Background:Insulin resistance (IR) elevates the risk of coronary artery disease (CAD). The triglyceride-glucose (TyG) index is a reliable substitute indicator for IR. Computed tomography-derived fractional flow reserve (CT-FFR) and coronary flow reserve (CFR) effectively assess coronary vascular function. This study aimed to investigate the relationship between the TyG index and coronary vascular function assessed by CT-FFR and CFR in suspected CAD patients. Methods:We enrolled 293 patients who underwent single-photon emission computed tomography (SPECT) along with coronary computed tomography angiography (CCTA), and analyzed the relationships among the CT-FFR, myocardial blood flow (MBF), CFR, and the TyG index. Results:Among the patients, those with a higher TyG index exhibited a relatively lower CT-FFR (0.80 vs. 0.85; P=0.02), rest-MBF (0.80 vs. 0.83; P=0.01), stress-MBF (1.92 vs. 2.26; P=0.01), and CFR (2.49 vs. 2.72; P=0.42). The TyG index was weakly and negatively correlated with the left ventricular (LV) CFR (r=-0.153; P=0.009). Among the patients without obstructive CAD, those with a high TyG index had a significantly lower CFR than those with a low TyG index (2.54 vs. 2.95; P=0.01), but no such significant difference was found in relation to the CT-FFR (0.91 vs. 0.93; P=0.72). Of the 879 vessels examined, 448 (51%) exhibited a reduced CFR. Compared with the vessels with a normal CFR, those with a decreased CFR exhibited a significantly increased obstructive CAD rate (40% vs. 29%; P<0.001), a lower CT-FFR (0.90 vs. 0.93; P<0.001), and a higher TyG index (8.81 vs. 8.67; P<0.001). In the vessels without obstructive CAD, the TyG index was higher in those with a reduced CFR compared with those with a normal CFR (8.80 vs. 8.59; P<0.001). The patient-level analysis revealed that male sex, the TyG index, obstructive CAD, and the CT-FFR were independently associated with the LV-CFR. The TyG index remained associated with the LV-CFR after adjustment for conventional risk factors. The TyG index remained independently associated with a reduced CFR in the patients without obstructive CAD. Conclusions:The TyG index was independently associated with coronary vascular function, including both epicardial artery and microcirculatory function. The patients without obstructive CAD and those with a decreased CFR exhibited an increased TyG index, indicating a relationship between the TyG index and microcirculatory dysfunction. The TyG index, as a marker of metabolic health, was also related to microvascular injury. Our results provide insights into the association between the TyG index and coronary vascular function, which may inform clinical risk assessment.

CT-derived fractional flow reserve (CT-FFR) enables noninvasive physiological assessment from coronary CT angiography. This study aimed to evaluate its diagnostic performance across six prespecified anatomical and calcification-related factors to clarify lesion-specific clinical applications. In this prospective multicenter trial, 317 patients with 366 target vessels underwent coronary CT angiography and invasive fractional flow reserve (FFR) within 7 days. CT-FFR performance was evaluated according to target vessel, lesion location, lesion length, bifurcation involvement, target-lesion calcification, and per-patient coronary calcium burden. These factors were selected a priori to address distinct anatomical or pathophysiological hypotheses. Subgroup analyses were exploratory, and nominal P values are reported. Overall vessel-level accuracy, sensitivity, specificity, positive predictive value, negative predictive value (NPV), and area under the receiver operating characteristic curve were 87.2

