CT联合MRI在评估CAD患者左心功能中的应用价值

doi:10.7517/issn.1674-0475.200718

摘要/Abstract

摘要： 本文探讨多排CT （MDCT）、心脏磁共振成像（CMRI），以及二者联合评估冠心病（CAD）患者左心功能的临床应用价值。对93例CAD患者进行MDCT及CMRI检查，计算舒张末期容积（EDV）、收缩末期容积（ESV）、每搏输出量（SV）、射血分数（EF），并分析两种检查方式间各指标的相关性及一致性。93例CAD患者中心绞痛21例、心肌梗死72例，心肌梗死患者根据临床症状及查体进行Killip分级，比较各级间CT及MRI对心功能评估的差异。结果显示，MDCT与CMR相比，两检查结果间相关性较强，对左心室功能评估的一致性较高。二者对CAD患者左心功能受损的诊断价值均较高（AUC>0.79）。并联试验对CAD患者心功能受损的诊断准确度可达将近80%。MDCT和CMRI诊断CAD患者左心功能受损情况有较高的敏感性、特异性和准确性。

关键词: 计算机断层扫描, 磁共振成像, 左心室功能, 冠状动脉疾病

Abstract: The clinical value of computed tomography, magnetic resonance imaging and the combined testing in assessment of left ventricular function in patients with coronary artery disease (CAD) is discussed in this article. 93 patients with known CAD were enrolled, all these patients had been scanned with cardiac MDCT and MRI. End-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF) were calculated. Among these patients,21 had angina and 72 had myocardial infarction. Patients with myocardial infarction were graded using Killip classification according to clinical symptoms and physical examination, and the differences in CT and MRI assessment of cardiac function between different levels were analyzed. The results showed that there were strong correlations between MDCT and CMR results,and there was a high consistency in the assessment of left ventricular function. MDCT and CMRI have a high value of diagnostic in CAD patients with left heart impaired (AUC>0.79), and the diagnostic accuracy of the parallel test for CAD patients with impaired cardiac function was nearly 80%. MDCT and CMRI have a high sensitivity, specificity and accuracy in diagnosing patients with left heart impaired.

Key words: computed tomography, magnetic resonance imaging, left ventricular function, coronary artery disease

赵鹏飞, 陈同生. CT联合MRI在评估CAD患者左心功能中的应用价值[J]. 影像科学与光化学, 2021, 39(2): 320-324.

ZHAO Pengfei, CHEN Tongsheng. The Clinical Value of Evaluating Left Ventricular Function in Patients with CAD Using CT and MRI[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2021, 39(2): 320-324.

参考文献

[1] Zhou X, Ferrara F, Contaldi C,et al. Right ventricular size and function in chronic heart failure:Not to be forgotten[J]. Heart Failure Clinics,2019,15(2):205-217.
[2] Araujo-Filho J A B, Assuncao A N, Tavares de M M D, et al. Myocardial T1 mapping and extracellular volume quantification in patients with left ventricular non-compaction cardiomyopathy[J]. European Heart Journal-Cardiovascular Imaging,2018,19(8):888-895.
[3] Qureshi M Y, O'Leary P W,Connolly H M.Cardiac imaging in ebstein anomaly[J]. Trends in Cardiovascular Medicine,2018,28(6):403-409.
[4] Kinno M,Nagpal P,Horgan S,et al.Comparison of echocardiography, cardiac magnetic resonance, and computed tomographic imaging for the evaluation of left ventricular myocardial function:part 2(diastolic and regional assessment)[J]. Current Cardiology Reports,2017,19(1):62-65.
[5] Squeri A,Censi S,Reverberi C,et al.Three-dimensional echocardiography in various types of heart disease:a comparison study of magnetic resonance imaging and 64-slice computed tomography in a real-world population[J]. Journal of Echocardiography,2017,15(1):18-26.
[6] Saremi F,Sanchez-Quintana D,Mori S,et al.Fibrous skeleton of the heart:anatomic overview and evaluation of pathologic conditions with CT and MR imaging[J].Radiographics,2017,37(5):1330-1351.
[7] Di Bella G,Pizzino F,Donato R,et al.Advanced non-invasive imaging techniques in chronic heart failure and cardiomyopathies:focus on cardiac magnetic resonance imaging and computed tomographic[J]. Advances in Experimental Medicine and Biology,2018,1067:183-196.
[8] Dellegrottaglie S,Ostenfeld E,Sanz J,et al.Imaging the right heart-pulmonary circulation unit:the role of MRI and computed tomography[J]. Heart Failure Clinics,2018,14(3):377-391.
[9] Nagueh S F.Non-invasive assessment of left ventricular filling pressure[J]. European Journal of Heart Failure,2018,20(1):38-48.
[10] Kaniewska M,Schuetz G M,Willun S,et al.Noninvasive evaluation of global and regional left ventricular function using computed tomography and magnetic resonance imaging:a meta-analysis[J]. European Radiology,2017,27(4):1640-1659.
[11] Kara B,Nayman A,Guler I,et al. Quantitative assessment of left ventricular function and myocardial mass:a comparison of coronary CT angiography with cardiac MRI and echocardiography[J].Polish Journal of Radiology,2016,81:95-102.
[12] Marano R,Merlino B,Natale L,et al.Cross-modality accuracy of dual-step, prospectively electrocardiography-triggered dual-source computed tomorgaphy compared with same-day echocardiography and cardiac magnetic resonance imaging in the follow-up of heart-transplant patients[J]. Journal of Thoracic Imaging,2018,33(4):217-224.
[13] Malik S B,Chen N,Parker R A, et al.Transthoracic echocardiography:pitfalls and limitations as delineated at cardiac CT and MR imaging[J].Radiographics,2017,37(2):383-406.
[14] Li J,Kemp B A,Howell N L,et al.Metabolic changes in spontaneously hypertensive rat hearts precede cardiac dysfunction and left ventricular hypertrophy[J]. Journal of the American Heart Association,2019,8(4):e010926.
[15] Ko S M,Kim T H,Chun E J,et al.Assessment of left ventricular myocardial diseases with cardiac computed tomography[J].Korean Journal of Radiology,2019,20(3):333-351.