目的 探讨负荷动态CT心肌灌注 成像(CT-MPI)对冠状动脉粥样硬化的诊 断价值。方法 纳入疑似冠状动脉粥样 硬化患者60例，记录其CT-MPI灌注结果 及量化指标[心肌血流量(MBF)、心肌血 容量(MBV)、达峰时间(TTP)]，依据冠 状动脉造影将心肌节段分为灌注正常组 (狭窄面积＜50%)、灌注异常组(狭窄面 积＞50%)，比较两组MBF、MBV、TTP， 应用ROC曲线分析CT-MPI诊断效能。结 果 CT-MPI显示35例共52支血管、329个 节段显示心肌灌注减低，灌注异常率为 58.33%(35/60)；灌注异常组MBF、MBV低 于灌注正常组，而TTP较灌注正常组延长 (P＜0.05)；在患者、血管、节段水平 上，CT-MPI诊断冠状动脉粥样硬化的灵 敏度为90.00%、93.75%、91.17%%，特异 度为57.50%、85.13%、97.21%，准确度 为68.33%、86.67%、95.20%，Kappa值为 0.400、0.634、0.891，ROC曲线下面积 为0.697、0.719、0.951。结论 负荷动 态CT-MPI诊断冠状动脉粥样硬化有较高 诊断价值，值得在临床推广应用。

Objective To explore the diagnostic values of dynamic load CT myocardial perfusion imaging (CT-MPI) in coronary atherosclerosis. Methods 60 patients with suspected coronary atherosclerosis were enrolled. The CT-MPI perfusion results and quantitative indexes [myocardial blood flow (MBF) and myocardial blood volume (MBV), time to peak (TTP)] were recorded. According to coronary arteriography, myocardial segments were divided into normal perfusion group (stenosis area<50%) and abnormal perfusion group (stenosis area >50%). The MBF, MBV and TTP were compared between two groups, and the diagnostic efficacy of CT-MPI was analyzed by ROC curve. Results CT-MPI showed that there were 35 cases with 52 vessels and 329 segments with myocardial perfusion reduction, and the abnormal rate of perfusion was 58.33% (35/60). The levels of MBF and MBV in abnormal perfusion group were lower than those in normal perfusion group, and the level of TTP was significantly longer than that in normal perfusion group (P<0.05). In level of patients, blood vessels, segment, the sensitivity of CT-MPI in the diagnosis of coronary atherosclerosis were 90%, 93.75% and 91.17%%, and the specificity were 57.50%, 85.13% and 97.21%, and the accuracy were 68.33%, 86.67% and 95.20%, and the Kappa values were 0.400, 0.634 and 0.891, and the area under the ROC curve were 0.697, 0.719 and 0.951. Conclusion Dynamic load CT-MPI has a high diagnostic value in coronary atherosclerosis and is worthy of clinical promotion and application.