天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (7): 869-873.doi: 10.11958/20150415

• 临床研究 • 上一篇    下一篇

宝石能谱CT冠状动脉造影评估不同程度冠状动脉狭窄的动态体模研究

苗振伟1,张璋2,李东3,于铁链3   

  1. 1 天津市宝坻区人民医院（邮编 301800）；2天津医科大学总医院
  • 收稿日期:2015-12-22 修回日期:2016-01-05 出版日期:2016-07-15 发布日期:2016-07-15
  • 通讯作者: 张璋 E-mail:filea1249@sina.com
  • 作者简介:苗振伟（1979）， 男， 硕士研究生， 主要从事心胸疾病CT诊断方面研究
  • 基金资助:
    国家自然科学基金青年科学基金资助项目（81301217）；天津市应用基础与前沿技术研究计划重点项目（14JCZDJC57000）

Evaluation of coronary stenosis by using the gemstone spectral CTCA: A Phantom Study

SU Yan， YANG Liping， HUANG Chong， GONG Lianggeng， YIN Jianhua， LIAN Luo， QIN Xiaohua， ZHAN Jinfeng， TU Weiping， FANG Xiangdong   

  1. 1 Tianjin Baodi Hospital, Tianjin 301800, China; 2 Tianjin Medical University General Hospital
  • Received:2015-12-22 Revised:2016-01-05 Published:2016-07-15 Online:2016-07-15
  • Contact: Zhang Zhang E-mail:filea1249@sina.com

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摘要： 目的 使用动态心脏体模中不同狭窄程度冠状动脉模型评价能谱CT测量冠状动脉狭窄的准确性。方法 将3根冠状动脉体模（内径3 mm）沿长轴方向固定于动态心脏体模上，每根冠状动脉体模残余管腔直径剩余率依次为75%、50%、25%。使用宝石能谱CT扫描机分别对动态心脏体模行能谱模式（GSI）和普通轴位扫描（AXIAL）2种方式的冠状动脉CT造影检查（CTCA）。利用GSI处理/重建平台获得40～140 keV间距为10 keV的11组单能量图像及AXIAL图像。分别在血管轴位（横断面）上测量不同狭窄程度冠状动脉模型直径及残余管腔的直径，并计算残余管腔直径剩余率（%）。比较GSI与AXIAL 2组图像在不同狭窄程度冠状动脉模型残余管腔测量上的差别。结果 40～140 keV单能量图像之间在测量不同狭窄程度的残余管腔上无差别（P>0.05）。选取GSI（70 keV）图像与AXIAL图像比较，两者间在测量残余管腔为50%的冠状动脉模型的残余管腔直径剩余率上有显著差异（t =4.617，P＜0.05）。以真实狭窄率作为标准，GSI（70 keV）图像测量残余管腔直径剩余率的平均差异与AXIAL图像的平均差异之间存在差异（t =14.560，P＜0.01）。特别是在轻度狭窄管腔（75%残余管腔），GSI稍低估狭窄程度，而AXIAL稍高估狭窄程度。结论 GSI单能量图像（70 keV）测量冠状动脉体模残余管腔直径剩余率的一致性稍高于AXIAL图像。

关键词: CT冠状动脉血管造影, 能谱成像, 螺旋锥束计算机体层摄影术, 冠心病, 冠状动脉狭窄

Abstract: Objective: To evaluate diagnosis accuracy for coronary stenosis from diameter measurements of different severities of stenosis by using gemstone spectral imaging（GSI）. Methods: Totally 3 different coronary artery models（internal diameter: 3.00 mm）with different severities of stenosis (residual lumen diameter ratio : 75%, 50%, 25%,) were placed in a pulsating cardiac phantom （ALPHA 1-VT PC, Fuyo Corporation, Japan）. The coronary phantom was scanned in 2 models: gemstone spectral imaging （GSI） and Axial scan model（AXIAL）. All the spectral imaging data were analyzed by using GSI viewer to reconstruct the VMS images （40～140keV by 10 keV interval） and AXIAL. CT values (HU) of the remained lumen from all different stenositc lumens were measured. The residual rate (%) was calculated by dividing the diameters of the remained lumen to normal lumen on the reformatted short axial images. One-Way ANOVA was used to compare the residual rate measurement difference between VMS. Student t test was used to compare the residual rate measurement difference between VMS and AXIAL. Bland-Altman test was used to compare the measured residual rates and the gold standard. P＜0.05was considered as significant differences. Results: There were no significant differences among the VMS diameter measurements（P>0.05）. From student t test, only significant difference between 70keV VMS and AXIAL was found on 50% stenosis（t =4.617，P＜0.042）. From the Bland-Altman test, residual rate measurement from 70keV VMS was more accurate than AXIAL by taking the real model stenosis rate as gold standard（t =14.560，P＜0.000）. In the mild severity of stenosis (75% of the residual lumen), GSI slightly underestimated the degree of stenosis, while AXIAL slightly overestimated the stenosis. The accuracy of the GSI measurement was slightly higher than that of AXIAL. Conclusion: VMS image (70keV) showed more accurate than AXIAL images on both diameter measurement and evaluation of the coronary stenosis rate.

Key words: Spiral cone-beam computed tomography, Coronary disease, coronary stenosis, CT angiography, Dual energy imaging