电子束CT探测冠状动脉狭窄在冠心病诊断中的价值

目的评价电子束CT(EBCT)增强扫描对冠状动脉狭窄的诊断意义。方法80例患者分别行EBCT增强扫描和冠状动脉血管造影术(CAG),分别由2位不知造影结果的医师进行阅片,并以CAG结果作为标准进行对比分析。结果EBCT判断近段血管狭窄(管腔狭窄≥50%)的灵敏度是:左主干(LM)100%,右冠状动脉(RCA)93%,左前降支(LAD)90%,左回旋支(LCX)81%,判断远段血管狭窄的灵敏度为:RCA67%,LAD43%,LCX46%(P<0.05)。结论EBCT增强扫描及其三维重建与冠状动脉血管造影结果具有高度的相关性,通过经静脉增强造影,EBCT可以清楚地显示冠状动脉并判断管腔的狭窄,尤其是近段的重度狭窄。     

64层螺旋CT在冠心病诊断中的价值

目的评价64层螺旋CT增强扫描对冠状动脉狭窄的诊断意义。方法156冽患者分别行64层螺旋CT增强扫描和经皮冠状动脉血管造影术（CAG）,由两位不知造影结果的医师进行阅片,并以CAG结果作为标准进行对比分析。结果64层螺旋CT判断近段血管狭窄（管腔狭窄≥50％）的灵敏度是：左主干（LM）99％,右冠状动脉（RCA）93％,左前降支（LAD）89％,左回旋支（LCX）82％,判断远段血管狭窄的灵敏度为：RCA56％,LAD45％,LCX43％（P〈0．05）。结论64层螺旋CT增强扫描及其三维重建与冠状动脉血管造影结果具有高度的相关性,通过经静脉增强造影,64层螺旋CT可以清楚显示冠状动脉并判断管腔的狭窄,尤其是近段的重度狭窄。     

冠状动脉CTA对冠脉临界病变管腔狭窄程度的诊断价值

目的探讨冠状动脉CTA对冠脉临界病变管腔狭窄程度的诊断效果。方法选取2016年4月至2018年4月我院收治的冠脉狭窄患者80例,随机分为两组,对照组进行冠状动脉造影(CAG)检查,研究组进行冠状动脉CTA。比较研究组狭窄程度评分、两组检查结果及诊断价值。结果研究组多支病变的右冠状动脉、左回旋支狭窄程度评分高于前降支单支病变(P<0.05),研究组前降支单支病变前降支狭窄程度评分高于多支病变(P<0.05);冠状动脉造影检查与冠状动脉CTA检查一致性的为50%~70%的狭窄共有65段,冠状动脉造影检查判断≤50%的狭窄有2段,冠状动脉CTA检查为5段,冠状动脉CTA检查显影≥70%的有6段;研究组特异度、敏感度、阴性预测值、阳性预测值高于对照组(P<0.05)。结论冠脉临界病变管腔狭窄程度检查中,冠状动脉CTA的诊断结果更准确,应该在临床上广泛推广应用。     

CTA对T2DM合并冠心病患者冠脉狭窄的诊断价值

目的探讨64排螺旋CT冠脉造影(CTA)对2型糖尿病(T2DM)合并冠心病患者冠脉狭窄的诊断价值。方法回顾性分析我院140例拟诊断冠心病的T2DM患者的临床资料,所有患者均先后接受CTA检查、选择性冠状动脉造影检查(CAG)。以CAG为金标准,评价CTA筛查冠心病、诊断病变血管以及管腔狭窄程度的灵敏度、特异度、阳(阴)性预测值和Kappa值(一致性)。结果 CTA筛查冠心病的灵敏度为0.953,特异度为0.912,准确度为0.943,阳性预测值为0.971,阴性预测值为0.861,Kappa值为0.848,CTA与CAG具有较好的一致性;CTA与CAG对左主干(LM)病变诊断的一致性一般,对左前降支(LAD)、左回旋支(LCX)以及右冠状动脉(RCA)病变诊断的一致性较好;CTA诊断对轻、中、重度管腔狭窄均具有较高的灵敏度。结论 CTA对于T2DM合并冠心病患者的筛查具有较高的准确性,可精准判断血管病变与其狭窄程度。     

