摘要目的:探讨基于原始Patlak Plots法，应用两次大螺距前瞻性心电门控扫描模式（Double FLASH）冠状动脉CTA（CCTA）评估心肌血流灌注的可行性。方法:前瞻性纳入2018年1月至2020年1月因冠心病或疑似冠心病于天津医科大学总医院行负荷动态心肌CT灌注（CTP）+CTA扫描的非缺血性心脏病受试者。入组患者年龄>18岁且CTA上无中度以上狭窄。使用FRONTIER平台分析软件进行动态CTP分析，并计算心肌血流量（MBF CTP）。通过测量Double FLASH扫描2个时间点的主动脉和心肌的CT衰减值来计算MBF CTA。使用线性回归、Pearson相关性和Bland-Altman分析比较MBF CTP和MBF CTA结果。 结果:本研究共纳入50例受试者。MBF CTA与MBF CTP存在线性相关，室间隔中部：MBF CTA=0.936MBF CTP-11.999， r2= 0.600， P<0.01；左心室游离壁：MBF CTA=1.010MBF CTP-9.206， r2=0.448， P<0.01；心尖部：MBF CTA=0.822MBF CTP+16.904， r2=0.375， P<0.01。Bland-Altman分析显示，MBF CTA与MBF CTP的测量结果无显著偏差。与动态CTP扫描［（4.33±1.89）mSv］相比较，Double FLASH扫描明显降低了辐射剂量［（1.38±0.19）mSv］，差异具有统计学意义（ t=4.378， P=0.030）。 结论:本研究以CTP为参考标准，验证了基于Patlak Plots理论、利用Double FLASH CCTA图像计算MBF方法的可行性和一致性，该方法有潜力为同时评估冠状动脉与心肌缺血状态的一站式检查拓展临床应用前景。

abstractsObjective:To explore the feasibility of using Double FLASH coronary CTA (CCTA) to evaluate myocardial blood perfusion based on the original Patlak Plots.Methods:A total of 50 subjects with non-ischemic heart disease were prospectively included in the study who received dynamic myocardial CT perfusion (CTP) and Double FLASH CTA scans in General Hospital of Tianjin Medical University from January 2018 to January 2020 due to coronary heart disease or suspected coronary heart disease. The age of the enrolled patients was at least 18 years old and there was no moderate or above stenosis on CTA. The dynamic CTP images were analyzed by using CTP analysis software on FRONTIER platform to calculate the CTP derived MBF (MBF CTP). While the CTA derived MBF (MBF CTA) was calculated from the CT attenuation values of both aorta and myocardium segments on two scanning time set of Double FLASH CTA which were measured by two independent radiologists. Pearson correlation and Bland-Altman analysis were used to compare the results of MBF CTP and MBF CTA. Results:There was a strong linear correlation between MBF CTP and MBF CTA measurements. In the mid anteroseptal level: MBF CTA=0.936MBF CTP-11.999, r2=0.600, P<0.01. In the mid anterolateral level: MBF CTA=1.010MBF CTP-9.206, r2=0.448, P<0.01. In the apex: MBF CTA=0.822MBF CTP+16.904, r2=0.375, P<0.01. Bland-Altman analysis also showed there were no significant differences between MBF CTP and MBF CTA measurements. Compared with dynamic CTP scan, Double FLASH CTA mode significantly reduced the radiation dose [(4.33±1.89) mSv vs. (1.38±0.19) mSv, t=4.378, P=0.030]. Conclusions:This study validated the feasibility and accuracy of the MBF CTA measurement based on the theory of Patlak Plots only using Double FLASH CTA images. This method might have the potential to expand the clinical application of one-stop CTP examination for simultaneously evaluating coronary artery and myocardial ischemia in the clinic.