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1.
OBJECTIVES: The applicability of four-detector multislice computed tomography (MSCT) was investigated for evaluating coronary arteries. METHODS: MSCT (Somatom Volume Zoom, Siemens) was used to evaluate the coronary arteries in 94 patients. The reconstructed images were analyzed using retrospective electrocardiographic gating to determine the image quality of the coronary arteries. In addition, the ability of MSCT to detect coronary artery lesions of > or = 70% (> or = 50% in the left main trunk) diameter stenoses documented by standard coronary angiography was assessed in 67 patients who underwent coronary angiography within the same period. RESULTS: Good image quality was displayed in 488 (58%) and fair in 184 (22%) of a total of 846 coronary segments, but non-assessable in 174 (21%) due to degraded image quality. MDCT detected 33 stenotic lesions correctly in 494 assessable segments, comparable to coronary angiography. The sensitivity and specificity of MSCT were 0.79 and 0.95, respectively. However, an additional 15 lesions were detected by coronary angiography among the non-assessable segments. In total, 24 lesions were missed by MSCT. Accordingly, coronary segments were completely assessable and correctly detected by MSCT in only 20 patients (30%), or 35 (52%) if the distal coronary segments were excluded from analysis. CONCLUSIONS: Four-detector MSCT for detection of coronary artery lesions was applicable to assessable segments. However, clinical use may presently be limited because of the insufficient overall accuracy. Further technical improvement is expected in the near future.  相似文献   

2.
64层螺旋CT血管成像在冠心病诊断中的应用   总被引:2,自引:1,他引:1  
目的评价64层螺旋CT(MSCT)血管成像在冠心病诊断中的应用价值。方法选择80例冠心病或可疑冠心病患者行心电门控的MSCT冠状动脉成像,在特定工作站完成图像重建,并与冠状动脉造影结果对照,分析64层MSCT冠状动脉成像在诊断冠心病中的应用价值。结果80例患者中共1200个冠状动脉节段,其中1096个冠状动脉节段可供临床诊断分析,104(8.7%)个冠状动脉节段因图像质量差不能进行诊断分析。在所有可供分析的78例患者中MSCT诊断冠心病的敏感度、特异度、阳性预测值、阴性预测值和诊断准确度分别是96.1%、85.2%、92%和92.3%。1096个可供评价的冠状动脉节段中MSCT识别直径狭窄≥50%病变的敏感度、特异度、阳性预测值、阴性预测值分别为93.2%、89.3%、85.6%、95.2%和92.3%。结论64层MSCT冠状动脉成像对冠心病的诊断有良好的准确性。  相似文献   

3.
AIMS: Multislice spiral computed tomography (MSCT) is a promising non-invasive method to diagnose coronary artery disease (CAD). As no detailed comparative evaluation in consecutive patients referred for evaluation of CAD has been reported, this prospective study evaluating 2384 coronary segments in 149 consecutive patients was performed. METHODS AND RESULTS: The coronary artery tree was analysed in 16 segments both for coronary angiography (CA) and MSCT; a luminal narrowing > or = 50% based on visual assessment was considered significant. By MSCT, 77% of 2110 angiographically assessable segments could be evaluated, 94% per patient in proximal and 70% in distal segments (P<0.001). Sensitivity of MSCT to detect significant stenoses was 30% in all, but only 10% in peripheral segments. The main limitations were calcifications in 34% of segments and motion artefacts in 24% of patients. Overall diagnostic sensitivity for the presence of significant CAD was 86% but specificity was only 49%. CONCLUSION: When compared with invasive CA, 16-slice MSCT is of limited diagnostic value for the diagnosis of CAD in consecutive patients. Despite a clinically useful sensitivity for the overall diagnosis of significant CAD, specificity is low. Thus, relevant decisions regarding the need of and suitability for possible revascularization procedures cannot be based on MSCT findings alone.  相似文献   