冠脉CTA在评估糖尿病患者冠脉临界病变管腔狭窄程度中的应用

目的探究冠脉CT血管造影(CTA)在评估糖尿病患者冠脉临界病变管腔狭窄程度中的应用。方法回顾性分析2016年5月至2017年5月于我院就诊的经冠状动脉造影(CAG)检查确诊为冠脉病变临界病变的62例2型糖尿病患者。所有患者均行CTA检查,对患者血管狭窄率进行评价,以CAG所测的狭窄率作为金标准,以50%作为判断血管狭窄程度的边界值,计算CTA检测的灵敏度、特异度及准确率,并比较CTA与CAG测量结果的一致性。结果 CTA评估冠脉临界病变的灵敏度为90.80%,特异度为88.89%,阳性预测值为79.79%,阴性预测值为95.23%,准确率为89.51%,CTA与CAG在冠状动脉狭窄性病变的诊断上具有较好的一致性(Kappa=0.769)。结论CTA在评估糖尿病患者冠脉临界病变管腔狭窄程度时有较高的特异度、灵敏度、阴性预测值及准确性,临床上可用于糖尿病患者冠脉临界病变管腔狭窄程度检查。     

选择性冠状动脉造影308例分析

目的 探讨冠心病冠状动脉造影(CAG)的X线表现及左室壁瘤的形成与冠脉病变支数、侧支循环的关系。方法 用Judkins法行选择性左、右冠脉造影及左室造影308例，观察冠脉及左室病变的形态、范围和程度等，进行统计学分析。结果 308例冠脉造影中，冠心病179例(58．1％)，其中单支血管病变82例(45．8％)、双支56例(31．3％)、3支35例(19．6％)、4支6例(3．4％)。共累及323支血管，其中前降支(LAD)139支(43．0％)、回旋支(LCX)72支(22．3％)、右冠状动脉(RCA)95支(29．4％)、左主干(LM)17支(5．3％)。出现侧支循环27例、真性室壁瘤52例，其中同时出现侧支和室壁瘤的22例；左室附壁血栓7例，二尖瓣反流5例，左房血栓2例。结论 CAG能直接显示冠脉病变的形态、范围和程度，冠心病室壁瘤的形成与冠脉病变支数、侧支循环有较密切的关系。     

经胸超声心动图测定冠状动脉血流储备对冠脉狭窄的诊断价值

目的 经胸超声心动图测定冠状动脉血流储备(CFR)对冠脉狭窄的诊断价值.方法 共选择117例患者.其中有胸痛但造影正常组45例;心绞痛组37例;急性心肌梗死组35例,对所有患者均进行了经胸超声心动图冠状动脉血流储备测定和选择性冠状动脉造影及造影评价.结果 ①三支血管显像率:前降支(LAD)为89%,左旋支(LCX)为76%,右冠脉(RCA)为82%.②心绞痛组和急性心肌梗死组冠状动脉血流储备明显低于造影正常组(P＜0.01);并且心绞痛组罪犯血管CFR与管腔狭窄程度明显相关,两者呈负相关关系(r=-0.662,P＜0.001);但急性心肌梗死组梗死相关动脉(IRAs)的CFR与管腔狭窄程度无明显相关性(r=-0.152,P＞0.05).结论 CFR测定可协助对冠状动脉狭窄程度的判断;但微循环功能的损伤,可影响CFR对冠脉狭窄病变的评估.     

