256层CT扫描对急性胸痛的诊断价值
|
摘要
目的探讨256层CT扫描在不典型急性胸痛患者中的应用价值。方法 51例不典型急性胸痛患者均行胸痛三联一站式CT扫描,评估图像质量,分析诊断结果。冠状动脉主支血管狭窄>50%或急性冠状动脉综合征患者行急诊/择期冠状动脉造影检查37例,根据CT检查前的心率分为低心率组20例(心率≤70次/min)和高心率组17例(心率>70次/min),比较2组CT参数、冠状动脉CT血管成像质量及诊断准确率。结果 51例患者均完成胸痛三联一站式CT扫描,胸主动脉、肺动脉造影剂充盈良好,管腔显示清晰;冠状动脉CT血管成像图像质量4分21例,3分15例,2分13例,1分2例;其中诊断急性冠状动脉综合征33例,主动脉夹层3例,急性肺栓塞2例,胸膜炎、胸腔积液2例,肺炎2例,心包炎、心包积液1例,气胸1例,肋骨骨折1例,胸部肿瘤1例,正常5例;低心率组辐射剂量[(9.19±1.63)mSv]低于高心率组[(10.99±1.36)mSv],冠状动脉成像质量优于高心率组(P<0.05),冠状动脉CT血管成像诊断结果与冠状动脉造影符合32例,有效诊断率为86.5%,低心率组诊断准确率(90.0%)优于高心率组(82.4%),但差异无统计学意义(P>0.05)。结论胸痛三联一站式256层CT扫描能为以急性胸痛为主诉的患者提供快速准确的检查手段,对心率控制的要求较低。
Objective To explore the value of 256 slice CT to the diagnosis of atypical chest pain. Methods Fifty-one patients with atypical acute chest pain received triple rule-out CT scan, the quality of the images was evaluated and diagnosis results were analyzed. Primary/elective coronary angiography was performed in 37 patients with coronary artery stenosis >50% or acute coronary syndrome. According to the heart rate before CT scan, 37 patients were divided into 20 patients with heart rate ≤70 beats/min(low heart rate group) and 17 patients with heart rate > 70 beats/min(high heart rate group). The CT parameters, CT angiography imaging quality and diagnostic accuracy were compared between two groups. Results All these 51 patients completed CT scan, showing well filling of chest aorta and pulmonary arteriography contrast, and clear cavity. The image quality score of CT angiography was 4 in 21 cases, 3 in 15, 2 in 13 and 1 in 2. The diagnosis results included acute coronary syndrome in 33 cases, aortic dissection in 3, acute pulmonary embolism in 2, pleurisy and pleural effusion in 2, pneumonia in 2, pericarditis and pericardial effusion in 1, pneumothorax in 1, rib fracture in 1, thoracic tumor in 1, and normal in 5. The CT angiography radiation dose was significantly smaller in low heart rate group((9.19±1.63) mSv) than that in high heart rate group((10.99±1.36) mSv), and the image quality was better than that in high heart rate group(P<0.05). The CT angiography diagnosis of 32 patients was accorded with final coronary angiography, and the effective diagnosis rate was 86.5%. The diagnostic accuracy rate was significantly higher in low heart rate group(90.0%) than that in high heart rate group(82.4%), but the difference was not statistically significant(P>0.05). Conclusion 256 slice CT could provide quick and accurate examination for patients with compliance of acute chest pain, and requires lower heart rate control.
Objective To explore the value of 256 slice CT to the diagnosis of atypical chest pain. Methods Fifty-one patients with atypical acute chest pain received triple rule-out CT scan, the quality of the images was evaluated and diagnosis results were analyzed. Primary/elective coronary angiography was performed in 37 patients with coronary artery stenosis >50% or acute coronary syndrome. According to the heart rate before CT scan, 37 patients were divided into 20 patients with heart rate ≤70 beats/min(low heart rate group) and 17 patients with heart rate > 70 beats/min(high heart rate group). The CT parameters, CT angiography imaging quality and diagnostic accuracy were compared between two groups. Results All these 51 patients completed CT scan, showing well filling of chest aorta and pulmonary arteriography contrast, and clear cavity. The image quality score of CT angiography was 4 in 21 cases, 3 in 15, 2 in 13 and 1 in 2. The diagnosis results included acute coronary syndrome in 33 cases, aortic dissection in 3, acute pulmonary embolism in 2, pleurisy and pleural effusion in 2, pneumonia in 2, pericarditis and pericardial effusion in 1, pneumothorax in 1, rib fracture in 1, thoracic tumor in 1, and normal in 5. The CT angiography radiation dose was significantly smaller in low heart rate group((9.19±1.63) mSv) than that in high heart rate group((10.99±1.36) mSv), and the image quality was better than that in high heart rate group(P<0.05). The CT angiography diagnosis of 32 patients was accorded with final coronary angiography, and the effective diagnosis rate was 86.5%. The diagnostic accuracy rate was significantly higher in low heart rate group(90.0%) than that in high heart rate group(82.4%), but the difference was not statistically significant(P>0.05). Conclusion 256 slice CT could provide quick and accurate examination for patients with compliance of acute chest pain, and requires lower heart rate control.
