多层螺旋CT 评价冠状动脉内软斑块的准确性

多层螺旋CT 评价冠状动脉内软斑块的准确性
毛定飚 滑炎卿 张国桢 王鸣鹏 吴威岚 胡非 丁其勇 葛虓俊
【摘要】 目的 评价多层螺旋CT( MSCT) 测定冠状动脉内斑块密度的可靠性及影响因素。
方法 选用4 具成年人尸体心脏标本, 将取自标本心室内血栓和心包脂肪颗粒( 大小分别为2. 0、
1. 5、1. 0、0. 5 mm) 置入冠状动脉模拟冠状动脉内斑块。对比剂配成1∶30、1∶40、1∶50 3 种浓度注入冠
状动脉内。原始数据以2 种不同层厚( 1. 00、0. 75 mm) 重建横断面图像。结果 当对比剂浓度为
1∶30时, 血栓CT 值分别为109 HU( 层厚1. 00 mm、大小2. 0 mm) 、115 HU ( 层厚1. 00 mm、大小
1. 5 mm) 、101 HU( 层厚0. 75 mm、大小2. 0 mm) 、113 HU( 层厚0. 75 mm、大小1. 5 mm) ; 脂肪CT 值分
别为- 23 HU( 层厚1. 00 mm、大小2. 0 mm) 、- 17 HU( 层厚1. 00 mm、大小1. 5 mm) 、- 9 HU( 层厚
1. 00 mm、大小1. 0 mm) 、- 27 HU( 层厚0. 75 mm、大小2. 0 mm) 、- 19 HU( 层厚0. 75 mm、大小
1. 5 mm) 、- 13 HU( 层厚0. 75 mm、大小1. 0 mm) 。当对比剂浓度为1∶40 时, 血栓CT 值分别为79 HU
( 层厚1. 00 mm、大小2. 0 mm) 、87 HU( 层厚1. 00 mm、大小1. 5 mm) 、115 HU( 层厚1. 00 mm、大小
1. 0 mm) 、73 HU( 层厚0. 75 mm、大小2. 0 mm) 、80 HU( 层厚0. 75 mm、大小1. 5 mm) 、110 HU( 层厚
0. 75 mm、大小1. 0 mm) ; 脂肪的CT 值分别为- 31 HU( 层厚1. 00 mm、大小2. 0 mm) 、- 22 HU( 层厚
1. 00 mm、大小1. 5 mm) 、- 10 HU( 层厚1. 00 mm、大小1. 0 mm) 、- 35 HU( 层厚0. 75 mm、大小
2. 0 mm) 、- 25 HU( 层厚0. 75 mm、大小1. 5 mm) 、- 19 HU( 层厚0. 75 mm、大小1. 0 mm) 。当对比剂
浓度为1∶50 时, 血栓CT 值分别为53 HU( 层厚1. 00 mm、大小2. 0 mm) 、60 HU( 层厚1. 00 mm、大小
1. 5 mm) 、63 HU( 层厚1. 00 mm、大小1. 0 mm) 、51 HU( 层厚0. 75 mm、大小2. 0 mm) 、64 HU( 层厚
0. 75 mm、大小1. 5 mm) 、67 HU( 层厚0. 75 mm、大小1. 0 mm) 、145 HU( 层厚0. 75 mm、大小0. 5 mm) ;
脂肪的CT 值分别为- 39 HU( 层厚1. 00 mm、大小2. 0 mm) 、- 28 HU( 层厚1. 00 mm、大小1. 5 mm) 、
- 22 HU( 层厚1. 00 mm、大小1. 0 mm) 、17 HU( 层厚1. 00 mm、大小0. 5 mm) 、- 41 HU( 层厚
0. 75 mm、大小2. 0 mm) 、- 36 HU( 层厚0. 75 mm、大小1. 5 mm) 、- 27 HU( 层厚0. 75 mm、大小
1. 0 mm) 、3 HU( 层厚0. 75 mm、大小0. 5 mm) 。血栓的密度值与层厚无关( t = - 0. 143, P > 0. 05) , 但
与斑块大小( t = - 6. 624, P < 0. 05) 和对比剂浓度( t = - 8. 184, P < 0. 05) 相关。层厚这个因素没有统
计学意义可能是由于1. 00 与0. 75 mm 的层厚过于接近, 以及样本量较少所致。层厚( t = - 2. 595,
P < 0. 05) 、斑块大小( t = - 12. 369, P < 0. 05) 和对比剂浓度( t = - 7. 814, P < 0. 05) 均为影响脂肪密度
值的因素。结论 冠状动脉斑块的密度值与斑块大小、层厚及对比剂浓度相关。
【关键词】 体层摄影术, X 线计算机; 冠状血管; 冠状动脉疾病
Accur acy of evaluat e cor onar y soft plaque by multi-slice CT MAO Ding-bia o, HUA Yan-qing, ZHANG
Guo-zhen, WANG Ming-peng, WU Wei-lan, HU Fei, DING Qi-yong, GE Xiao-jun. CT Unit, Hua dong
Hospital, Shanghai 200040, China
【Abstra ct 】 Obj ective To evaluate accuracy of density measurements within coronary plaque by
multi-slice spiral CT and factors that influence measurements. Methods Four adult cadaver hearts were
used. Thrombus and pericardial fat which acquired from specimen ( size 2. 0, 1. 5, 1. 0 and 0. 5 mm
respectively) were placed into coronary artery to simulate coronary plaques. The contrast medium( three
different concentrations 1∶30, 1∶ 40, and 1∶50) were injected into coronary artery. The raw date were
reconstructed with two slice width ( 1. 00 and 0. 75 mm) . Results When contrast medium concentrations