64层螺旋CT与选择性冠状动脉造影对照性研究及其临床应用

目的：探讨64层螺旋CT（MSCT）冠状动脉造影的临床应用。方法：对256例患者行64层螺旋CT冠状动脉造影检查,利用其先进的后处理功能对冠状动脉进行重建,以显示冠状动脉各主支及其分支,并对冠状动脉病变进行诊断。其中66例患者同时行选择性血管造影检查。结果：256例行64层螺旋CT冠状动脉造影的患者有249例成功地显示冠状动脉各主支(左冠脉主支、左冠脉回旋支、左冠脉前降支及右冠状动脉主支)及其分支（包括右冠脉的后降支、左室后支、圆锥支、窦房结动脉及左冠脉的对角支、钝缘支等）,另外7例由于扫描过程出现心率过快（＞90次）或出现严重心律不齐,重建图像质量欠佳或出现锯齿状伪影,部分冠状动脉显影欠佳。138例64-MSCT诊断201支冠状动脉有斑块形成并管腔不同程度的狭窄。其中66例患者的64-MSCT诊断冠脉狭窄的患者行选择性血管造影检查,诊断 62例的78支冠状动脉伴有不同程度的狭窄,64层螺旋CT的诊断准确率为93.94%。结论：64层螺旋CT对冠脉疾病的诊断准确率接近选择性冠状动脉造影,是一种准确可靠的检查方法。     

64层螺旋CT诊断冠状动脉粥样硬化狭窄准确性研究

目的 评价64层螺旋CT(64-MSCT)诊断冠状动脉粥样硬化狭窄的准确性.方法 61例疑似冠心病患者在5～20 d内行64层MSCT冠状动脉成像(CTA)和血管造影(CAG)检查,其中男52例、女9例,平均年龄58岁±11岁.冠状动脉成像质量按照4分标准对右冠状动脉、左主干、左前降支和左回旋支4支血管分别进行评价.CTA与CAG冠状动脉病变狭窄程度以50%为界,对以上4支血管进行评价.对比分析MSCT诊断冠状动脉狭窄程度≥50%和＜50%的敏感性、特异性、假阳性、假阴性等指标.根据斑块的成分将其分为钙化和非钙化斑块两组,对二者所导致的管腔狭窄分别进行分析比较.结果 所有61例患者均获得优良的冠状动脉影像,冠状动脉成像质量评分为(3.57±0.18)分.CTA与CAG对比,诊断冠状动脉狭窄程度灵敏度为95.45%、特异度为96.15%、假阳性率为3.85%、假阴性率4.55%、阳性预测值为93.33%、阴性预测值为97.40%.对于非钙化斑块所致的管腔显著性狭窄的诊断敏感度和特异度均为85.71%;对于钙化斑块所致的显著性狭窄的诊断敏感度和特异度分别为83.33%和31.57%.结论 64-MSCT可准确显示冠状动脉硬化所致狭窄性病变,可用于冠心病的无创性检查,对于钙化斑块所导致的管腔狭窄的判断特异度低.     

Duke评分在冠状动脉病变程度预测中的价值研究

目的探讨平板运动试验评分即Duke评分（DTS）在冠状动脉病变程度预测中的价值。方法对179例先后接受平板运动试验（TET）和冠状动脉造影（CAG）检查病例的临床和心电图资料分析，揭示Duke评分和冠状动脉病变程厦的相关性。结果低危Duke评分组38例无〉75％狭窄，5例1支血管〉75％狭窄，7例2支血管〉75％狭窄或前降支病变，2例3支血管〉75％狭窄或左主干病变；中危Duke评分组18例无〉75％狭窄，11例1支血管〉75％狭窄，41例2支血管〉75％狭窄或前降支病变，7例3支血管〉75％狭窄或左主干病变；高危13uke评分组2例无〉75％狭窄，2例1支血管〉75％狭窄，19例2支血管〉75％狭窄或前降支病变，27例3支血管〉75％狭窄或左主干病变。Duke评分与冠脉病变的严重程度和范围呈明显相关性（P〈0．01）。结论Duke评分对冠脉病变的严重程度和范围具有一定的预测价值。     

