[多层螺旋计算机断层扫描在急性心肌梗死患者心肌灌注缺损识别中的信息价值]

[Informative value of multislice spiral computed tomography in identifying myocardial perfusion defect in patients with acute myocardial infarction].

作者信息

Veselova T N, Ternovoĭ S K

出版信息

Ter Arkh. 2013;85(4):16-21.

Abstract

AIM

To estimate the informative value of multislice spiral computed tomography (MSCT) in the diagnosis of myocardial infarction (MI).

SUBJECTS AND METHODS

The study enrolled 171 patients with acute coronary syndrome (ACS), including 121 patients diagnosed with acute ST-segment elevation MI (STEMI), 19 with non-STEMI, and 31 with unstable angina. A comparison group consisted of 52 patients with stable coronary heart disease (CHD) and a control group comprised 17 patients without CHD. Intravenous contrast-enhanced MSCT was performed using a 64-spiral CT scanner. MSCT was carried out in the patients with ACS on days 3-5 of the onset of a pain attack and in the other patients electively. It was redone in 44 patients with acute MI (AMI) 6 months after a primary examination.

RESULTS

Left ventricular (LV) perfusion defect was imaged in 94.3% of the patients with AMI and in 10% of those with unstable angina. LV contrast defects were undetectable in the patients from the stable CHD and control groups. The sensitivity, specificity, prognostic value of a positive result, negative prognostic value of a result, and accuracy of MSCT in the diagnosis of MI were 94.3, 97.1, 97.8, 92.5, and 96.70%, respectively. In the patients with STEMI, myocardial perfusion defect was larger and transmural perfusion defect was more common than in those with non-STEMI. Comparison of the values of myocardial perfusion defect size and myocardial density according to the data of primary and repeat MSCT revealed no statistically significant differences: 2.0 (0.50; 5.45) and 1,8 (0.35; 5.00) cm3 (p = 0.15); 41.7 +/- 10.2 and 46.1 +/- 12.2 HU, respectively (p = 0.07).

CONCLUSION

Contrast-enhanced MSCT allows visual and quantitative assessments of myocardial perfusion defect in patients with ACS. Myocardial perfusion defect from MSCT data suggests previous MI with a high probability, but does not permit the determination of the duration of the disease.

摘要

目的

评估多层螺旋计算机断层扫描（MSCT）在心肌梗死（MI）诊断中的信息价值。

对象与方法

本研究纳入171例急性冠状动脉综合征（ACS）患者，其中121例诊断为急性ST段抬高型心肌梗死（STEMI），19例为非STEMI，31例为不稳定型心绞痛。对照组由52例稳定型冠心病（CHD）患者组成，另一对照组包含17例无CHD患者。使用64层螺旋CT扫描仪进行静脉造影增强MSCT检查。ACS患者在疼痛发作后第3 - 5天进行MSCT检查，其他患者则择期进行。44例急性心肌梗死（AMI）患者在初次检查6个月后再次进行检查。

结果

94.3%的AMI患者和10%的不稳定型心绞痛患者出现左心室（LV）灌注缺损。稳定型CHD组和对照组患者未检测到LV造影剂缺损。MSCT诊断MI的敏感性、特异性、阳性结果的预后价值、结果的阴性预后价值及准确性分别为94.3%、97.1%、97.8%、92.5%和96.70%。与非STEMI患者相比，STEMI患者的心肌灌注缺损更大，透壁灌注缺损更常见。根据初次和重复MSCT数据比较心肌灌注缺损大小和心肌密度值，差异无统计学意义：分别为2.0（0.50；5.45）和1.8（0.35；5.00）cm³（p = 0.15）；分别为41.7±10.2和46.1±12.2 HU（p = 0.07）。