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冠状动脉CT血管成像扫描与报告书写专家共识

国家心血管病专业质控中心专家委员会 心血管影像质控专家工作组 金征宇

国家心血管病专业质控中心专家委员会, 心血管影像质控专家工作组, 金征宇. 冠状动脉CT血管成像扫描与报告书写专家共识[J]. 协和医学杂志, 2019, 10(1): 23-30. doi: 10.3969/j.issn.1674-9081.2019.01.005
引用本文: 国家心血管病专业质控中心专家委员会, 心血管影像质控专家工作组, 金征宇. 冠状动脉CT血管成像扫描与报告书写专家共识[J]. 协和医学杂志, 2019, 10(1): 23-30. doi: 10.3969/j.issn.1674-9081.2019.01.005
National Center for Cardiovascular Quality Improvement,China, Working Group on Cardiovascular Imaging Quality Control, Zheng-yu JIN. Expert Consensus on the Scan and Report of Coronary Computed Tomography Angiography[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(1): 23-30. doi: 10.3969/j.issn.1674-9081.2019.01.005
Citation: National Center for Cardiovascular Quality Improvement,China, Working Group on Cardiovascular Imaging Quality Control, Zheng-yu JIN. Expert Consensus on the Scan and Report of Coronary Computed Tomography Angiography[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(1): 23-30. doi: 10.3969/j.issn.1674-9081.2019.01.005

冠状动脉CT血管成像扫描与报告书写专家共识

doi: 10.3969/j.issn.1674-9081.2019.01.005
基金项目: 

科技部"十三五"国家重点研发计划 2016YFC1300402

详细信息
    通讯作者:

    金征宇  电话:010-69155442,E-mial:jin_zhengyu@163.com

  • 中图分类号: R445

Expert Consensus on the Scan and Report of Coronary Computed Tomography Angiography

More Information
  • 摘要: 冠状动脉CT血管成像(coronary computed tomography angiography, CCTA)检查已成为临床筛查冠状动脉疾病安全、可靠的首选技术之一。随着技术发展, 后64排高端CT设备近年已有大量装机, 但在扫描适应证、扫描方式及对比剂使用等方面仍存在大量不合理、不规范的现象, CCTA扫描与报告书写的规范化、标准化应用水平亟待提高。制定本共识的目的即是建立可共同遵循的扫描适应证及规范化扫描方案和影像报告等指导原则, 以便在全国范围内进行规范化推广应用。
    利益冲突  无
  • 表  1  不同冠状动脉CT血管成像扫描模式选择

    患者心律/心率 前瞻性心电门控扫描 回顾性心电门控螺旋扫描
    前瞻性大螺距螺旋扫描 前瞻性步进式轴位扫描
    心律齐
    心率<70次/min 心率变化<3次/min时推荐;心电脉冲窗宽:70% R-R间期 推荐;心电脉冲窗宽:70% R-R间期 不推荐
    心率70~90次/min 心率变化<3次/min时推荐;
    心电脉冲窗宽:30%~70% R-R间期
    推荐;心电脉冲窗宽:30%~70% R-R间期 不推荐
    心率>90次/min 不推荐 推荐;心电脉冲窗宽:30%~45% R-R间期 不推荐
    心律不齐 不推荐 可尝试;心电脉冲窗宽:30%~70% R-R
    间期或R-R绝对时相
    可尝试
    下载: 导出CSV

    表  2  相同碘流率、不同体重患者的对比剂用量(ml)

    体重(kg) 浓度300 mgI/ml、注射流速4 ml/s 浓度370 mgI/ml、注射流速3.2 ml/s
    90 72 59
    80 64 52
    70 56 46
    60 48 39
    50 40 33
    40 32 30
    本表中数值为使用120 kV管电压情况下推荐的注射流速(ml/s),如果使用迭代重建和低一级别的管电压(例如100 kV),注射流速可降低30%
    下载: 导出CSV

    表  3  低对比剂个体化注射方案

    自动管电压调制(kV) 对比剂用量(ml) 注射速率(ml/s)
    70 18 3.0
    80 21 3.0
    90 28 4.0
    100 32 4.0
    注:本注射方案中对比剂浓度为370 mgI/ml
    下载: 导出CSV

    表  4  国际心血管CT协会管腔直径狭窄程度分级量表

    管腔直径狭窄程度(%) 术语
    0 无狭窄
    1~24 极小狭窄
    25~49 轻度狭窄
    50~69 中度狭窄
    70~99 重度狭窄
    100 闭塞
    下载: 导出CSV

    表  5  稳定性胸痛患者冠状动脉疾病报告与数据分类

    CAD-RADS 冠状动脉狭窄的
    最大程度
    解释 进一步心脏检查 处理
    0 0 证明无CAD 考虑非动脉粥样硬化导致的胸痛,安慰
    1 1%~24% 极小非阻塞性CAD 考虑非动脉粥样硬化导致的胸痛,预防性治疗,改善危险因素
    2 25%~49% 轻度非阻塞性CAD 考虑非动脉粥样硬化导致的胸痛,预防性治疗,改善危险因素,尤其是对多节段非阻塞性斑块患者
    3 50%~69% 中度狭窄 考虑功能评估 考虑症状引导的抗心肌缺血和预防性药物治疗,如指南中改善危险因素的建议,其他治疗应考虑指南的治疗建议
    4 A.70%~99%
    B.左主干>50%或三支血管阻塞性病变≥70%
    严重狭窄 A.考虑冠状动脉造影或功能评估
    B.建议冠状动脉造影
    考虑症状引导的抗心肌缺血和预防性药物治疗,如指南中改善危险因素的建议;其他治疗(包括血运重建),应考虑指南的治疗建议
    5 100% 完全闭塞 考虑冠脉造影和/或心肌存活性评估 考虑症状引导的抗心肌缺血和预防性药物治疗,如指南中改善危险因素的建议;其他治疗(包括血运重建),应考虑指南的治疗建议
    N 不能诊断 不排除阻塞性CAD 可能需要额外的或辅助评估
    CAD-RADS:冠状动脉疾病报告与数据制度;CAD:冠状动脉疾病
    下载: 导出CSV
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  • 收稿日期:  2018-10-31
  • 刊出日期:  2020-02-01

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