多层螺旋CT血管成像对冠状动脉狭窄的临床应用

目的：探讨多层螺旋CT血管成像（multi-slice spiral CT angiography,MSCTA）对冠状动脉狭窄的临床应用价值。方法：对临床可疑冠状动脉狭窄的23例患者进行了多层螺旋CT（multi-slice spiral CT,MSCT）及选择性冠状动脉造影（selective coronary angiography,SCA）检查,男14例,女9例,年龄35-76岁。以管腔狭窄≥50％为诊断标准,将MSCTA与SCA检查结果进行对照分析,评价MSCTA在诊断冠状动脉狭窄中的应用价值。结果：23例患者中,用于评价的92个血管分支中2种检查方法均为阳性的血管节段为30支,均为阴性者8支,SCA阳性而MSCrA阴性1支,SCA阴性而MSCTA阳性5支,MSCTA敏感度96．8％,特异度61．5％,阳性预测值85．7％,阴性预测值88．9％;MSCrA诊断冠状动脉狭窄和SCA有很好的一致性（P〉0．005）;21例冠状动脉狭窄阳性患者中有17例发现冠状动脉壁存在钙化。结论：MSCTA对冠状动脉狭窄具有重要的临床应用价值。     

冠状动脉多层螺旋CT血管造影扫描技术的应用及其临床价值

目的探讨冠状动脉多层螺旋CT血管造影(MSCTA)扫描技术的应用及其临床价值。方法86例受试者均行冠状动脉MSCTA,对照分析不同扫描条件下重建图像对冠状动脉的显示能力;并将25例冠心病患者的MSCTA结果与选择性冠状动脉造影(SCA)结果对照,分析冠状动脉及其分支的通畅性,狭窄发生的部位和严重程度,评价MSCTA的临床应用价值。结果(1)通过对照分析不同扫描条件下MSCTA重建图像对冠状动脉的显示结果,以心率控制在60次/min以下、注射流率3.0~3.5 ml/s、注射剂量120~150 ml、延迟22~25 s扫描时冠状动脉显示最佳;(2)以SCA为“金标准”,25例冠心病患者的冠状动脉支中,71支MSCTA显示无狭窄,其中68支显示正确;29支显示狭窄的动脉支中,19支显示正确。其阴性预测值和阳性预测值分别为87.2%和65.5%;敏感度、特异度和准确度分别为86.4%、87.2%、87.0%。结论MSCTA作为无创性检查,是评价冠状动脉病变的重要的筛选手段。     

经静脉电子束CT冠状动脉造影的临床应用

目的 探讨经静脉电子束CT（EBCT）冠状动脉造影的临床应用价值。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造影诊断冠心病和冠状动脉狭窄的准确性。结果 （1）EBCT造影可清晰显示和评价共38例152支心外膜冠状动脉中的134支（88．2％），另18支（11．8％）显影不清。左主干全部清晰显示，左前降支，左回旋支和右冠状动脉显影清晰者分别为94．7％，81．6％和76．3％，左主干和前降支显示的比例高于左回旋支和右冠状动脉，统计学上差异有显著性意义（P＜0．05）；（2）EBCT造影诊断冠心病的敏感度，特异度，准确度，阳性和阴性预测值分别为88．0％，84．6％，86．8％，91．7％和78．6％；（3）在38支腔径狭窄≥50％的血管中，EBCT造影低估了其中8支的病变程度，敏感度为78．9％；在96支无明显狭窄的血管中，EBCT造影高估了其中7支的病变程度，特异度为92．7％。结论 经静EBCT冠状动脉造影是1种很有价值的无创性诊断冠心病的方法，其诊断左主干和前降支病变的价值高于右冠状动脉及左回旋支。     

