Sun Kai, Han Ruijuan, Zhao Ruiping, Bai Shuancheng, Wang Junyan, Hu Jiang, Lu Bin
1 Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China.
2 Department of Radiology, Baotou Central Hospital, Inner Mongolia , Baotou , China.
Br J Radiol. 2018 Jul;91(1087):20170569. doi: 10.1259/bjr.20170569. Epub 2018 May 11.
We assessed the diagnostic value of "one-step" dual energy CT (DECT) in combination with coronary CT angiography and iodine mapping within the myocardial blood pool in detecting acute myocardial infarction (AMI).
Five minipigs were subjected to transcatheter embolization of coronary artery with a gelatin sponge to induce AMI. Arterial-phase myocardial DECT imaging was carried out 1 h before and 24 h after embolism of the coronary. Color-coded iodine maps were used to evaluate myocardial blood pool deficits in the 17-segment model. Myocardial DECT imaging 24 h after MI induction was used for final comparison with post-mortem histology.
We found a sensitivity of 95.55% and a specificity of 95%, respectively, for AMI detection by DECT-based iodine mapping within the myocardial blood pool. The dose-length product values were 219.4 ± 60.9 mGy.cm (172-321 mGy.cm) and the effective radiation dose was 5.7 ± 1.5 mSv (4.4-8.3 mSv).
This experimental study demonstrated that DECT-based iodine mapping shows a high value for the detection of myocardial perfusion defects in the first-pass myocardial perfusion. Hybrid heart images obtained by coronary CT angiography and DECT-based iodine mapping may yield valuable data and help clinicians accurately identify cases requiring further treatment after AMI. Advances in knowledge: This study demonstrated that DECT-based iodine mapping is a promising new technique for the detection of myocardial perfusion defects in the first-pass myocardial perfusion.
我们评估了“一站式”双能量CT（DECT）联合冠状动脉CT血管造影及心肌血池碘图在检测急性心肌梗死（AMI）中的诊断价值。
对5只小型猪行经导管冠状动脉明胶海绵栓塞术以诱导AMI。在冠状动脉栓塞前1小时及栓塞后24小时进行动脉期心肌DECT成像。采用彩色编码碘图评估17节段模型中的心肌血池缺损情况。将心肌梗死诱导后24小时的心肌DECT成像结果与尸检组织学结果进行最终对比。
我们发现基于DECT的心肌血池碘图检测AMI的灵敏度和特异度分别为95.55%和95%。剂量长度乘积值为219.4±60.9 mGy.cm（172 - 321 mGy.cm），有效辐射剂量为5.7±1.5 mSv（4.4 - 8.3 mSv）。
本实验研究表明，基于DECT的碘图在首次通过心肌灌注中检测心肌灌注缺损具有很高的价值。通过冠状动脉CT血管造影和基于DECT的碘图获得的混合心脏图像可能会产生有价值的数据，并有助于临床医生准确识别AMI后需要进一步治疗的病例。知识进展：本研究表明，基于DECT的碘图是检测首次通过心肌灌注中心肌灌注缺损的一种有前景的新技术。