Objective: To investigate the incremental value of pericoronary fat attenuation index (FAI) in routine coronary artery computed tomography angiography (CCTA) to identify culprit lesions in acute coronary syndrome (ACS). Methods: We reviewed the CCTA data from 80 ACS patients and 40 individuals with stable coronary atherosclerosis. ACS patient plaques were categorized into culprit and nonculprit groups. The plaque-specific pericoronary FAI was assessed using the Perivascular Fat Analysis Tool. We applied a default prespecified window of -190 to -30 Hounsfield units (HU) and a broader prespecified window of -190 to 20 HU. FAI values within these prespecified windows and the types and severity of plaque stenosis were compared across the 3 groups. Additionally, we investigated high-risk characteristics of plaques in the ACS group and their correlation with FAI. The effectiveness and worthiness of FAI in identifying culprit lesions were analyzed based on the receiver operating characteristic curve. Results: The FAI values under the 2 prespecified windows were higher in the culprit group than in the nonculprit and control groups (all P < 0.001). The culprit group showed the most mixed plaques and the most severe stenosis (all P < 0.001). In the ACS group, the FAI value was significantly lower around calcified lesions (-85.00 +/- 9.97 HU) than around noncalcified (-78.00 +/- 11.52 HU) and mixed plaques (-78.00 +/- 9.24 HU) (both P < 0.001). The culprit group had more high-risk plaques, and high-risk plaques had higher FAI values than those without high-risk characteristics (-70.00 +/- 7.67 HU vs -82.00 +/- 10.16 HU, P < 0.001). The efficacy of FAI under the default prespecified window in identifying culprit lesions was higher compared than that under the broader prespecified window (area under the curve = 0.799 vs 0.761, P = 0.042), and the diagnostic cutoff values were -77 versus -58 HU. The FAI under the default prespecified window exhibited an incremental value for identifying culprit lesions, as compared with stenosis severity (area under the curve = 0.970 vs 0.939, P < 0.001). Conclusion: The culprit lesions have higher FAI than the nonculprit lesions and the controls. FAI is a worthy parameter for identifying culprit lesions in routine CCTA according to stenosis severity, and the default prespecified window is a better option.

BackgroundIn this study, we aim to investigate the relationship between the attenuation of peri-coronary adipose tissue (PCAT) in patients with suspected coronary artery disease (CAD) and the assessment of coronary vascular functions using coronary flow reserve (CFR).MethodsWe included 364 patients who underwent 13N-NH3 positron emission tomography/computed tomography and coronary computed tomography angiography (CCTA). We determined the relationship between fat attenuation index (FAI), PCAT volume, and other qualitative CT-derived anatomic parameters with CFR.ResultsWe detected a decrease in CFR (<2.5) in 206 (57%) patients. At the patient level, those with reduced CFR showed a significantly higher prevalence of diffused atherosclerosis (41% vs. 23%; P < 0.001) and higher FAI (−75.5 HU vs. −77.1 HU; P = 0.014). In patients without obstructive CAD, FAI was significantly higher in those with reduced CFR (−75.5 HU vs. −77.7 HU, P = 0.026). On the vessel level, 1,092 vessels were analyzed, and 642 (59%) exhibited reduced CFR. The vessels with reduced CFR presented a significantly higher prevalence of obstructive CAD (37% vs. 26%; P < 0.001), diffused atherosclerosis (22% vs. 11%; P < 0.001), low-attenuation plaque (6% vs. 3%; P = 0.030), and positive remodeling (7% vs. 2%; P = 0.001). FAI was higher in vessels with reduced CFR (−80.8 HU vs. −81.8 HU; P = 0.045) than in normal CFR. In the patient-level analysis, obstructive CAD, diffused atherosclerosis, and FAI were independently linked with CFR. FAI was still associated with global CFR after adjusting for traditional risk factors (age, hypertension, diabetes, hyperlipidemia, and smoking). FAI remained independently associated with reduced CFR in patients without obstructive CAD.ConclusionsCoronary perivascular inflammation evaluated by CCTA was independently associated with coronary vascular function. In patients without obstructive CAD, FAI was higher in the presence of reduced CFR. Altogether, FAI can help reveal microcirculatory damage in patients who do not exhibit epicardial artery stenosis.

Purpose: Study aims to investigate the consistency of delayed enhancement cardiac magnetic resonance imaging (DE-CMR) and 18 F-FDG PET myocardial imaging in evaluating myocardial viability before CABG. Methods: The study analyzed data from 100 patients who were examined with DE-CMR, PET imaging, and echocardiography before and after CABG. All subjects were followed up for 6–12 month post- CABG. Results: DE-CMR and PET imaging have high consistency (90.1%; Kappa value = 0.71, p < 0.01) in determining myocardial viability. The degree of delayed enhancement was negatively correlated with the improvement in myocardial contractile function in this segment after revascularization ( P < 0.001). The ratio of scarred myocardial segments and total DE score was significantly lower in the improvement group than non-improvement group. Multivariate regression identified that hibernating myocardium (OR = 1.229, 95%CI: 1.053–1.433, p = 0.009) was influencing factor of LVEF improvement after CABG. Conclusion: Both imaging techniques are consistent in evaluating myocardial viability. Detecting the number of hibernating myocardium by PET is also important to predict the left heart function improvement after CABG.

