心包积液患者冠状动脉CT血管造影图像上的运动伪影。

Kondo Takeshi, Takamura Kazuhisa, Fujimoto Shinichiro, Takase Shinichi, Sekine Takako, Matsutani Hideyuki, Rybicki Frank J, Kumamaru Kanako K

Department of Cardiology, Takase Clinic, Takasaki 370-0036, Japan.

Department of Cardiology, Takase Clinic, Takasaki 370-0036, Japan; Department of Cardiology, Juntendo University, Tokyo 113-8431, Japan.

J Cardiovasc Comput Tomogr. 2014 Jan-Feb;8(1):19-25. doi: 10.1016/j.jcct.2013.09.005. Epub 2013 Oct 18.

BACKGROUND

Patients with a pericardial effusion can have a pendulum-like movement of the heart. No reports associate the presence of pericardial fluid with coronary CT angiography (CTA) images that are degraded by motion artifact.

OBJECTIVE

We tested the hypothesis that patients with pericardial effusion have coronary CTA images compromised by motion artifacts, even when other known causes of motion artifact in coronary imaging are minimized.

METHODS

Among the prospectively electrocardiogram-gated single heart beat 320-detector row coronary CTA studies performed from September 2009 to May 2013, 13 consecutive studies acquired with a heart rate <60 beats/min that indicate a pericardial effusion formed an effusion cohort. A control cohort included 13 studies with no pericardial fluid performed by the same CT scanner; these were pair-matched to the effusion cohort for heart rate, sex, age, and body mass index. All studies were free of arrhythmia and respiratory motion. Motion artifact was separately assessed (3-point scale) at 8 coronary segments by 2 cardiovascular imaging teams.

RESULTS

The mean pericardial effusion volume for the effusion cohort was 129 ± 57 mL (range, 39-222 mL). Intra-observer/interobserver reproducibility of the motion artifact scores were good (κ = 0.636-0.791). Motion artifacts were more frequently observed in the effusion cohort for the left circumflex (no, mild, severe artifact, 54%, 46%, 0% vs. 81%, 19%, 0%, respectively, for effusion vs. control; P = .039) and right coronary arteries (no, mild, severe artifact = 41%, 44% 15% vs. 79%, 21%, 0%, respectively, for effusion vs control; P < .001), especially for the middle or distal segments. Larger effusion volumes were associated with more severe motion artifacts.

CONCLUSION

Patients with pericardial effusion have coronary CTA images compromised by cardiac motion artifacts, particularly in the left circumflex and right coronary arteries.

背景

心包积液患者的心脏可出现钟摆样运动。尚无报道表明心包积液的存在与因运动伪影而质量下降的冠状动脉CT血管造影（CTA）图像有关。

目的

我们检验了这样一个假设，即即使将冠状动脉成像中其他已知的运动伪影原因降至最低，心包积液患者的冠状动脉CTA图像仍会受到运动伪影的影响。

方法

在2009年9月至2013年5月进行的前瞻性心电图门控单心跳320排冠状动脉CTA研究中，连续13项心率<60次/分钟且提示心包积液的研究组成了积液队列。一个对照队列包括由同一台CT扫描仪进行的13项无心包积液的研究；这些研究在心率、性别、年龄和体重指数方面与积液队列进行配对。所有研究均无心律失常和呼吸运动。由2个心血管影像团队在8个冠状动脉节段分别评估运动伪影（3分制）。

结果

积液队列的心包积液平均体积为129±57 mL（范围39 - 222 mL）。运动伪影评分的观察者内/观察者间重复性良好（κ = 0.636 - 0.791）。在积液队列中，左旋支（无、轻度、重度伪影，积液组与对照组分别为54%、46%、0% vs. 81%、19%、0%；P = 0.039）和右冠状动脉（无、轻度、重度伪影，积液组与对照组分别为41%、44%、15% vs. 79%、21%、0%；P < 0.001）更频繁地观察到运动伪影，尤其是在中段或远段。积液量越大，运动伪影越严重。