电子束CT与选择性冠状动脉造影的节段对比分析

[目的]探讨电子束CT(EBCT)造影对冠状动脉各节段病变诊断价值的差异.[方法]同期行选择性冠状动脉造影和EBCT冠状动脉造影检查的患者38例,对照选择性冠状动脉造影的结果计算EBCT造影检测冠状动脉各节段狭窄病变的准确性.[结果]①选择性冠状动脉造影可清晰显影的332个节段中,EBCT造影可清晰显示和评价占264段(79.5%),68段(20.5%)显影不清.左主干和前降支可评价节段的比例显著高于左回旋支和右冠状动脉(P＜0.05或0.01),同一支血管中近段可评价的比例显著高于远段(P＜0.05或0.01).②EBCT造影检测节段病变总的敏感性、特异性、准确性、阳性和阴性预测值分别为81.0%、95.9%、93.6%、79.1%和96.4%;EBCT造影对诊断左主干和左前降支各节段病变的价值高于左回旋支和右冠状动脉,检测冠状动脉近段病变的价值高于远段.[结论]电子束CT冠状动脉造影对冠状动脉的评价和病变检测受解剖部位和血管大小的影响,检测左主干和左前降支各节段病变的价值高于左回旋支和右冠状动脉,对冠状动脉近段病变的诊断价值高于远段.     

多排螺旋CT冠状动脉成像在诊断冠状动脉狭窄中的价值

目的:探讨多排螺旋CT(MSCT)冠状动脉成像(MSCTA)在冠状动脉狭窄的诊断中的临床应用价值.方法:37例临床疑为冠心病的患者同时行MSCTA和传统选择性冠状动脉造影DSA(CAG)检查,以CAG结果为"金标准",将二者进行对照分析,了解MSCTA诊断冠心病的敏感性和特异性.结果:37例患者行CAG检查均能显示冠状动脉的各主支及其各段血管,与其相比,MSCTA检查可显示370段血管中的352段血管,显示率为95.2%.各节段冠脉重建图像中左主干、左前降支近中段和右冠近段显示率最高.经CAG证实,37例患者中确诊为冠心病者26例,冠脉未见明显病变者11例.行MSCTA检查有28例显示冠脉明显狭窄,9例未见冠脉明显病变.MSCTA判断冠状动脉狭窄假阳性者3例,假阴性者1例,敏感性96.2%,特异性72.7%,阳性预测值89.3%,阴性预测值88.9%,符合率91.7%.结论:MSCTA是一种简便易行、安全可靠的无创性检查方法,可作为临床诊断冠心病的有效筛选手段.     

Comparison of 99mTc-methoxyisobutylisonitrile myocardial single-photon emission computed tomography and electron beam computed tomography for detecting coronary artery disease in patients with no myocardial infarction

Background Previous studies have compared single-photon emission computed tomography (SPECT) and electron beam computed tomography (EBCT) in detection of coronary artery disease (CAD) in patients with myocardial infarction (MI). The purpose of this study was to compare SPECT with EBCT in detection of CAD in patients with no MI.Methods One hundred and forty-seven patients with suspected CAD underwent stress-rest 99mTc-methoxyisobutylisonitrile (99mTc-MIBI) myocardial SPECT, cardiac EBCT and coronary angiography (CAG) within one month. Of them, 73 patients (aged 52.6±10.6 years old) with no history of MI were included in this study. Coronary artery calcium (CAC) was defined as a CT value ≥130 HU within the boundary of coronary artery on EBCT. Results There were 35 and 38 patients with or without CAD according to CAG. Ninety-six percent of the patients with abnormal SPECT and CAC had a coronary arteries stenosis ≥50%, and 90.9% patients with normal SPECT and EBCT showed no CAD. The sensitivity of SPECT and EBCT in detection of CAD was comparable, and the specificity of SPECT (92.1%) was significantly higher than that of EBCT (55.3%) (P&lt;0.005). For the detection of individual coronary artery stenosis, both sensitivity and specificity of SPECT (75.0% and 93.7%) were significantly higher than those of EBCT (53.3% and 76.7%) (P&lt;0.025 and P&lt;0.005, respectively). In patients without chest pain, the sensitivity and specificity of SPECT (76.9% and 91.4%) were significantly higher than those of EBCT (23.1% and 69.0%) in detection of a coronary artery stenosis of ≥50% (P&lt;0.01 and P&lt;0.005, respectively). However, in patients with chest pain, both sensitivity and specificity of SPECT were comparable to those of EBCT. In patients ≤45 years old, the sensitivity of SPECT (77.8%) was significantly higher than that of EBCT (27.8%) in assessing a coronary artery stenosis of ≥50% (P&lt;0.005), and the specificity of SPECT was comparable to that of EBCT. In patients &gt;45 years old, the specificity of SPECT (94.3%) was significantly higher than that of EBCT (70.5%) (P&lt;0.005), and the sensitivity of SPECT was comparable to that of EBCT. Conclusion 99mTc-MIBI myocardial perfusion SPECT has higher accuracy than that of EBCT in detection of CAD in patients without MI.     