左心室辅助装置常用于心力衰竭患者的过渡治疗或最终治疗，可提高患者生存率及生存质量。本文介绍1例小切口左心室辅助装置植入术患者病例，回顾术前及术后胸部X线、CT的影像学特征，探讨影像学检查对患者术前心尖定位及术后并发症的评估价值，以期辅助临床手术及治疗策略的制定。

Objective:To investigate the association between CITP/MMP-1 ratio and the severity of Myocardial fibrosis (MF) in patients with Chronic Heart failure (CHF) and its diagnostic and prognostic value in patients with MF.Methods:A retrospective study was conducted to select 110 cases [86 males, (56.60±11.15) years old;24 females, (60.06±12.02) years old] who were hospitalized in the Department of Cardiology, Teda International Cardiovascular Hospital from May 18, 2021 to February 30, 2022 and underwent magnetic magnetic examination. Serum CITP and MMP-1 were detected by enzyme-linked immunoassay and CITP/MMP-1 ratio was calculated. Plasma brain natriuretic peptide (BNP) was detected by automatic chemiluminescence analyzer. Anova and non-parametric test were used to compare the difference of indexes among all groups. Spearman analysis was used to analyze the correlation between serum collagen metabolites and the severity of myocardial fibrosis. Logistic regression analysis was performed for multivariate analysis, and ROC curve was used to evaluate the auxiliary diagnostic value of related indexes. Major adverse cardiac events within 1 year after discharge were recorded, including cardiogenic death, HF rehospitalization, malignant arrhythmia, and myocardial infarction. The risk factors of poor prognosis were analyzed by Cox regression. Patients were divided by the median value of CITP/MMP-1 ratio or the median value of CITP/MMP-1 ratio and BNP. Survival analysis was performed by Kaplan-Meier and Log Rank test was performed.Results:Serum MMP-1 and BNP in LGE (+) group were higher than those in LGE (-) group (1.79 ng/ml > 0.91 ng/ml, Z=-2.924; 503 pg/ml > 367 pg/ml, Z=-1.932; P<0.05); The CITP/MMP-1 ratio in the LGE (+) group was lower than that in the LGE (-) group (3.84 < 10.85, Z=-3.601, P<0.001). MMP-1 in CHF with arrhythmia group was higher than that in CHF group (1.98 ng/ml > 1.25 ng/ml, Z=-2.016), while CITP/MMP-1 ratio was lower than that in CHF group (3.25 < 5.73, Z=-2.751), all P<0.05. CITP/MMP-1 ratio in CHF patients was negatively correlated with the severity of MF ( r=-0.363, P<0.001), and BNP and MMP-1 were positively correlated with the severity of MF ( r=0.267, r=0.264, P<0.05). Serum BNP was positively correlated with collagen metabolite MMP-1 and negatively correlated with CITP/MMP-1 ratio (all P<0.05). Logistic multivariate regression analysis showed that only CITP/MMP-1 was a predictor of myocardial fibrosis, with an OR value of 0.624 ( P=0.005). ROC curve was used to evaluate serum BNP, MMP-1 and CITP/MMP-1 ratio in the diagnosis of myocardial fibrosis in HF patients, with AUC of 0.653, 0.696 and 0.754, respectively. The accuracy of CITP/MMP-1 ratio in diagnosing fibrosis was better than that of BNP by comparing their AUC, and the difference was statistically significant ( Z=-3.808, P<0.001). Cox regression analysis showed that CITP/MMP-1 ≤3.84 was a risk factor for poor prognosis, OR=2.647 ( P=0.009). Kaplan-Meier survival analysis at 1-year follow-up showed that the survival rate of the group with lower CITP/MMP-1 ratio was significantly lower than that of the group with higher CITP/MMP-1 ratio ( P=0.014). The survival rate of CITP/MMP-1 increased and BNP decreased group was higher than that of CITP/MMP-1 decreased and BNP increased group ( P=0.011). Conclusions:The ratio of CITP/MMP-1 can be used as a negative correlation indicator of the degree of cross-linking, which is better than BNP in the evaluation of MF, and has a good auxiliary diagnostic value for myocardial fibrosis in patients with chronic heart failure, and is expected to become a protective indicator for patients with chronic heart failure and be used in clinical evaluation of myocardial fibrosis. CITP/MMP-1 ratio is associated with the incidence of major adverse cardiac events, and CITP/MMP-1 ≤3.84 can be used as a predictor of prognostic adverse cardiovascular events in CHF patients.

