64层螺旋CT冠脉重建钙化积分检测技术在诊断冠心病中的应用
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摘要
本文通过对86例患者进行64排层螺旋CT冠状动脉血管重建及冠状动脉钙化积分的测量,探讨冠状动脉钙化积分检测技术在冠心病诊断中的应用:以CAG诊断冠心病结果为标准,对比64层螺旋CT检测冠状动脉钙化积分在诊断冠心病中的敏感性和特异性,评价冠状动脉钙化积分在诊断冠心病中的优缺点,分析漏诊及误诊的原因,进一步提高对冠心病的诊断的水平;另外通过多种后处理技术对冠状动脉重建,总结冠状动脉成像的技术要点、参数选择以及最佳的图像后处理方法,进而为临床诊断冠心病提供无创性检查手段及更详实的实验数据和影像资料。
本组所有研究对象具有完整的影像学资料,本研究通过选择适宜的扫描方式、造影剂的用量及注入速度。对患者进行CT扫描,得到多组序列的影像图像,通过测定各支血管的钙化积分来诊断和预测冠心病发生的可能性。为临床诊断冠心病提供新的无创检查途径。另外通过不同的后处理技术重建冠状动脉血管,能进一步反应血管的狭窄程度、是否有不同成份的斑块形成等信息。通常选择的重建技术有容积重建(Volume Rendering , VR),最大密度投影(Maximum Intensity Projection, MIP),多平面重建(Multiplainar Reconstruction, MPR)等。
虽然在冠心病的影像学诊断中,血管内超声和导管法X线选择性冠状动脉造影一直是评价冠心病的金标准。但由于上述方法操作技术复杂,检查费用高且对病人具有一定的生命危险,对那些不适宜介入治疗的患者不仅增加了经济负担,还要承担一定风险。另外EBCT是一种无创性检查,也是一种常用的普查或筛查的手段,对冠状动脉钙化的敏感性和特异性均较高。但由于价格昂贵,适应证单一,限制了其应有的发展前景。以CAG诊断结果将所有选择对象分为冠心病组和非冠心病组,然后通过CT检测钙化积分来诊断冠心病的可靠性,敏感度达到75%;特异性75.6%,而且还可以通过多种后处理技术对冠脉进行重建以得到更多的信息。
总之随着多层螺旋CT及后处理技术的不断发展,CT检测冠状动脉钙化积分及其后处理技术会给临床带来更加全面、具体、准确的影像学数据,尤其在高危无症状冠心病病人和那些不能完成或者不适合行运动实验的患者,MSCT是一种优良的无创早期检测手段,在已经确诊和疑诊冠心病的患者,MSCT提供独立于常规危险因素的预测价值,不管年龄和性别,以及其他危险因素,MSCT具有很高的诊断价值,值得进一步推广应用。
Objective:
Coronary heart disease is based on the pathophysiology of coronary atherosclerotic plaque formation. Coronary artery calcification is formed by calcium deposition of coronary atherosclerosis Department,which is an important indicator of coronary atherosclerosis Accurate detection of coronary atherosclerosis can significantly improve the prediction of cardiovascular disease incidence.Coronary angiography can direcely determine the extent of the Artery stenosis In the clinical aspects.which has unique advantages in the diagnosis and treatment of coronary heart disease and is considered the gold standard for diagnosis of coronary heart disease. But it has some limitations ,for it is a noninvasive examination and has a threat to the health of patients.
With the invention of MSCT, its scanning speed, combined with the ECG-gated triggering technology, rule out the possibility of cardiac pulsatility and effects produced by respiratory .And it has high time and spatial resolution,which can be carried out on the quantitative detection of CAC.The high sensitivity and non-invasive examination of CAC64 layer CT (MSCT) detection allows is increasingly becoming an important methods for early prediction and provides a new reliable method for the patients with coronary artery disease for the early diagnosis of coronary heart disease.
