翁婷雯,齐琳,李骋,关韶峰,韩文正,石川,李铭,曲新凯

• 1:复旦大学附属华东医院心内科、老年科
• 2:复旦大学附属华东医院放射科

摘要(Abstract)：

目的 分析动态CT心肌灌注显像（CTP）对功能性显著狭窄冠心病的诊断价值，比较两种定量分析指标[心肌血流量（MBF）比值与心肌血流储备（MFR）比值]评判心肌灌注显像结果的准确性，并比较CTP与冠状动脉CT血流储备分数（CT-FFR）对功能性显著狭窄冠心病的诊断价值。方法 对疑似冠心病的患者行冠状动脉CT血管造影（CCTA）和CTP检查。CCTA图像采集后行CT-FFR检测，CTP在静息相、腺苷三磷酸（ATP）诱导负荷相采集图像，用西门子CT灌注软件进行图像分析。所有患者均接受有创冠状动脉造影（ICA）检查，并进一步行定量血流分数（QFR）检测以作为参考标准。利用负荷状态各节段的MBF与最大值比值算得的MBF比值以及由各节段负荷相与静息相MBF比值算得的MFR与所有节段平均值的比值得到的MFR比值，两种CTP的定量指标评估冠状动脉狭窄所致的心肌缺血，CT-FFR评估各支冠状动脉功能性狭窄的情况。通过分析各种评估方式的受试者工作特征曲线，计算敏感度、特异度、准确度等诊断效能指标以及与QFR结果的一致性，对各评估方式进行比较。结果 研究共纳入48例患者，分析132支血管，其中男23例，平均年龄（65±8）岁。在血管水平，MBF比值判断冠状动脉功能性狭窄的曲线下面积（AUC）为0.857(P<0.001)，敏感度、特异度、准确度分别为68.00%、89.72%、85.61%;MFR比值判断冠状动脉功能性狭窄的AUC为0.824(P<0.001)，敏感度、特异度、准确度分别为64.00%、87.85%、83.33%;CT-FFR判断冠状动脉功能性狭窄的AUC为0.896(P<0.001)，敏感度、特异度、准确度分别为84.00%、86.92%、86.36%。以上三种评估方法的AUC两两比较，差异无统计学意义（均P>0.05），而MFR比值较MBF比值需要更高的有效辐射剂量[（7.66±2.04）mSv比（3.76±1.09）mSv,P<0.001]。CTP联合CT-FFR综合判断冠状动脉功能性狭窄的敏感度、特异度、准确度分别为80.00%、96.26%、93.18%。与QFR结果的一致性分析显示，MBF比值、MFR比值、CT-FFR、CTP+CT-FFR的Kappa值分别为0.552、0.489、0.615和0.774。结论 CTP的两种定量指标诊断效能差异无统计学意义，但MBF比值有效辐射剂量更低，故可作为CTP评估方法的首选；CTP与CT-FFR具有相似的诊断效能，CTP联合CT-FFR可明显提高对冠状动脉病变的诊断效能，有助于为冠心病患者提供最佳的无创诊断结果。

关键词(KeyWords)： 冠心病;动态CT心肌灌注显像;心肌血流量比值;心肌血流储备比值;CT血流储备分数;定量血流分数

Abstract:

Keywords:

基金项目(Foundation): 上海市卫健委保健医疗科研专项课题（202040082）;上海市卫健委临床研究专项课题（20204Y0299）;; 上海申康医院发展中心促进市级医院临床技能与临床创新能力三年行动计划项目（SHDC2020CR3024B）;; 华东医院老年医学临床研究中心-老年冠心病诊疗中心

作者(Author): 翁婷雯,齐琳,李骋,关韶峰,韩文正,石川,李铭,曲新凯

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