Mechanical circulatory support (MCS) has become a processing technique used in end-stage heart failure (ESHF) because it can significantly improve survival and quality of life in patients with ESHF as either a transitional support therapy or a permanent replacement therapy before heart transplant. However, various potential complications associated with MCS need to be considered, especially aortic root thrombus formation. It's critical to have an appropriate diagnosis of aortic root thrombus and "watershed" because the prognosis and treatment are different. Both "watershed" and aortic root thrombus formation can be characterized by computed tomography angiography. The CT manifestations of two patients who had MCS device implantation in our hospital (one with intra-aortic balloon pumps + extracorporeal membrane oxygenators, the other with left ventricular assist devices) were reported, and a literature review that recognized of "watershed" phenomenon in the aortic root was conducted.

Aims: To explore the effect of coronary calcification severity on the measurements and diagnostic performance of computed tomography-derived fractional flow reserve (FFR; CT-FFR). Methods: This study included 305 patients (348 target vessels) with evaluable coronary calcification (CAC) scores from CT-FFR CHINA clinical trial. The enrolled patients all received coronary CT angiography (CCTA), CT-FFR, and invasive FFR examinations within 7 days. On both per-patient and per-vessel levels, the measured values, accuracy, and diagnostic performance of CT-FFR in identifying hemodynamically significant lesions were analyzed in all CAC score groups (CAC = 0, > 0 to <100, ≥ 100 to <400, and ≥ 400), with FFR as reference standard. Results: In total, the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under receiver operating characteristics curve (AUC) of CT-FFR were 85.8, 88.7, 86.9, 87.8, 87.1%, 0.90 on a per-patient level and 88.3, 89.3, 89.5, 88.2, 88.9%, 0.88 on a per-vessel level, respectively. Absolute difference of CT-FFR and FFR values tended to elevate with increased CAC scores (CAC = 0: 0.09 ± 0.10; CAC > 0 to <100: 0.06 ± 0.06; CAC ≥ 100 to <400: 0.09 ± 0.10; CAC ≥ 400: 0.11 ± 0.13; p = 0.246). However, no statistically significant difference was found in patient-based and vessel-based diagnostic performance of CT-FFR among all CAC score groups. Conclusion: This prospective multicenter trial supported CT-FFR as a viable tool in assessing coronary calcified lesions. Although large deviation of CT-FFR has a tendency to correlate with severe calcification, coronary calcification has no significant influence on CT-FFR diagnostic performance using the widely-recognized cut-off value of 0.8.

目的 通过与经胸超声心动图(TTE)对照,评价256排宽体探测器CT扫描定量诊断紫绀型复杂先心病的能力.方法 选取在我院行影像学检查的48例紫绀型先心病儿童.比较宽体探测器CT及TTE两种检查方法对主肺动脉、左肺动脉、右肺动脉、降主动脉、室间隔缺损(VSD)测量值及McGoon比值的差别并对三岁以下患儿体重和心率对VSD测量值及McGoon比值的影响作以分析.结果 两种检查方法比较主肺动脉、左肺动脉、右肺动脉、降主动脉测量值以及McGoon比值均有统计学意义(P<0.05),宽体探测器CT主动脉、肺动脉直径测量值及McGoon比值显著高于TTE.VSD的大小比较差别亦有统计学意义(P=0.000),宽体探测器CT测量值显著小于TTE结果.两种方法对三岁以下患儿VSD的测量值及McGoon比值比较与体重和心率有关,体重越重、心率越快,两种方法的一致性越好.结论 宽体探测器CT测量值对肺动脉发育不良型紫绀型先心病患儿的术前评估有重要意义.宽体探测器CT收缩期扫描会低估VSD的大小,术前需要参考TTE结果.

