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目的:探讨能谱CT双能量成像在梗死心肌检测中的作用。方法:对35例冠心病患者行常规冠状动脉(冠脉)CT血管造影扫描模式和能谱CT双能量扫描模式检查,另其中18例和27例患者在1周内分别再行单光子发射计算机断层扫描(SPECT)和MRI心肌灌注扫描。在碘基物质密度图像上分别测得患者梗死区域、梗死周围区域、正常心肌、主动脉碘浓度,同时记录相应部位标准化碘浓度和病灶-正常碘浓度比值、病灶周围-正常碘浓度比值(有效原子序数值),记录SPECT和MRI心肌灌注图像上找到的梗死心肌区域,并对所得数据进行定量分析。结果:能谱CT 40～140 keV单能量图像结合物质密度图像(碘基物质密度图像)梗死心肌检出率比常规冠脉CT血管造影混合能量图像的明显提高(48个梗死灶比19个梗死灶),且图像显示的心肌梗死区与SPECT(r=0.979)及MRI(r=0.975)检查显示的心肌灌注情况间有良好的相关性。梗死区域、梗死周围区域、正常心肌间的标准化碘浓度值差异有统计学意义(P=0.006);病灶-正常心肌碘浓度比值与病灶周围-正常心肌碘浓度比值间差异有统计学意义(P=0.015);梗死区域、梗死周围区域、正常心肌间的有效原子序数值亦存在显著差异(P=0.003)。结论:能谱CT常规冠脉CT血管造影结合能谱CT双能量扫描模式,一次扫描不但可常规分析冠脉血管形态,还可通过物质分离成像及其他能谱定量分析参数提高梗死心肌的检出率,且与SPECT及MRI心肌灌注的检查结果间有较高的一致性。
Objective: To explore the role of energy spectrum CT dual-energy imaging in the detection of myocardial infarction. Methods: 35 cases of coronary heart disease patients underwent coronary angiography (coronary) CT scan mode and energy spectrum CT dual-energy scanning mode of examination, and the other 18 cases and 27 patients within 1 week were re-single photon emission computer Tomography (SPECT) and MRI myocardial perfusion scan. The iodine-based material density images were measured in the patient’s infarct area, infarct area, normal myocardium, aorta iodine concentration, while recording the corresponding part of the standardized iodine concentration and lesions - normal iodine concentration ratio, the surrounding lesion - normal iodine concentration ratio (effective Atomic number), recorded infarct myocardium areas found on SPECT and MRI myocardial perfusion images, and the resulting data were quantitatively analyzed. Results: The detection rate of infarction myocardium in single energy image combined with CT image (CTD) of 40 ~ 140 keV was significantly higher than that of conventional coronary CT angiography (48 infarcts vs 19 infarcts There was a good correlation between myocardial infarction size and myocardial perfusion revealed by SPECT (r = 0.979) and MRI (r = 0.975). There were significant differences in normalized iodine concentration between infarcted area, infarct area and normal myocardium (P = 0.006). There was a significant difference between the ratio of iodine concentration in lesion to normal myocardium and the ratio of iodine concentration in peri-normal myocardium (P = 0.015). There was also a significant difference in the effective atomic number between infarcted area, infarct area and normal myocardium (P = 0.003). Conclusion: CT coronary angiography combined with energy spectrum CT dual-energy scanning mode, a scan can not only routine analysis of coronary artery morphology, but also through the material separation imaging and other quantitative analysis of parameters to improve the detection of myocardial infarction Rate, and with SPECT and MRI myocardial perfusion test results between the higher consistency.