diagnosis of myocardial infarction. Three enhancement patterns were observed on delayed phase of scan: isolated subendocardial LE, subendocardial RD and subepicardial LE, and subendocardial RD. Infarction volume assessed on delayed phase was significantly correlated with area under the curve of serum CPK （r=0.840）, LVEF determined by MSCT and TTE （r=0.800） and ventricular wall segmental motion disorders measured by TTE and MSCT (r=0.814)(P<0.001 for all). Conclusion Different enhancement pattern can be observed on dual phase MSCT in patients with AMI after PCI. Assessment of myocardial attenuation on MSCT gives additional information of the location and extent of infarction after reperfusion. Cardiac function and wall motion information can be obtained by one MSCT exam, which is well correlated with findings from TTE. MSCT is suitable for comprehensive assessment of AMI.

Key words: multislice CT, imaging, myocardial infarction