To assess the diagnostic performance of fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) (CT-FFR) obtained by a new computational fluid dynamics (CFD) algorithm to detect ischemia, using FFR as a reference, and analyze the characteristics of "gray zone" and misdiagnosed lesions. This prospective multicenter clinical trial (NCT03692936, https://clinicaltrials.gov/) analyzed 317 patients with coronary stenosis between 30 and 90% in 366 vessels from five centers undergoing CTA and FFR between November 2018 and March 2020. CT-FFR were obtained from a CFD algorithm (Heartcentury Co., Ltd., Beijing, China). Diagnostic performance of CT-FFR and CTA in detecting ischemia was assessed. Coronary atherosclerosis characteristics of gray zone and misdiagnosed lesions were analyzed. Per-vessel sensitivity, specificity and accuracy for CT-FFR and CTA were 89.9, 87.8, 88.8% and 89.3, 35.5, 60.4%, respectively. Accuracy of CT-FFR was 80.0% in gray zone lesions. In gray zone lesions, lumen area and diameter were significantly larger than lesions with FFR < 0.76 (both p < 0.001), lesion length, non-calcified and calcified plaque volume were all significantly higher than non-ischemic lesions (all p < 0.05). In gray zone lesions, Agatston score (OR = 1.009, p = 0.044) was the risk factor of false negative results of CT-FFR. In non-ischemia lesions, coronary stenosis >50% (OR = 2.684, p = 0.03) was the risk factor of false positive results. Lumen area (OR = 0.567, p = 0.02) and diameter (OR = 0.296, p = 0.03) had a significant negative effect on the risk of false positive results of CT-FFR. In conclusion, CT-FFR based on the new parameter-optimized CFD model provides better diagnostic performance for lesion-specific ischemia than CTA. For gray zone lesions, stenosis degree was less than those with FFR < 0.76, and plaque load was heavier than non-ischemic lesions.

脊髓供血系统有其独有的解剖特点,多层螺旋CT血管成像及MR血管成像是评估脊髓供血系统的重要影像方法.主动脉腔内修复(EVAR)术前了解脊髓供血动脉的解剖特点及受累情况,对手术方案的制定有重要指导意义,也有利于降低脊髓缺血的发生率,改善病人预后.就脊髓供血系统的特点、影像学评估及其预防EVAR术后脊髓缺血意义进行综述.

目的 探讨心脏血管瘤的临床表现、影像特征和病理特点,以提高对心脏血管瘤的认识和鉴别诊断能力.方法 回顾性分析1例经手术病理证实的心脏血管瘤病人的影像及病理资料并行文献复习.结果 超声心动图上可见胸腔内主动脉根部右后方、腹主动脉膈肌水平左前方一实性为主的中等回声团,内部可见低、无回声区,周边可见强回声的钙化,血流未见异常.CT显示心脏肿物位于左室下壁,密度欠均匀,内部及边缘可见明显钙化;增强后病变轻度强化.MRI显示左室下壁基底段肿物明显向腔外突出,信号不均匀,增强后呈不均匀轻度强化.选择性冠状动脉造影可见肿瘤供血动脉来源于右冠状动脉.PET/CT显示病灶呈糖代谢缺失.正电子发射计算机断层扫描(PET/CT)显示病灶呈糖代谢缺失.结论 心脏血管瘤可发生于心脏肌层,如发现心脏肌层肿物存在冠状动脉供血及明显蛋壳样钙化时,即使不具有典型强化表现,也需考虑血管瘤的诊断.

目的 探讨心房颤动单心动周期绝对时相收缩末期冠状动脉CT血管成像的可行性.资料与方法前瞻性纳入临床疑似冠心病且心房颤动受检者208例,按照随机数字表法分为两组,两组均行绝对时相冠状动脉CT成像检查.研究组107例,在收缩末期(260～360 ms)采集数据;对照组101例,根据心率变化选择采集期相(心率＜65次/分:400～750 ms;心率66～75次/分:200～550ms;心率76～90次/分:200～500ms;心率≥91次/分:200～400ms).根据美国心脏协会冠状动脉15分段并以4分法进行主观评价,比较两组基本资料及主动脉根部、前降支中段、右冠状动脉中段CT值和SD值、有效辐射剂量(ED)和主观评分.结果 两组受检者的年龄、体质量指数、扫描心率、心率波动等差异均无统计学意义(P均＞0.05).研究组绝对期相为(304.7±22.3) ms;对照组绝对期相88.1％ (89/101)分布在收缩末期,11.9％ (12/101)分布在舒张中晚期,绝对期相分别为(326±48) ms和(690±61) ms.研究组第9段图像主观评分低于对照组(Z=-2.261,P=0.024),其他分段差异无统计学意义(P＞0.05).研究组ED低于对照组[(1.5±0.5)mSv比(3.2±1.1)mSv,P＜0.01].结论 对于心房颤动受检者单心动周期收缩末期绝对时相冠状动脉CT血管成像可行,且能够有效降低辐射剂量.