Studies have shown that detection of CAC of MSCT is the independent factor of prediction of coronary heart disease and future cardiovascular events. The effectiveness of early prediction of coronary heart disease is stronger than all the combined traditional risk factors. Investigate the detection to coronary calcium score of 64-slice CT can diagnosis the coronary artery disease and is an evaluation of reliability.studing on determination of 64-slice spiral CT coronary artery calcification score reliability and the best coronary artery of reconstruction phase, and understanding the relations of coronary artery calcification score with diabetes, high blood pressure, high cholesterol and other factors can ultimately determine the best threshold of diagnosis of coronary artery calcification score. Methods:
86 patients with suspected coronary heart disease in newly diagnosed patients and for treatment and medical examination to our hospital,and some patients with previous non-coronary angioplasty and bypass grafting in their history take the post-coronary 64-slice MSCT (41 cases in which the heart rate more than 70 times/min before CT scan have atenolol 12.5 ~ 25 mg 30 minutes before of MSCT to sublingual the heart rate to 70 times / min or less)
①Scanning method of detection of coronary artery calcification: used ECG-gated MSCT scan of the patient from the bottom to the apex of heart , 0.8s spiral scanning, 2.75mm thick, the range of Z-axis is 120-150mm (40-50 layers). After scanning the image is reconstructed by segment, matrix 512×512, field of vision 26cm pixel 0.26mm, requires patients to complete the scan in a breath-hold. Before that it should be connected with the EKG, to synchronize record and image acquisition at the same time.②The technical methods and parameters of MSCT coronary angiography : first ,positioning the chest and heart CT scan,calculatiing the delay time of coronary artery scan.After that complete the breath-hold 64-slice MSCT scanning according to a certain delay time . After scaning the restructuring data can be transmitted to the AW4 image processing workstation.The use of retrospective ECG-gated reconstruction of the RR of 45-85% during the reconstruction (between 5%) can restruct the cross-sectional images, and then proceed to the reconstruction of coronary artery volume, select the best images to take CACS measurements.
CACS measured using Agatston to learn the various branches of coronary artery calcification and coronary artery calcification rate, calcification score in terms of gender, age distribution; and to analyze the rate of coronary artery calcification, calcium score and coronary heart disease. The selected patients in the intervention of our hospital center take the coronary angiography, we can determine the predictive value of coronary heart disease according to MSCT angiography.
Results:
1.Coronary artery calcification rate and calcification score in people who have coronary aryery disease is higher than who havein non-coronary heart disease. Coronary heart disease increases with age increasing continuously. The rate of coronary artery calcification and calcium score in after-60-year-old age group are above the before-60-year-old age group, and the calcification rate and calcification score in anterior descending artery were the highest, LCX and right coronary artery followed by ,the left main trunk is the minimum.
2.The rate of coronary artery calcification and calcification score of male slightly higher than the female. This study P = 0.106 showed that no significant difference between men and womem.
3.The image of of all the 344 coronary vascular of 86 patients in MSCT examination image shows well and meet the imaging evaluation. 234 blood vessels is normal,mild stenosis (<50%) of vascular is 37, moderate and severe stenosis (≥50%) is 73 .Compared with results using CGA checking, the two homology rate is 96.6%, 83.3%, 95.7 %.
Conclusion:
1.When the heart rate is less than 70 times / min, we should use the application of multi-phase reconstruction, (usually at intervals of 5%). 75 percent of reconstruction phase of the majority show the backbone of coronary artery and its branches of 2-3 level, as well as the extent of the open cavity of tube; varying degrees of coronary artery calcification has high sensitivity and can be the reconstruction of blood vessels, and calculated the degree of coronary heart disease risk in accordance with the luminal diameter stenosis. This can be used as a screening tool. If coronary artery of special patients is poor we can use the other phase reconstruction to obtain the best results. Generally using 45% -85% of the reconstruction phase neither would be too many images, but also to ensure that image quality.