4.
目的评价64层螺旋CT在冠状动脉造影方面的诊断价值。方法58例临床诊断或可疑冠心病患者行64层螺旋CT冠状动脉成像检查,分别对左主干、左前降支、回旋支和右冠状动脉及其分支的重建图像行影像学评价,所有患者均行常规选择性冠状动脉造影检查作为对照。结果58例患者共757(87.0%)节段的冠状动脉(血管直径≥1.5 mm)成像,638节段(84.3%)可用于多层螺旋CT和冠状动脉造影定量分析。冠状动脉造影共发现狭窄101节段,多层螺旋CT发现狭窄104节段,多层螺旋CT对冠状动脉狭窄诊断的敏感性为86.1%,特异性为96.8%。结论64层螺旋CT冠状动脉造影可作为诊断冠状动脉病变的一种无创筛选方法。  相似文献   

5.
BACKGROUND: Multislice computed tomography (MSCT) is a promising noninvasive method of detecting coronary artery disease (CAD). However, most data have been obtained in selected series of patients. The purpose of the present study was to investigate the accuracy of 64-slice MSCT (64 MSCT) in daily practice, without any patient selection. METHODS AND RESULTS: Using 64-slice MSCT coronary angiography (CTA), 69 consecutive patients, 39 (57%) of whom had previously undergone stent implantation, were evaluated. The mean heart rate during scan was 72 beats/min, scan time 13.6 s and the amount of contrast media 72 mL. The mean time span between invasive coronary angiography (ICAG) and CTA was 6 days. Significant stenosis was defined as a diameter reduction of > 50%. Of 966 segments, 884 (92%) were assessable. Compared with ICAG, the sensitivity of CTA to diagnose significant stenosis was 90%, specificity 94%, positive predictive value (PPV) 89% and negative predictive value (NPV) 95%. With regard to 58 stented lesions, the sensitivity, specificity, PPV and NPV were 93%, 96%, 87% and 98%, respectively. On the patient-based analysis, the sensitivity, specificity, PPV and NPV of CTA to detect CAD were 98%, 86%, 98% and 86%, respectively. Eighty-two (8%) segments were not assessable because of irregular rhythm, calcification or tachycardia. CONCLUSION: Sixty-four-MSCT has a high accuracy for the detection of significant CAD in an unselected patient population and therefore can be considered as a valuable noninvasive technique.  相似文献   

6.
OBJECTIVE: We aimed to determine the diagnostic accuracy of 64-slice multi-slice computed tomography (MSCT) to detect significant coronary artery stenosis with comparison to conventional coronary angiography (CCA). METHODS: In 100 patients (70 men, average age 58 +/- 10 years and age range 31-75 years) scheduled to have conventional coronary angiography, MSCT was performed before catheterization (within 2 months). All patients were in sinus rhythm, able to hold breath for 15 seconds, and had serum creatinine levels < 1.5 mg/dl. MSCT scans were analysed by a radiologist and a cardiologist. Sensitivity, specificity, positive and negative predictive values for the detection of significant stenoses by MSCT in comparison with CCA were calculated on patient, vessel, and segmental bases. RESULTS: 64-slice computed tomography is able to detect significant coronary artery stenosis on a segmental basis with a sensitivity of 88% and specificity of 99% when compared with CCA. All patients with significantly stenotic coronary artery disease are correctly diagnosed. The presence of significant stenosis was correctly diagnosed by MSCT in 126 of 144 segments. Twelve non-significant lesions on CCA were overestimated by MSCT. On vessel-based analysis, the sensitivity and specificity of MSCT for detecting significant stenosis were 91% and 97%, respectively. CONCLUSION: Our results indicate that 64-slice computed coronary angiography is a reliable diagnostic modality for the detection of significant coronary artery stenosis in patients with sinus rhythm and scheduled to have CCA, but still has limitations of diagnostic performance on a per-segment and per-vessel basis.  相似文献   

7.
BACKGROUND: Non-invasive identification and characterization of mildly stenotic atherosclerotic lesions is an increasingly important focus of coronary imaging. DESIGN: We examined the accuracy of multi (16)-slice computed tomography (MSCT) for imaging of these lesions in comparison with intravascular ultrasound (IVUS). MATERIALS: Mildly stenotic segments of the left coronary artery were identified by coronary angiography and analyzed using IVUS and contrast-enhanced MSCT. Independent reviewers evaluated the accuracy of MSCT for presence, composition and distribution of atherosclerotic plaque and remodeling response in comparison to IVUS using receiver operating characteristic (ROC) data analysis. RESULTS: Of 46 segments in 14 patients, diagnostic characterization by MSCT was possible in 37 (80.4%) segments. In these segments the accuracy of MSCT for identifying plaque presence, calcification, distribution and positive remodeling was consistently greater than 0.90 (reader 1) and 0.87 (reader 2). CONCLUSION: State-of-the-art MSCT can accurately identify mildly stenotic coronary atherosclerosis and provide an assessment of morphology and remodeling response.  相似文献   