引文
[1] JINDAL A, SINGHI S. Acute chest pain[J]. Indian J Pediatr,2011,78(10):1262-1267.
[2] POLDERVAART J M, LANGEDIJK M, BACKUS B E, et al. Comparison of the GRACE, HEART and TIMI score to predict major adverse cardiac events in chest pain patients at the emergency department[J]. Int J Cardiol,2017,227(1):656-661.
[3] BURRIS A C 2nd, BOURA J A, RAFF G L, et al. Triple rule-out versus coronary CT angiography in patients with acute chest pain: results from the ACIC Consortium[J]. JACC Cardiovasc Imaging,2015,8(7):817-825.
[4] 李金燕,张国伟,王锡明,等.大螺距三联个体化对比剂方案在胸痛患者检查中的价值分析[J].中华医学杂志,2015,95(29):2363-2367.
[5] MADAN R, CHEN J H, TROTMAN-DICKENSON B, et al. The spectrum of Castleman's disease: mimics, radiologic pathologic correlation and role of imaging in patient management[J]. Eur J Radiol,2012,81(1):123-131.
[6] DE LA MORA CERVANTES R, DENNIE C. Triple rule-out cardiac computed tomography: is it finally a reality?[J]. Minerva Cardioangiol,2017,65(3):225-234.
[7] 李鹏雨,李坤成,杜祥颖,等.64层螺旋CT三联检查在急性胸痛诊断中的应用[J].中华放射学杂志,2007,41(10):1032-1035.
[8] 王锡明,晁宝婷,武乐斌,等.64层螺旋CT心胸联合造影在急性胸痛病因鉴别诊断中的价值[J].中华放射学杂志,2006,40(8):812-814.
[9] METTLER F A Jr, HUDA W, YOSHIZUMI T T, et al. Effective doses in radiology and diagnostic nuclear medicine: a catalog[J]. Radiology,2008,248(1):254-263.
[10] WESTWOOD M E, RAATZ H D, MISSO K, et al. Systematic review of the accuracy of dual-source cardiac CT for detection of arterial stenosis in difficult to image patient groups[J]. Radiology,2013,267(2):387-395.
[2] POLDERVAART J M, LANGEDIJK M, BACKUS B E, et al. Comparison of the GRACE, HEART and TIMI score to predict major adverse cardiac events in chest pain patients at the emergency department[J]. Int J Cardiol,2017,227(1):656-661.
[3] BURRIS A C 2nd, BOURA J A, RAFF G L, et al. Triple rule-out versus coronary CT angiography in patients with acute chest pain: results from the ACIC Consortium[J]. JACC Cardiovasc Imaging,2015,8(7):817-825.
[4] 李金燕,张国伟,王锡明,等.大螺距三联个体化对比剂方案在胸痛患者检查中的价值分析[J].中华医学杂志,2015,95(29):2363-2367.
[5] MADAN R, CHEN J H, TROTMAN-DICKENSON B, et al. The spectrum of Castleman's disease: mimics, radiologic pathologic correlation and role of imaging in patient management[J]. Eur J Radiol,2012,81(1):123-131.
[6] DE LA MORA CERVANTES R, DENNIE C. Triple rule-out cardiac computed tomography: is it finally a reality?[J]. Minerva Cardioangiol,2017,65(3):225-234.
[7] 李鹏雨,李坤成,杜祥颖,等.64层螺旋CT三联检查在急性胸痛诊断中的应用[J].中华放射学杂志,2007,41(10):1032-1035.
[8] 王锡明,晁宝婷,武乐斌,等.64层螺旋CT心胸联合造影在急性胸痛病因鉴别诊断中的价值[J].中华放射学杂志,2006,40(8):812-814.
[9] METTLER F A Jr, HUDA W, YOSHIZUMI T T, et al. Effective doses in radiology and diagnostic nuclear medicine: a catalog[J]. Radiology,2008,248(1):254-263.
[10] WESTWOOD M E, RAATZ H D, MISSO K, et al. Systematic review of the accuracy of dual-source cardiac CT for detection of arterial stenosis in difficult to image patient groups[J]. Radiology,2013,267(2):387-395.