目的 多层螺旋CT(MSCT)在评估 心肌梗死患者心肌活性的应用。方法 选 取我院2013年6月至2015年6月68例心肌 梗死患者为研究对象，所有患者均行前 瞻性首过和延迟增强64层MSCT及磁共振 成像(MR)心肌灌注成像，比较MSCT心肌 梗死首过期、延迟期结果，MSCT与MRI首 过灌注、延迟增强对照分析。结果 本 组68例患者，97.06%出现延迟强化， 延迟强化形式为非透壁增强32.35%、透 壁增强17.65%、混合型44.12%、无增 强2.94%。所有患者中，61.76%首过期 出现灌注缺损，延迟期出现强化；其中 2.94%患者首过灌注缺损，延迟期出现 强化。首过期与延迟期无显著关联性 (P>0.05)。68例患者997个心肌段，两组 同时表现为灌注缺损的段数为59段，同 时表现为无灌注缺损的段数为883段，符 合率为94.48%，则MSCT与MRI判断首过灌 注一致性较好。以MRI作参照标准，两者 同时表现为无强化段数为680段，非透壁 型强化为30段，透壁型强化为105段，故 符合率为81.75%，则MSCT与MRI判断心肌 活性一致性较好，但MSCT高估了梗死的 范围。结论 MSCT与MRI评估心肌活性的一 致性较好，MSCT可初步用于检测心肌活 性，具有较好的临床应用价值。

Objective To evaluate the application of multi-slice spiral CT (MSCT) in evaluating myocardial activity in patients with myocardial infarction. Methods Sixtyeight patients with myocardial infarction admitted in our hospital from June 2013 and June 2015 were selected as the study subjects. Prospective first pass and delayed enhanced 64 slice MSCT and magnetic resonance (MR) myocardial perfusion imaging were performed in all patients. The results of MSCT in first pass phase and delayed phase were compared. MSCT and MRI first pass perfusion and delayed enhancement were comparatively analyzed. Results Of 68 patients in the study, 97.06% had delayed enhancement. The delayed enhancement in 32.35% was non transmural enhancement, transmural enhancement in 17.65%, mixed type in 44.12%, and no enhancement in 2.94%. Of all the patients, 61.76% had perfusion defect in the first pass phase and enhancement in delayed phase; 2.94% of the patients had first pass perfusion defect and enhancement in delayed phase. There was no significant correlation between the first pass phase and the delayed phase (P>0.05). There were a total of 997 myocardial segments in 68 patients, including 59 segments manifesting as perfusion defects in the two groups at the same time and 883 segments manifesting as non perfusion defects, and the coincidence rate was 94.48%. The consistency of MSCT and MRI in judging first pass perfusion was good. With MRI as the reference standard, both showed 680 segments without enhancement, 30 segments with non transmural enhancement and 105 segments with transmural enhancement. The coincidence rate was 81.75%, and the consistency of MSCT and MRI in judging myocardial activity was good but MSCT overestimated the range of infarction. Conclusion The consistency of MSCT and MRI in the evaluation of myocardial activity is good. MSCT can be used to detect myocardial activity.