摘要
目的 探讨急诊胸痛诊断应用电子计算机断层扫描血管造影(computed tomographic angiography,CTA)胸痛三联征扫描方案的效果,为今后临床治疗胸痛提供依据。方法 回顾性分析兴安盟人民医院2022年11月—2024年6月收治的274例急诊胸痛患者的临床资料。依据扫描方案不同进行分组,其中接受肺动脉CTA检查的68例患者作为肺动脉组,接受主动脉CTA检查的68例患者作为主动脉组,接受冠状动脉CTA检查的68例患者作为冠状动脉组;行CTA胸痛三联征检查的70例患者作为三联组。比较三联组、肺动脉组、主动脉组、冠状动脉组患者图像质量总优良率、辐射剂量和CT值,并选取典型病例进行影像学分析。结果 4组患者图像质量总优良率比较,差异无统计学意义(P > 0.05)。三联组容积CT剂量指数为(26.85±3.02),高于肺动脉组的(15.89±2.44)与主动脉组的(18.41±2.58);三联组剂量长度乘积为(1 315.24±107.25)mGy·cm,高于肺动脉组的(510.46±15.22)mGy·cm、主动脉组的(928.11±15.14)mGy·cm与冠状动脉组(422.16±16.79)mGy·cm;三联组有效剂量为(20.13±1.16)mSv,高于肺动脉组的(7.11±0.26)mSv与主动脉组的(14.01±1.37)mSv、冠状动脉组的(6.99±0.45)mSv,差异有统计学意义(P<0.001);冠状动脉组容积CT剂量指数均高于肺动脉组与主动脉组,剂量长度乘积均低于肺动脉组与主动脉组,有效剂量低于主动脉组,差异有统计学意义(P<0.001);主动脉组容积CT剂量指数、剂量长度乘积、有效剂量均高于肺动脉组,差异有统计学意义(P<0.001)。三联组患者肺动脉主干CT值为(458.22±14.18)HU,高于肺动脉组的(325.46±10.19)HU,差异有统计学意义(P<0.001);三联组患者降主动脉、升主动脉CT值分别为(458.17±12.29)HU、(511.05±15.79)HU,均高于主动脉组的(393.46±11.15)HU、(421.44±14.15)HU,差异有统计学意义(P<0.001);冠状动脉组与三联组左回旋支近段CT值、左前降支近段CT值、右冠状动脉近段CT值比较,差异无统计学意义(P > 0.05)。此外,三联组的有效剂量仅为肺动脉组、主动脉组、冠状动脉组之和的71.61%。结论 急诊胸痛诊断中应用CTA胸痛三联征扫描方案可清晰显示患者主、肺以及冠状动脉情况,而获取的图像质量与单一部位CTA检查相当,且可有效降低辐射剂量,具有一定的诊断优势。
Objective To explore the effect of computed tomographic angiography(CTA)chest pain triad scanning scheme in the diagnosis of emergency chest pain,and to provide evidence for clinical treatment of chest pain in the future.Methods The clinical data of 274 emergency chest pain patients admitted to Xing'an League People's Hospital from November 2022 to June 2024 were analyzed retrospectively,and they were divided into groups according to different scanning schemes.Among them,68 patients who received pulmonary artery CTA were classified as the pulmonary artery group,68 patients who received aortic CTA were classified as the aortic group,and 68 patients who received coronary artery CTA examination were classified as the coronary artery group.A total of 70 patients who underwent triple CTA examination for chest pain were regarded as the triple group.The total excellent and good rate of image quality,radiation dose and CT value of patients in the triple group,pulmonary artery group,aorta group and coronary artery group were compared,and typical cases were selected for imaging analysis.Results There was no difference in the total excellent and good rate of image quality among the four groups(P>0.05).The volume CT dose index of the triple group was(26.85±3.02),which was higher than that of the pulmonary artery group[(15.89±2.44)]and the aortic group[(18.41±2.58)].The dose-length product of the triple group was(1315.24±107.25)mGy·cm,which was higher than that of the pulmonary artery group[(510.46±15.22)mGy·cm],the aortic group[(928.11±15.14)mGy·cm]and the coronary artery group[(422.16±16.79)mGy·cm].The effective dose of the triple group was(20.13±1.16)mSv,which was higher than that of the pulmonary artery group[(7.11±0.26)mSv],the aortic group[(14.01±1.37)mSv],and the coronary artery group[(6.99±0.45)mSv],and the differences were statistically significant(P<0.001).The volume CT dose index in the coronary artery group was higher than that in the pulmonary artery group and the aortic group,the dose-length product was lower than that in the pulmonary artery group and the aortic group,and the effective dose was lower than that in the aortic group,the differences were statistically significant(P<0.001).The volume CT dose index,dose-length product and effective dose in the aortic group were all higher than those in the pulmonary artery group,and the differences were statistically significant(P<0.001).The CT value of pulmonary artery trunk in the triple group was(458.22±14.18)HU,which was higher than(325.46±10.19)HU in the pulmonary artery group,and the difference was statistically significant(P<0.001).The CT values of the descending aorta and ascending aorta in the triple group were(458.17±12.29)HU and(511.05±15.79)HU respectively,which were both higher than(393.46±11.15)HU and(421.44±14.15)HU in the aortic group,and the differences were statistically significant(P<0.001).There was no statistically significant difference in the CT values of the proximal segment of the left circumambulation branch,the proximal segment of the left anterior descending branch,and the proximal segment of the right coronary artery between the coronary artery group and the triple group(P>0.05).In addition,the effective dose of the triple group was only 71.61%of the sum of the pulmonary artery group,the aortic group and the coronary artery group.Conclusion In the emergency diagnosis of chest pain,the triple CTA examination of chest pain can clearly show the patient's main,lung and coronary artery,and the obtained image quality is equivalent to that of single CTA examination,and it can effectively reduce the radiation dose,which has certain diagnostic advantages.
作者
李新星
唐继梅
车晓华
门宏莹
韩晶
郭首强
LI Xinxing;TANG Jimei;CHE Xiaohua;MEN Hongying;HAN Jing;GUO Shouqiang(Department of Medical Imaging,Xing'an League People's Hospital,Xing'an League Inner Mongolia 137400,China)
出处
《中国卫生标准管理》
2025年第18期99-104,共6页
China Health Standard Management
基金
兴安盟科技计划项目(MB202227)。