64排螺旋CT冠脉成像与冠状动脉造影对高龄冠心病诊断的对比研究

目的:评价64排螺旋CT冠脉成像(64-SCTCA)对高龄冠心病患者冠状动脉狭窄病变的临床诊断价值.方法:2010年1月～2011年1月期间住院的16例临床诊断或疑诊冠心病的高龄(≥60岁)患者,先后行64-SCTCA和冠状动脉造影(CAG)检查,参照美国心脏协会冠状动脉分段法对冠状动脉进行分段,评价64-SCTCA诊...     

多层螺旋CT冠状动脉造影在冠心病患者中的应用

目的:评价多层螺旋CT冠状动脉造影对冠状动脉狭窄性疾患的临床应用价值.方法:对216例以冠心病入院的患者进行了多层螺旋CT冠状动脉造影,以选择性冠状动脉造影结果为金标准进行对照.采用Somatom Volume Zoom (4-detector-row, Siemens, Germany)进行扫描,并对冠状动脉的主干及主要分支进行了重建和诊断,其结果与金标准结果相对照,分析多层螺旋CT冠状动脉造影的敏感性和特异性.结果:多层螺旋CT所显示的1 512支冠状动脉中冠状动脉狭窄160支,正确诊断139支,漏诊21支,误诊9支,敏感性87%,特异性98%,假阳性率2%,假阴性率13%.其中,对左前降支发生的病变敏感最高,达到91%.结论:多层螺旋CT对冠状动脉狭窄诊断有较高的准确性,作为一种无创性检查可用于高危人群的普查筛选,并可作为冠状动脉造影前的常规检查手段.但由于运动伪影的影响其临床应用还存在一定的限度.     

Assessment of coronary artery disease with second harmonic myocardial perfusion contrast echocardiography

Objectives To assess the relationship between myocardial regional perfusion using second harmonic myocardial contrast echocardiography (MCE) by venous injection of Levovist and coronary artery stenosis detected by coronary angiography to determine whether MCE can be used to detect coronary artery disease (CAD) and its sensitivity and specificity for detecting CAD.Methods Thirty-six patients who underwent coronary artery angiography and MCE formed the study groups.Ten myocardial segments (5 each in the apical two- and four-chamber views) from the images were scored for detecting myocardial perfusion as follows: 1, normal perfusion; 2, decreased perfusion; and 3, perfusion defect.The arteries were classified as normal or diseased.The diseased arteries were classified into three groups according to the perfusion scores.Results There were significant differences in coronary diameter stenosis among the different perfusion score groups (P&lt;0.001).There were 10 total occluded arteries, and the myocardial perfusion scores were different because of different collateral circulation.In the normal perfusion group (Group A), the coronary diameter stenosis was 65%±12%, and the myocardial perfusion score index was 1±0.00.In the decreased perfusion group (Group B), the average coronary diameter stenosis was 82%±8%, and the myocardial perfusion score was 1.93±0.16.The diameter stenosis was less than 85% in 63 % of the coronary arteries (including diameter stenosis ≤75% in 12% of the vessels).The diameter stenosis was 85%-90% in 22% of the coronary arteries and &gt;90% in 15% of the arteries.In the perfusion defect group (Group C), the average diameter stenosis was 90%±6%, and the myocardial perfusion score index was 2.89±0.24.The diameter stenosis was　≥85% in 94% of the coronary arteries, and the diameter stenosis was &lt;85% and &gt;75% only in 6% of the coronary arteries.The overall sensitivity and specificity of MCE in identifying angiographic coronary diameter stenosis was 67% and 100%, respectively.The false negative rate was 32.6% for the 108 coronary arteries.Further subdivided analysis showed the sensitivities in Groups A, B and C were 0, 100%, and 100%, respectively.The sensitivity increased with increased lumen diameter stenosis of coronary arteries.Conclusions There is a close relationship between coronary artery stenosis and MCE perfusion scores.MCE with venous injection of new generation contrast can define the presence of CAD and lesion graded classifications.Some disagreements between perfusion score and coronary diameter of stenosis may indicate other factors such as different collateral circulation, which should be further investigated.As artery stenosis increases, the sensitivity of MCE is increased.     