2.Multi-slice spiral CT (MSCT) is a safe and non-innovative method of qualitative and quantitative researching CAC.The use of coronary calcium score to diagnostic disease has a higher sensitivity and specificity.This can be a method of clinical assessment and gradually become a new diagnostic imaging of coronary heart disease. Therefore, 64-slice spiral CT is ideal for the census means of coronary heart disease and can guide the further diagnosis and treatment, and for the diagnosis of coronary heart disease provide many rich dignosis basis.
本组所有研究对象具有完整的影像学资料,本研究通过选择适宜的扫描方式、造影剂的用量及注入速度。对患者进行CT扫描,得到多组序列的影像图像,通过测定各支血管的钙化积分来诊断和预测冠心病发生的可能性。为临床诊断冠心病提供新的无创检查途径。另外通过不同的后处理技术重建冠状动脉血管,能进一步反应血管的狭窄程度、是否有不同成份的斑块形成等信息。通常选择的重建技术有容积重建(Volume Rendering , VR),最大密度投影(Maximum Intensity Projection, MIP),多平面重建(Multiplainar Reconstruction, MPR)等。
虽然在冠心病的影像学诊断中,血管内超声和导管法X线选择性冠状动脉造影一直是评价冠心病的金标准。但由于上述方法操作技术复杂,检查费用高且对病人具有一定的生命危险,对那些不适宜介入治疗的患者不仅增加了经济负担,还要承担一定风险。另外EBCT是一种无创性检查,也是一种常用的普查或筛查的手段,对冠状动脉钙化的敏感性和特异性均较高。但由于价格昂贵,适应证单一,限制了其应有的发展前景。以CAG诊断结果将所有选择对象分为冠心病组和非冠心病组,然后通过CT检测钙化积分来诊断冠心病的可靠性,敏感度达到75%;特异性75.6%,而且还可以通过多种后处理技术对冠脉进行重建以得到更多的信息。
总之随着多层螺旋CT及后处理技术的不断发展,CT检测冠状动脉钙化积分及其后处理技术会给临床带来更加全面、具体、准确的影像学数据,尤其在高危无症状冠心病病人和那些不能完成或者不适合行运动实验的患者,MSCT是一种优良的无创早期检测手段,在已经确诊和疑诊冠心病的患者,MSCT提供独立于常规危险因素的预测价值,不管年龄和性别,以及其他危险因素,MSCT具有很高的诊断价值,值得进一步推广应用。
Objective:
Coronary heart disease is based on the pathophysiology of coronary atherosclerotic plaque formation. Coronary artery calcification is formed by calcium deposition of coronary atherosclerosis Department,which is an important indicator of coronary atherosclerosis Accurate detection of coronary atherosclerosis can significantly improve the prediction of cardiovascular disease incidence.Coronary angiography can direcely determine the extent of the Artery stenosis In the clinical aspects.which has unique advantages in the diagnosis and treatment of coronary heart disease and is considered the gold standard for diagnosis of coronary heart disease. But it has some limitations ,for it is a noninvasive examination and has a threat to the health of patients.
With the invention of MSCT, its scanning speed, combined with the ECG-gated triggering technology, rule out the possibility of cardiac pulsatility and effects produced by respiratory .And it has high time and spatial resolution,which can be carried out on the quantitative detection of CAC.The high sensitivity and non-invasive examination of CAC64 layer CT (MSCT) detection allows is increasingly becoming an important methods for early prediction and provides a new reliable method for the patients with coronary artery disease for the early diagnosis of coronary heart disease.