目的:通过与人工后处理法比较,探讨在冠状动脉CT血管成像后处理过程中人工智能(AI)技术的应用价值.方法:回顾性分析2020年4-6月在本院行冠状动脉CTA检查且符合纳入标准的107例患者的临床和影像资料.通过与人工法图像后处理进行比较,评价A I法后处理的工作效率、VR图像质量评分、冠脉血管节段(分为18段)显示率、标示符合率以及对冠脉狭窄程度的诊断符合率.结果:AI后处理的平均完成时间为(333.64±19.32)s,较人工方法[(642.62±90.90)s]缩短了约309s,平均时间增益率为48.13％;AI法获得的VR图像质量优良率为97.20％(104/107),人工方法为99.07％(106/107),两种方法获得的VR图像质量主观评分间的差异无统计学意义(P>0.05);在V R图像上冠脉血管节段的显示情况方面,AI组的总体显示率为99.88％(1605/1607),与人工组间的差异无统计学意义(P>0.05);AI组中标示冠脉各节段名称的符合率为96.88％(1555/1605),其中有6支冠脉节段的标示命名符合率与人工组之间的差异有统计学意义(P<0.05),分别为第二对角支(D2)、第一钝缘支(OM1)、左回旋支(LCX)中远段、第二钝缘支(OM2)、右室后支(R-PLB)和中间支(RI);AI组中对右冠状动脉(RCA)和左回旋支(LCX)近中段轻度血管狭窄的诊断结果与人工组之间的差异具有统计学意义(P值均<0.05),对左冠脉前降支(LAD)近中段血管无明显狭窄和轻度狭窄的诊断结果与人工组之间的差异有统计学意义(P值均<0.05),两组间其余冠脉分支近中段不同狭窄程度的诊断结果间的差异无统计学意义(P值均>0.05).结论:采用人工智能技术行冠状动脉CTA图像后处理可以明显提高工作效率,并能辅助影像医师进行诊断.

Objective: To investigate the feasibility of coronary computed tomography angiography (CCTA) with the individualized contrast medium injection scheme based on body mass and iodine flow rate by using wide detector CT at 100 kV. Methods: From May 2018 to July 2018,270 patients with clinically suspected coronary artery disease underwent CCTA in TEDA International Cardiovascular Hospital. They were randomly divided into three groups, 90 cases in each group: group A was 0.5 ml/kg, group B was 0.6 ml/kg, the flow rate of contrast medium injection in group A and group B was (body mass×25 mg)/the concentration of contrast medium,group C was 0.8 ml/kg and the flow rate of contrast medium was 5 ml/s. Iohexol (iodine concentration 350 mgI/ml) was used in all three groups. The CT values of the aorta root in the three groups, the CT value of the middle segment of LAD and RCA, SNR、CNR、SD of the aortic root, subjective score of coronary artery and effective dose (ED) were compared. Results: There was no significant difference in CT value of aortic root, CT value of middle LAD and RCA, SNR、CNR、SD of the aortic root, subjective score of coronary artery among group A, group B and group C (all P>0.05). The flow rates of the three groups of contrast agents were statistically different (4.5±0.5 vs 4.5±0.5 vs 5, P=0.015), and there was no statistical difference between group A and group B (P>0.05) but lower than group C (P=0.015); the amount of contrast agent in the three groups was statistically different (32±3 vs 38±4 vs 53±7, P<0.001), group A<B Group<C group; there was no significant difference in ED between the three groups (1.5±0.5 vs 1.5±0.6 vs 1.3±0.6, P=0.613). Conclusions: CCTA imaging with a wide body detector based on a 0.5 ml/kg contrast agent dosage and a flow rate of ((body mass × 25)/350) ml/s individualized injection scheme can ensure the image quality while reducing the total amount of contrast agent and realizing individualized iodine flow rate.