Value of Acceleration Flow in the Left Anterior Descending Coronary Artery for the Detection of Coronary Artery Stenosis by Transthoracic Coronary Color Doppler Echocardiography

Transthoracic color Doppler echocardiographyhas been widely used to measure the coronary ar-tery flowvelocity reserve[1].It is useful to providei mportant informationfor diagnosis of coronary ar-tery disease and assessment of curative effect afterpercutaneous coronary artery intervention.Butthis evaluats onlythe effect of the stenosis on coro-nary artery flow velocity reserve during maxi malhyperemia reaction.Hemodynamics demonstratesthat localized flow acceleration is present at thestenotic s…     

64层螺旋CT冠状动脉成像与选择性冠状动脉造影的比较分析

目的比较64层螺旋CT冠状动脉成像（64SCTCA）和选择性冠状动脉造影（CAG）对冠心病的诊断价值。方法对32例拟诊或确诊冠心病患者采用64SCTCA与CAG检查分析冠状动脉,并进行对比。结果同时行64SCTCA和CAG检查32例共128支血管,64SCTCA发现68支冠状动脉狭窄,CAG检查发现64支冠状动脉狭窄,两者比较x2=0.25,P=0.617,差异无统计学意义。64SCTCA诊断冠状动脉病变的灵敏度、特异度、阳性预测值、阴性预测值分别为97%、91%、91%、97%;对冠脉中度狭窄的灵敏度、特异度、阳性预测值、阴性预测值分别86.5%、96.8%、82.1%、98.2%;对冠脉重度狭窄的灵敏度、特异度、阳性预测值、阴性预测值分别为92.8%、98.5%、85.5%、99.9%。结论 64SCTCA是一种安全可靠的冠状动脉检查方法,在显示冠状动脉病变时具有较高的敏感性和特异性,对于预测及早期诊断冠心病具有重要的临床应用价值。     

16层螺旋CT与导管法冠脉成像的对照研究

目的 与导管法冠脉成像相对照，探讨16层螺旋CT冠脉造影的临床应用价值。方法 20例16层螺旋CT冠脉造影病例，使用GE Pro lightspeed Plus 16层螺旋CT，选择图像显示最优相位窗对所有管腔直径大于≥2mm冠脉及主要分支血管进行评估及狭窄评价，图像重建方法包括二维曲面重建（CPR）、最大密度投影（MIP）和容积再现（VR）重建，均行导管法冠脉造影对照。结果 在205支冠脉血管中180支可以进行评价，以导管法冠脉造影结果为对照，16层螺旋CT诊断冠脉狭窄≥50%的敏感度、特异度、阳性预测值、阴性预测值分别为89．4%、95．7%、88．5%、96．6%。结论 16层螺旋CT能较准确诊断冠状动脉50%以上的狭窄，是无创性诊断冠状动脉狭窄的有效检查方法。