Studies have shown that detection of CAC of MSCT is the independent factor of prediction of coronary heart disease and future cardiovascular events. The effectiveness of early prediction of coronary heart disease is stronger than all the combined traditional risk factors. Investigate the detection to coronary calcium score of 64-slice CT can diagnosis the coronary artery disease and is an evaluation of reliability.studing on determination of 64-slice spiral CT coronary artery calcification score reliability and the best coronary artery of reconstruction phase, and understanding the relations of coronary artery calcification score with diabetes, high blood pressure, high cholesterol and other factors can ultimately determine the best threshold of diagnosis of coronary artery calcification score. Methods:
86 patients with suspected coronary heart disease in newly diagnosed patients and for treatment and medical examination to our hospital,and some patients with previous non-coronary angioplasty and bypass grafting in their history take the post-coronary 64-slice MSCT (41 cases in which the heart rate more than 70 times/min before CT scan have atenolol 12.5 ~ 25 mg 30 minutes before of MSCT to sublingual the heart rate to 70 times / min or less)
①Scanning method of detection of coronary artery calcification: used ECG-gated MSCT scan of the patient from the bottom to the apex of heart , 0.8s spiral scanning, 2.75mm thick, the range of Z-axis is 120-150mm (40-50 layers). After scanning the image is reconstructed by segment, matrix 512×512, field of vision 26cm pixel 0.26mm, requires patients to complete the scan in a breath-hold. Before that it should be connected with the EKG, to synchronize record and image acquisition at the same time.②The technical methods and parameters of MSCT coronary angiography : first ,positioning the chest and heart CT scan,calculatiing the delay time of coronary artery scan.After that complete the breath-hold 64-slice MSCT scanning according to a certain delay time . After scaning the restructuring data can be transmitted to the AW4 image processing workstation.The use of retrospective ECG-gated reconstruction of the RR of 45-85% during the reconstruction (between 5%) can restruct the cross-sectional images, and then proceed to the reconstruction of coronary artery volume, select the best images to take CACS measurements.
CACS measured using Agatston to learn the various branches of coronary artery calcification and coronary artery calcification rate, calcification score in terms of gender, age distribution; and to analyze the rate of coronary artery calcification, calcium score and coronary heart disease. The selected patients in the intervention of our hospital center take the coronary angiography, we can determine the predictive value of coronary heart disease according to MSCT angiography.
Results:
1.Coronary artery calcification rate and calcification score in people who have coronary aryery disease is higher than who havein non-coronary heart disease. Coronary heart disease increases with age increasing continuously. The rate of coronary artery calcification and calcium score in after-60-year-old age group are above the before-60-year-old age group, and the calcification rate and calcification score in anterior descending artery were the highest, LCX and right coronary artery followed by ,the left main trunk is the minimum.
2.The rate of coronary artery calcification and calcification score of male slightly higher than the female. This study P = 0.106 showed that no significant difference between men and womem.
3.The image of of all the 344 coronary vascular of 86 patients in MSCT examination image shows well and meet the imaging evaluation. 234 blood vessels is normal,mild stenosis (<50%) of vascular is 37, moderate and severe stenosis (≥50%) is 73 .Compared with results using CGA checking, the two homology rate is 96.6%, 83.3%, 95.7 %.
Conclusion:
1.When the heart rate is less than 70 times / min, we should use the application of multi-phase reconstruction, (usually at intervals of 5%). 75 percent of reconstruction phase of the majority show the backbone of coronary artery and its branches of 2-3 level, as well as the extent of the open cavity of tube; varying degrees of coronary artery calcification has high sensitivity and can be the reconstruction of blood vessels, and calculated the degree of coronary heart disease risk in accordance with the luminal diameter stenosis. This can be used as a screening tool. If coronary artery of special patients is poor we can use the other phase reconstruction to obtain the best results. Generally using 45% -85% of the reconstruction phase neither would be too many images, but also to ensure that image quality.
2.Multi-slice spiral CT (MSCT) is a safe and non-innovative method of qualitative and quantitative researching CAC.The use of coronary calcium score to diagnostic disease has a higher sensitivity and specificity.This can be a method of clinical assessment and gradually become a new diagnostic imaging of coronary heart disease. Therefore, 64-slice spiral CT is ideal for the census means of coronary heart disease and can guide the further diagnosis and treatment, and for the diagnosis of coronary heart disease provide many rich dignosis basis.
引文
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