was 1∶30, the CT values of thrombus were 109 HU( slice width 1. 00 mm, size 2. 0 mm) , 115 HU( slice
width 1. 00 mm, size 1. 5 mm) , 101 HU ( slice width 0. 75 mm, size 2. 0 mm) , 113 HU ( slice width
0. 75 mm, size 1. 5 mm) ; the CT values of fat were - 23 HU ( slice width 1. 00 mm, size 2. 0 mm) ,
- 17 HU( slice width 1. 00 mm, size 1. 5 mm) , - 9 HU( slice width 1. 00 mm, size 1. 0 mm) , - 27 HU
( slice width 0. 75 mm, size 2. 0 mm) , - 19 HU( slice width 0. 75 mm, size 1. 5 mm) , - 13 HU( slice width
0. 75 mm, size 1. 0 mm) . When contrast medium concentrations was 1∶40, the CT values of thrombus were
79 HU( slice width 1. 00 mm, size 2. 0 mm) , 87 HU( slice width 1. 00 mm, size 1. 5 mm) , 115 HU( slice
width 1. 00 mm, size 1. 0 mm) , 73 HU( slice width 0. 75 mm, size 2. 0 mm) , 80 HU( slice width 0. 75 mm,
size 1. 5 mm) , 110 HU( slice width 0. 75 mm, size 1. 0 mm) ; the CT values of fat were - 31 HU( slice
width 1. 00 mm, size 2. 0 mm) , - 22 HU ( slice width 1. 00 mm, size 1. 5 mm) , - 10 HU( slice width
1. 00 mm, size 1. 0 mm) , - 35 HU( slice width 0. 75 mm, size 2. 0 mm) , - 25 HU( slice width 0. 75 mm,
size 1. 5 mm) , - 19 HU( slice width 0. 75 mm, size 1. 0 mm) . When contrast medium concentrations was
1∶50, the CT values of thrombus were 53 HU( slice width 1. 00 mm, size 2. 0 mm) , 60 HU( slice width
1. 00 mm, size 1. 5 mm) , 63 HU( slice width 1. 00 mm, size 1. 0 mm) , 51 HU( slice width 0. 75 mm, size
2. 0 mm) , 64 HU( slice width 0. 75 mm, size 1. 5 mm) , 67 HU( slice width 0. 75 mm, size 1. 0 mm) , 145 HU
( slice width 0. 75 mm, size 0. 5 mm) ; the CT values of fat were - 39 HU( slice width 1. 00 mm, size
2. 0 mm) , - 28 HU( slice width 1. 00 mm, size 1. 5 mm) , - 22 HU( slice width 1. 00 mm, size 1. 0 mm) ,
17 HU( slice width 1. 00 mm, size 0. 5 mm) , - 41 HU( slice width 0. 75 mm, size 2. 0 mm) , - 36 HU( slice
width 0. 75 mm, size 1. 5 mm) , - 27 HU( slice width 0. 75 mm, size 1. 0 mm) , 3 HU( slice width 0. 75 mm,
size 0. 5 mm) . The density values of thrombus were correlated with size ( t = - 6. 624, P < 0. 05) and
contrast medium concentration( t = - 8. 184, P < 0. 05) . The reason of slice width( t = - 0. 143, P > 0. 05 )
not found statistically significant may be caused by both too close slice width ( 1. 0 mm and 0. 75 mm) and
few samples. The slice width( t = - 2. 595, P < 0. 05) , size ( t = - 12. 369, P < 0. 05) and contrast medium
concentration( t = - 7. 814, P < 0. 05) were factors influencing fat density values. Conclusion The density
values of coronary plaques were found to be correlated with size, slice width and contrast medium
concentration.
【Key wor ds】 Tomography, X-ray computed; Coronary vessels; Coronary disease

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