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心电门控多排CT用于评估主动脉瓣狭窄的瓣膜形态和钙化情况。

Electrocardiographically gated multi-detector row CT for assessment of valvular morphology and calcification in aortic stenosis.

作者信息

Willmann Jürgen K, Weishaupt Dominik, Lachat Mario, Kobza Richard, Roos Justus E, Seifert Burkhardt, Lüscher Thomas F, Marincek Borut, Hilfiker Paul R

机构信息

Institute of Diagnostic Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.

出版信息

Radiology. 2002 Oct;225(1):120-8. doi: 10.1148/radiol.2251011703.

Abstract

PURPOSE

To evaluate the applicability and image quality of nonenhanced and contrast material-enhanced multi-detector row computed tomography (CT) combined with retrospective electrocardiographic (ECG) gating for visualization of the aortic valve, determination of aortic valve morphology and diameter of the aortic valve annulus, and assessment of the degree of valvular calcification in patients with aortic valve stenosis, as compared with results of surgery and echocardiography.

MATERIALS AND METHODS

Prior to surgical valve replacement, 25 patients with aortic valve stenosis and sinus rhythm underwent nonenhanced (n = 15) and contrast-enhanced (n = 25) retrospectively ECG-gated multi-detector row CT. Two readers working in consensus evaluated image quality and assessed valvular morphology and the degree of valvular calcification. In addition, the diameter of the aortic valve annulus was measured. Results were compared with surgical and echocardiographic findings by using the paired sign test, kappa statistics, and the method of Bland and Altman.

RESULTS

The aortic valve could be visualized nearly free of motion artifacts on all multi-detector row CT images. Image quality and diagnostic confidence for classification of aortic valve morphology were significantly superior on contrast-enhanced rather than nonenhanced images (P =.004 and P =.006, respectively). Nonenhanced and contrast-enhanced CT showed good agreement with surgical findings with regard to quantification of the degree of aortic valve calcification (kappa = 0.77 and kappa = 0.74, respectively). Measurement of the diameter of the aortic valve annulus was more reliable on contrast-enhanced images.

CONCLUSION

Contrast-enhanced retrospectively ECG-gated multi-detector row CT allows determination of aortic valve morphology, measurement of the diameter of the aortic valve annulus, and assessment of the degree of aortic valve calcification in patients with aortic stenosis.

摘要

目的

与手术及超声心动图结果相比较,评估非增强及对比剂增强的多排螺旋计算机断层扫描(CT)联合回顾性心电图(ECG)门控技术在主动脉瓣可视化、主动脉瓣形态及主动脉瓣环直径测定以及主动脉瓣狭窄患者瓣膜钙化程度评估中的适用性及图像质量。

材料与方法

在进行外科瓣膜置换术前,25例主动脉瓣狭窄且为窦性心律的患者接受了非增强(n = 15)及对比剂增强(n = 25)的回顾性ECG门控多排螺旋CT检查。两名意见一致的阅片者评估图像质量并评估瓣膜形态及瓣膜钙化程度。此外,测量主动脉瓣环直径。通过配对符号检验、kappa统计以及Bland和Altman方法将结果与手术及超声心动图结果进行比较。

结果

在所有多排螺旋CT图像上均可清晰显示主动脉瓣,几乎无运动伪影。对比剂增强图像上主动脉瓣形态分类的图像质量及诊断可信度显著优于非增强图像(分别为P = 0.004和P = 0.006)。在主动脉瓣钙化程度定量方面,非增强及对比剂增强CT与手术结果均具有良好的一致性(kappa分别为0.77和0.74)。对比剂增强图像上主动脉瓣环直径的测量更可靠。

结论

对比剂增强的回顾性ECG门控多排螺旋CT可用于确定主动脉瓣狭窄患者的主动脉瓣形态、测量主动脉瓣环直径以及评估主动脉瓣钙化程度。

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