利用多切面電腦斷層冠狀動脈影像評估合理左心室分率估算之方法

Evaluation of Feasible Ejection Fraction of Left Ventricular by MDCT for Cardiac Coronary Artery

張驊嫣(Hua-Yen Chang)

指導教授 ： 陳泰賓

義守大學/電機資訊學院/資訊工程學系/碩士(2015年)

https://doi.org/10.6343/ISU.2015.00160

摘要

利用電腦斷層心臟血管影像進行左心室容積之估算已在臨床廣泛應用；然而卻缺少方法之間的比較與正確性評估。因此，針對五種估算左心室容積之方法所推估之左心室射出分率(Left Ventricular Ejection Fraction, LVEF)，進行合理性與準確性比較，能提供評估合理LVEF估算之方法。
本研究利用多切面電腦斷層左心室動態影像，分別就原始影像以及經長軸旋轉後之影像進行Single-plane area-length technique (SPA)、Modified Simpson technique (MST)、Biplane area-length technique (BPA)、Cylinder method(Hemi-ellipse)、Teichholz等5種方法估算左心室容積，以手繪方式為金標準(Golden of Truth, GOT)。同時比較5種方法估算左心室容積與金標準之差異性與相關性。差異性分析利用T檢定與ANOVA檢定；採用迴歸模型、皮爾森相關係數分析以及M-A Plot (Bland–Altman plot)評估5種LVEF估算方法與GOT之相關強度。
實驗結果得知BPA與GOT方法之差異性最小(P=0.084)且與GOT量測結果左心室LVEF為高度正相關；未經旋轉影像條件下，經由M-A Plot得知MSA與GOT之結果最接近；經影像旋轉處理，由M-A Plot得知BPA與GOT之結果最接近。迴歸分析結果得知，在未經旋轉下與經影像旋轉條件下，BPA與GOT迴歸係數最接近1。
本研究針對五種幾何估算方法，在原始電腦斷層切片影像與經影像旋轉處理後，進行體積與左心室心搏輸出率的估算，比較後了解其中差異性及準確性，常見的幾何體積估算法中，以BPA較為可靠且可以信賴的方式。

關鍵字

左心室射出分率(LVEF) ； 多切面電腦斷層(MDCT) ； 電腦斷層心臟血管影像

並列摘要

The left ventricular ejection fraction (LVEF) estimated by multiple detector computed tomography (MDCT) is adopted to provide clinical applications. However, the estimated methods for LVEF were lack of comparison of accuracy. Hence, the geometric methods for LVEF were evaluated the accuracy and feasibility by MDCT.
The estimations of LVEF on MDCT angiography were measured by single-plane area-length technique (SPA), modified Simpson technique (MST), biplane area-length technique (BPA), cylinder method (Hemi-ellipse), Teichholz, and manual drawing (i.e., the Golden of True, GOT) approaches. The significant difference between geometric method and GOT was applied t-test and analysis of variance test (ANOVA). Meanwhile, the correlation between geometric method and GOT was used regression model, Pearson’s correlation coefficients, and M-A Plot (Bland–Altman Plot).
The LVEF computed by BPA was no significant difference with those of GOT (P=0.084). Moreover, the LVEF of BPA was high positive relation with those of GOT. The LVEF computed by MSA and BPA were closed to those of GOT investigated by M-A Plot with respectively to original and rotated MDCT. However, the coefficient of regression between BPA and GOT were closed to unitary no matter what original and rotated MDCT.
In this study, the LVEF or LV computed by BPA could be a reliable approach to evaluate the left ventricular ejection fraction.

並列關鍵字

Left Ventricular Ejection Fraction ； Multiple Detector Computed Tomography ； MDCT angiography

參考文獻

[1] Singh RM, Singh BM, Mehta JL. Role of cardiac CTA in estimating left ventricular volumes and ejection fraction. World J Radiol. 2014;28;6(9):669-76.

[3] Tops LF, Krishnàn SC, Schuijf JD, Schalij MJ, Bax JJ. Noncoronary applications of cardiac multidetector row computed tomography. JACC Cardiovasc Imaging. 2008;1(1):94-106.

[4] Schalij MJ, Jukema JW, van der Wall EE, Bax JJ. Assessment of global left ventricular function and volumes with 320-row multidetector computed tomography: A comparison with 2D-echocardiography. J Nucl Cardiol. 2010;17(2):225-31.

[5] Nasis A, Moir S, Seneviratne SK, Cameron JD, Mottram PM. Assessment of left ventricular volumes, ejection fraction and regional wall motion with retrospective electrocardiogram triggered 320-detector computed tomography: a comparison with 2D-echocardiography. Int J Cardiovasc Imaging. 2012;28(4):955-63.

[6] Lim SJ, Choo KS, Park YH, Kim JS, Kim JH, Chun KJ, Jeong DW.Assessment of left ventricular function and volume in patients undergoing 128-slice coronary CT angiography with ECG-based maximum tube current modulation: a comparison with echocardiography.Korean J Radiol. 2011;12(2):156-62.Epub 2011 Mar 3.