8.
The purpose of the present study was to determine the diagnostic accuracy of current 64-slice multislice computed tomography (MSCT) in the detection of significant coronary artery disease, using conventional coronary angiography as the gold standard. In 61 patients scheduled for conventional coronary angiography, 64-slice MSCT was performed and evaluated for the presence of significant (>or=50% luminal narrowing) stenoses. One patient had to be excluded because of a heart rate>90 beats/min during data acquisition. In the remaining 60 patients (46 men, 14 women; average age 60+/-11 years), 854 segments were available for evaluation. Of these segments 842 (99%) were of sufficient image quality. Conventional coronary angiography identified 73 lesions, of which 62 were detected by MSCT. The corresponding sensitivity and specificity were 85% and 97%, respectively. On a patient-per-patient analysis, sensitivity, specificity, and positive and negative predictive values were 94%, 97%, 97%, and 93%, respectively. In conclusion, the present study confirms that 64-slice MSCT enables the accurate and noninvasive evaluation of significant coronary artery stenoses.  相似文献   

9.
We compared the diagnostic accuracy of 64-slice computed tomographic (CT) coronary angiography to detect significant coronary artery disease (CAD) in women and men. The 64-slice CT coronary angiography was performed in 402 symptomatic patients, 123 women and 279 men, with CAD prevalence of 51% and 68%, respectively. Significant CAD, defined as > or =50% coronary stenosis on quantitative coronary angiography, was evaluated on a patient, vessel, and segment level. The sensitivity and negative predictive value to detect significant CAD was very good, both for women and men (100% vs 99%, p = NS; 100% vs 98%, p = NS), whereas diagnostic accuracy (88% vs 96%; p <0.01), specificity (75% vs 90%, p <0.05), and positive predictive value (81% vs 95%, p <0.001) were lower in women. The per-segment analysis demonstrated lower sensitivity in women compared with men (82% vs 93%, p <0.001). The sensitivity in women did not show a difference in proximal and midsegments, but was significantly lower in distal segments (56% vs 85%, p <0.05) and side branches (54% vs 89%, p <0.001). In conclusion, CT coronary angiography reliably rules out the presence of obstructive CAD in both men and women. Specificity and positive predictive value of CT coronary angiography were lower in women. The sensitivity to detect stenosis in small coronary branches was lower in women compared with men.  相似文献   

10.
冠心病是严重影响人类健康的一种常见的重大疾病。在临床症状出现之前及早诊断冠状动脉疾病有着重要的意义。尽管常规冠状动脉造影术仍然是诊断冠心病的“金标准” ,但一些其它非介入技术的应用具有代替常规冠脉造影术的潜在可能性。这样 ,冠状动脉疾病的非介入诊断成为当今医学关心的问题。新一代的多层螺旋CT具有高的分辨率 ,可以对心脏及冠状动脉进行显像评价。它不仅可以直接检测冠脉管腔狭窄 ,而且可以检测冠脉粥样硬化斑块。虽然由于冠脉运动尤其是右冠和回旋支中、远段造成的伪影 ,限制了MSCT的应用 ,但在获得足够的冠脉显像质量的情况下 ,多层螺旋CT冠脉管腔显像诊断明确狭窄的敏感性及特异性达 90 %左右。近几年来 ,CT技术的进步和显像质量的提高为冠脉显像诊断提供了日益增加的临床价值。另一方面 ,多层螺旋CT通过对冠脉钙化的评价 ,进行冠脉斑块负荷的测量 ,可评价、预测心血管病的危险性。通过钙化斑块负荷和造影剂管腔显像结合可增加诊断的准确性。总之 ,MSCT作为评价冠状动脉疾病的非介入方法正在快速发展 ,将来可能成为一种有前途的诊断方法。  相似文献   

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