目的:研究新型宽体探测器CT在先天性心脏病(CHD)患儿心脏CT成像中冠状动脉的可视性及成像质量.方法:连续纳入172例CHD患儿作为研究对象,按年龄分为4组,组1(年龄≤1岁,97例)、组2(1岁<年龄≤5岁,48例)、组3(5岁<年龄≤10岁,18例)、组4(年龄>10岁,9例).由两名放射科医师利用4分法对冠状动脉各节段(共11个节段)的显示质量进行主观评价,另一名放射科医师记录升主动脉根部CT值、噪声值、信噪比(SNR)及对比噪声比(CNR)评价客观图像质量.分析评价CHD患儿冠状动脉的可视性并对4组的客观图像质量进行比较.结果:本组CHD患儿冠状动脉异常发生率12.2％,冠状动脉总可视率87.1％,开口、近段、中段及远段可视率依次下降,分别为97.1％(331/341)、90.5％(617/682)、76.6％(262/342)及63.3％(324/512).冠状动脉11个节段中左主干开口可视率最高98.8％,回旋支远段可视率最低44.2％.不同年龄组间的图像质量与年龄无相关性(P>0.05).结论:新型宽体探测器CT对CHD患儿行心脏CT扫描成像中对冠状动脉的显示效果佳,可以满足对冠状动脉异常的诊断.

目的:探讨在快速心率(≥100次/分)患者中超高速宽体探测器CT单心动周期冠状动脉成像质量和最佳期相.方法:回顾性分析临床疑似冠状动脉病变而行单心动周期冠状动脉宽体探测器CT扫描的300例患者的病例资料,其中快速心率组(≥100次/分)150例,对照组(≤65次/分)150例.测量两组MSCT图像上主动脉根部、LAD和RCA中段的CT值,计算前降支中段的信噪比(SNR)和对比噪声比(CNR),分析冠状动脉可诊断率和图像质量优等率,计算两组扫描的有效辐射剂量(ED),比较两组间各项测量指标间的差异.结果:快速心率组最佳期相为(49.1％±6.7％)R-R间期,对照组为(72.1％±11.8％)R-R间期.两组图像质量客观指标(主动脉根部CT值、LAD和RCA中段CT值、前降支中段的SNR和CNR)间的差异均无统计学意义(P＞0.05).两组图像上LAD、LCX和RCA可诊断率的差异均无统计学意义(P＞0.05);但图像优等率的差异均有统计学意义(P＜0.05),快速心率组均低于对照组(72.6％vs.83.2％,60.1％ vs.84.5％,74.6％ vs.90.6％).两组间扫描中辐射剂量的差异有统计学意义(P＜0.05),快速心率组低于对照组.结论:超高速宽体探测器CT单心动周期冠状动脉成像可作为快速心率患者的常规检查方法,但成像质量的优等率低于慢心率的患者.

目的:探讨宽体探测器CT绝对时相单心动周期扫描在心律不齐患者冠状动脉CT成像中的可行性.方法:连续选取心律不齐(6个心动周期内心率变化大于20次/分)及窦性律齐患者各100例,行冠状动脉CT成像检查.心律不齐组采用绝对时相扫描,窦性律齐组采用相对时相扫描.比较两组的主动脉根部CT值、有效辐射剂量(ED)、信噪比(SNR)、对比噪声比(CNR)及冠状动脉图像质量评分.结果:两组患者的性别、年龄、体质量指数(BMI)、扫描心率差异均无统计学意义(P值分别为0.572、0.763、0.347、0.551).心律不齐组心率波动[(55.22±23.27)次/分]大于窦性律齐组[(2.34±1.69)次/分],差异有统计学意义(P=0.000).两组图像的主动脉根部CT值、SNR、CNR和冠状动脉图像质量评分差异均无统计学意义(P值分别为0.458、0.350、0.203、0.813).心律不齐组的有效辐射剂量(3.21±1.20) mSv]高于窦性律齐组(2.59±1.16) mSv],差异有统计学意义(P=0.000).结论:宽体探测器CT绝对时相单心动周期扫描在心律不齐患者冠状动脉CT成像中具有可行性,但有效辐射剂量稍高于窦性律齐患者的相对时相扫描.