回顾性心电门控结合心电编辑在64层螺旋CT冠状动脉成像中的应用

目的 探讨回顾性心电门控技术结合心电编辑在64层螺旋CT冠状动脉成像(MSCTA)中的应用价值.方法 因临床拟诊冠心病而行冠状动脉64层MSCTA检查的患者67例,其中37例扫描中出现期前收缩(房性17例,室性20例),16例心电信号出现错误触发点,14例部分R波上触发点缺失而导致R-R间期不等.对患者的心电信号进行编辑,结合回顾性心电门控技术和后处理工作站重组编辑后的图像.12例患者在MSCTA后4～30 d行冠状动脉导管造影(CAG)检查.结果 1例房性期前收缩患者未能实施心电编辑.66例763段冠状动脉中质量为优、良、中和差者分别为473(62.0%)、213(27.9%)、51(6.7%)和26段(3.4%);可用于诊断的血管为737段(96.6%).12例患者冠状动脉MSCTA检查结果 与CAG检查进行对照,MSCTA诊断血管狭窄程度1≥50%的敏感性为84.6%(22/26);诊断血管狭窄程度＜50%的敏感性为83.3%(10/12);诊断血管狭窄的特异性为96.3%(105/109),阴性预测值为97.2%(105/108).结论 回顾性心电门控配合心电编辑冠状动脉MSCTA能明显改善患者期前收缩和心电信号中触发点错误的图像质量,扩大了冠状动脉MSCTA检查的适应证范围.

The application of the retrospective electrocardiographic gating technique combined With electrocardiographic editing in 64 multislice spiral CT coronary angiography

Objective To assess the value of the retrospective electrocardiographic gating technique with electrocardiographic editing in 64 multislice spiral CT coronary angiography(MSCTCA).Methods Sixty-seven patients with suspicion of coronary artery disease underwent coronary angiography with 64 MSCT,including arrhythmia(n=37,17 with atrial extrasystoles and 20 with ventricular extrasystoles),unequal R-R intervals resulted from the absence of trigger points on partial R waves(n=14)and inaccurate trigger points(n=16).The images were reconstructed with the retrospective electrocardiographic gating technique after electrocardiacgraphic signal editing and processed On the postprocessing workstation.Results The electrocardiographic signal editing was failed in one patient with atrial extrasystole.According to the image quality,763 segments of coronary arteries in 66 patients were defined as excellent(n=473,62.0%),good (n=213,27.9%),moderate(n=51,6.7%)or poor(n=26,3.4%)and divided into 4 groups.The images of 737 segments(96.6%)of coronary arteries were diagnostable.The Results of CT angiography in 12 patients were compared with coronary angiography(CAG),and the sensitivity of 64-slice spiral CT for the≥50% stenosis and＜50% stenosis were 84.6%(22/26)and 83.3%(10/12),respectively.The specificity was 96.3%(105/109)and the negative predictive value was 97.2%(105/108)in the diagnosis of coronary artery stenosis.Conclusion The retrospective electrocardiographic gating technique combined with electrocardiographic signal editing expands the applications of 64 MSCTCA.