| ObjectiveCoronary computed tomographic angiography(CCTA)has been proved to have a good correlation with coronary angiography.It has the advantages of simple operation,non-invasive,low risk and low cost.It has high diagnostic sensitivity,specificity and wide clinical application.However,some patients still can not accept coronary CT angiography because of high heart rate,arrhythmia or breath-holding,which limits the application of coronary CT angiography.At present,combined CT angiography of different parts is rare in clinical application.256-row Revolution CT has a 16 cm wide body detector.Therefore,the whole heart can be covered,and coronary artery anatomical imaging can be obtained by rotating the tube in one circle.It only takes 0.28 seconds to rotate the tube in one circle,and coronary artery anatomy,perfusion and cardiac function imaging can be obtained within one cardiac cycle without the influence of heart rate,rhythm and breathing.When the coronary artery axis scan is completed,the tube can be quickly adjusted to the spiral scan mode,and the next part of the blood vessel can be scanned jointly.This study is divided into three parts.Firstly,the feasibility of wide-body detector CT coronary angiography with high heart rate and free breathing was studied.Secondly,to evaluate the feasibility of coronary CT angiography in patients with atrial fibrillation by wide detector CT.Finally,according to the characteristics of diabetes mellitus which is easy to combine with multiple cardiovascular complications,coronary CT angiography combined with lower extremity artery imaging is performed to explore the feasibility of its combined imaging,which provides a simple,easy,efficient and accurate diagnostic basis for clinical judgment of coronary heart disease and lower extremity artery disease in diabetic patients.MethodsPart I: 116 consecutive patients with CT coronary angiography were prospectively collected.According to the heart rate,they were divided into two groups: high heart rate(HHR group,heart rate(> 70 beats/min)and low heart rate(LHR group,heart rate < 70 beats/min).Both groups did not use drugs to control heart rate,did not carry out breath training before examination,and did not need breath holding during examination.Under the condition of free breathing,the image quality and radiation dose of the two groups were compared according to the subjective and objective scores of the two groups.Part II: Coronary CT angiography images of 43 patients with atrial fibrillation(AF group)were retrospectively analyzed and compared with 58 patients with normal heart rhythm(NAF group).The image quality,assessment ability of coronary artery,heart rate,arrhythmia and radiation dose were evaluated in the two groups.Part III: At last,20 patients with diabetic heart disease(combined group)were prospectively collected and compared with 20 patients with diabetes mellitus(single coronary artery group)and 20 patients with lower extremity artery angiography(single lower extremity group)in the same period.The combined scan image quality and radiation dose.was evaluated.ResultsPart I: 116 cases were included in the study,including 54 males(46.5%)and 62 females(53.4%).The average age was 63.3±15.2 years(36 ~ 82 years),and the average BMI was 23.5±3.2 kg/m2.The average heart rate of HHR group and LHR group was 79.8±15.7bpm and 61.1±10.2bpm,respectively,and the assessable rate of coronary artery was 97.9% and 97.4%.There was no significant difference in sex,age,BMI,assessable rate of coronary artery and image quality between the two groups(P > 0.05),but there was significant difference in heart rate between the two groups(P < 0.05).The dose-length multiplier of group A and group LHR was 152.0±59.2 mGy cm)and 173.8±57.4 mGy cm,respectively.The average effective dose was 2.1±0.9 mSv)and 2.4±0.76 mSv,with significant difference(P < 0.05).Part II: 101 cases were included,including 50 males(49.5%)and 51 females(50.5%).The average age was 62.1 ± 13.7(35~81years),and the average BMI was 22.9 ± 4.8 kg/m 2.The assessment rates of coronary artery in AF group and NAF group were 98.7% and 98.8%,respectively.There were no significant differences in gender,age,BMI,coronary artery assessability rate and image quality between the two groups(P > 0.05).The scan time,heart rate,heart rate change and arrhythmia in AF group were significantly higher than those in normal group(P < 0.05 p),and the average ED in both groups was significantly higher than that in normal group(P < 0.05 p).There was no significant difference(P > 0.05).Part III: A total of 60 subjects were included,including 38 males and 22 females,aged 37-79 years,with an average age of 63.2 ± 14.8 years and an average BMI of 24.7±3.7 kg/m.There was no significant difference in age,gender,BMI and heart rate among the three groups(P > 0.05).There was no significant difference in image quality score among the three groups(P > 0.05).There was no significant difference in radiation dose between single lower extremity group and single coronary artery group(P < 0.05),which was higher than that of single coronary artery group(P > 0.05).ConclusionsRevolution CT can perform coronary artery imaging in patients with high heart rate and atrial fibrillation under free breathing.The quality of coronary artery image is stable.It is of great value for defining coronary artery lesions and follow-up of coronary artery.Wide body detector can eliminate stepped artifacts,but it can not eliminate motion artifacts.SSF technology can further correct motion artifacts and obtain higher quality coronary CT images.Compared with retrospective ECG-gated coronary CT angiography,the radiation dose of prospective ECG-gated triggered coronary CT angiography is much lower.Cardiovascular complications of type 2 diabetes often involve multiple organs.Revolution CT can perform one-stop CT angiography of coronary artery and lower extremity artery in diabetic patients.It is accurate and efficient,and can provide more useful information for clinical diagnosis,treatment and prognosis. |
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