医学影像学杂志

目的 探讨低剂量CT心肌灌注成像（CT-MPI）定量参数对急性心肌梗死（AMI）患者经皮冠状动脉介入治疗（PCI）后心肌灌注不良的早期诊断价值。方法 选取100例接受PCI的AMI患者，根据PCI后心肌灌注水平分为灌注不良组31例与灌注良好组69例。患者于PCI后1周内进行低剂量CT-MPI检查，测量心肌血流量（MBF）、心肌血容量（MBV）、血管外容积、达峰时间。收集患者临床资料，包括性别、年龄、BMI、发病至入院时间、基础疾病、吸烟史、饮酒史、心肌梗死类型、病变支数以及左心功能指标[左心室舒张末期容积、左心室收缩末期容积、左心室射血分数（LVEF）]。采用多因素Logistic回归分析筛选AMI患者PCI后心肌灌注状态的影响因素，采用ROC曲线分析CT-MPI定量参数对AMI患者PCI后心肌灌注不良的诊断效能。结果 灌注不良组年龄高于灌注良好组，LVEF低于灌注良好组（P均<0.01）。灌注不良组MBF、MBV均低于灌注良好组（P均<0.05）。多因素Logistic回归分析显示，年龄、MBF、MBV是AMI患者PCI后心肌灌注不良的独立影响因素（P均<0.05）。ROC曲线分析显示，MBF、MBV诊断AMI患者PCI后心肌灌注不良的最佳截断值分别为45.61 mL/（min·100 mL）、4.80 mL/100 mL，其对应的AUC分别为0.663、0.688,MBF联合MBV诊断AMI患者PCI后心肌灌注不良的AUC为0.827，高于单一指标（P均<0.05）。结论 低剂量CT-MPI定量参数MBF、MBV对AMI患者PCI后心肌灌注不良具有较高的早期诊断价值，可为临床诊疗提供可靠的影像学依据。

Objective To investigate the value of quantitative parameters derived from low-dose CT myocardial perfusion imaging(CT-MPI) in the early diagnosis of poor myocardial perfusion after percutaneous coronary intervention(PCI) in patients with acute myocardial infarction(AMI). Methods A total of 100 patients with AMI who underwent PCI were enrolled. Based on the level of myocardial perfusion after PCI, they were divided into the poor perfusion group(n=31) and the good perfusion group(n=69). All patients received low-dose CT-MPI examination within one week after PCI to measure myocardial blood flow(MBF), myocardial blood volume(MBV), extravascular volume, and time to peak. Clinical data of the patients were collected, including gender, age, BMI, time from onset to admission, underlying diseases, smoking history, drinking history, type of myocardial infarction, number of diseased vessels, and left ventricular function indicators, in terms of left ventricular end-diastolic volume, left ventricular end-systolic volume, and left ventricular ejection fraction(LVEF). Multivariate logistic regression analysis was used to screen factors influencing myocardial perfusion status after PCI in patients with AMI. ROC curves were used to evaluate the diagnostic efficacy of CT-MPI parameters for poor myocardial perfusion. Results Patients in the poor perfusion group were older than those in the good perfusion group, and LVEF in the poor perfusion group was lower than that in the good perfusion group(both P<0.01). MBF and MBV in the poor perfusion group were lower than those in the good perfusion group(both P<0.05). Multivariate logistic regression analysis showed that age, MBF, and MBV were influencing factors for poor myocardial perfusion after PCI in patients with AMI(all P<0.05). ROC curve analysis showed that the optimal cutoff values of MBF and MBV for diagnosing poor myocardial perfusion after PCI in patients with AMI were 45.61 mL/（min·100 mL） and 4.80 mL/100 mL, respectively. The corresponding AUCs were 0.663 and 0.688, respectively. The AUC of MBF combined with MBV for diagnosing poor myocardial perfusion was 0.827, which was greater than that of each indicator(both P<0.05). Conclusion Low-dose CT-MPI parameters, i.e., MBF and MBV, have high value in the early diagnosis of poor myocardial perfusion after PCI in patients with AMI, thereby providing a reliable imaging basis for clinical diagnosis and treatment.