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目的探讨多层螺旋CT(MSCT)对急性心肌梗死(AMI)患者介入治疗后早期的综合性评估价值。方法以接受经皮冠状动脉介入治疗(PCI)的18例AMI患者作为研究对象,治疗后1周内对所有患者进行双期MSCT扫描检查。分析MSCT图像中早期相灌注缺损(ED)及延迟相晚期增强(LE)和残余缺损(RD)区域和增强特点。将MSCT测量的梗死容积、左心室射血分数(MSCTLVEF)、室壁节段运动情况与血液生化指标血清肌酸激酶(CPK)曲线下面积及超声心电图(TTE)测量的LVEF(TTELVEF)和室壁节段运动情况进行对比分析。结果早期扫描相检出ED 17例,其判断心肌梗死的敏感性和特异性均为94%。延迟扫描相表现出3种不同的增强特征,分别为孤立性心内膜下LE、心内膜下RD和心外膜下LE以及单纯心内膜下RD。延迟相测得的梗死容积与血清CPK曲线下面积(r=0.840)、MSCTLVEF与TTELVEF(r=0.800)以及TTE与MSCT对室壁节段运动异常的评估结果(r=0.814)均呈显著正相关(均P<0.001)。结论 AMI患者接受PCI治疗后的双期MSCT扫描表现出不同的增强特征。MSCT检查对再灌注后梗死部位和范围的判定具有应用价值。一次MSCT检查尚可了解患者心功能和室壁节段运动情况,且与TTE检查结果高度一致。MSCT可用于对AMI患者进行全方位的综合评估。
Objective To investigate the comprehensive evaluation value of multislice spiral CT (MSCT) early after interventional therapy in patients with acute myocardial infarction (AMI). Methods Eighteen patients with AMI undergoing percutaneous coronary intervention (PCI) were enrolled in this study. All patients underwent two-phase MSCT scans within one week after treatment. Analysis of early phase perfusion defects (ED) and late phase enhancement (LE) and residual defect (RD) regions and enhancement features in MSCT images. The infarct volume, left ventricular ejection fraction (MSCTLVEF), regional wall motion and the area under the curve of serum creatine kinase (CPK) and the LVEF (TTELVEF) measured by MSCT and ventricular wall Segmental movement comparative analysis. Results Early detection of ED detected 17 cases of ED, the sensitivity and specificity to determine myocardial infarction were 94%. The delayed scan phase showed three distinct enhancement features: solitary subendocardial LE, subendocardial RD and subependymal LE, as well as subendocardial subretinal RD alone. (R = 0.840), MSCTLVEF and TTELVEF (r = 0.800) and TTE and MSCT (r = 0.814), respectively, showed significant positive correlations between infarct volume and serum CPK (r = 0.814) Related (all P <0.001). Conclusions Two-phase MSCT scans of patients with AMI after PCI have shown different enhancement features. MSCT examination of infarct after reperfusion and determine the extent and scope of the application of value. A MSCT examination can still understand the patient’s cardiac function and wall segment motion, and with the TTE examination results are highly consistent. MSCT can be used to conduct a comprehensive and comprehensive assessment of AMI patients.