多层螺旋CT回顾性心电门控冠状动脉重建的最佳R-R时相及其临床应用

目的 探讨多层螺旋CT回顾性心电门控冠状动脉重建的最佳R-R时相，评价多层螺旋CT冠状动脉重建的临床应用价值。方法 对20例拟诊冠心病患者多层螺旋CT扫描后，利用回顾性心电门控重建出37．5％、50．0％、62．5％、75．0％R-R时相的横断面图像。然后进行冠状动脉容积重建及仿真血管内窥镜重建，分析不同R-R时相各支冠状动脉的显示情况。以选择性冠状动脉造影结果为对照，评价多层螺旋CT冠状动脉重建图像诊断冠状动脉≥50％管径狭窄的临床应用价值。结果 左前降支、左回旋支和右冠状动脉重建的最佳时相为50．0％和62．5％R-R时相；多层螺旋CT冠状动脉重建图像诊断冠状动脉≥50％管径狭窄的敏感度、特异度、阳性预测值、阴性预测值和诊断正确率分别为91．7％、83．3％、28．2％、99．3％和83．9％。结论 选择回顾性心电门控最佳R-R时相重建冠状动脉可以最大限度减轻心脏运动伪影，提高图像质量；多层螺旋CT冠状动脉重建图像具有很高的敏感度和阴性预测值，可以作为选择性冠状动脉造影前的筛选检查。     

冠状动脉MSCTA成像在冠心病诊断中的应用

目的评价多层螺旋CT冠状动脉成像对冠心病病变的临床诊断价值。方法对57例临床初诊或可疑冠心病患者行多层螺旋CT冠状动脉成像(MSCTA),并且与常规冠状动脉造影(CAG)做对照分析。结果 57例患者的228支冠脉分支中,冠脉CTA成像检出病变冠脉213支(93.4%),MSCTA诊断冠状动脉血管狭窄≥50%的均有较高的灵敏度、特异度、阳性预测值、阴性预测值和准确度,分别为88%、99%、91%、98%和99%。钙化斑块组的CT值(415.2±221.1)HU明显高于非钙化斑块的CT值(68.4±47.5)HU(P<0.01)。结论 MSCTA对显示有临床意义的冠状动脉狭窄(≥50%)具有优良诊断价值,几乎可以代替有严重并发症的冠状动脉造影,能够结合密度测定判定斑块的性质,对判断冠脉斑块的稳定性具有重要的临床意义,是安全、准确、可靠的冠心病诊断方法。     

64层VCT对冠状动脉狭窄的诊断价值：并与冠脉造影对照

目的：评价64层VCT对冠状动脉狭窄程度的诊断价值和限度。方法：48例临床高度可疑冠心病的患者做64层VCT冠状动脉成像检查，检查结果与同期导管法冠脉造影对照。结果：48例共624段血管中，能满足评价的为608段（占97．3％）。64层VCT显示50％以上狭窄的敏感性和特异性分别为92．8％、99．1％，阳性和阴性预测值分别为91．2％、99％。结论：64层VCT对冠状动脉狭窄（〉50％）有极高的诊断价值。     

多层螺旋CT冠状动脉造影扫描技术及图像质量的影响因素

目的探讨多层螺旋CT冠状动脉造影(MSCTA)的方法及影响图像质量的因素。资料与方法对106例临床疑有冠心病的患者进行MSCTA，其中58例疑有冠状动脉狭窄的患者进行了选择性冠状动脉造影，评价MSCT对冠状动脉近段、中段和远段的显示能力，分析影响图像质量的因素。结果MSCTA对冠状动脉近中段的显示率达91．2％以上，对冠状动脉远段的显示较差。结论MSCTA可作为冠状动脉粥样硬化疾病的筛选手段，显示冠状动脉图像清晰可靠。     

浅谈64层螺旋CT冠状动脉造影扫描技术及影响图像质量的因素

目的探讨多层螺旋CT冠状动脉造影（MSCTA）的方法及影响图像质量的因素。方法82例临床疑有冠心病的患者均经MSCTA检查，其中，46例疑有冠状动脉狭窄的患者又行选择性冠状动脉造影，评价MSCTA对冠状动脉近段、中段和远段的显示能力，分析影响图像质量的因素。结果MSCTA对冠状动脉近、中段的显示率达93．2％以上，对冠状动脉远段的显示略差。结论MSCTA可作为冠状动脉粥样硬化疾病的筛选手段，显示冠状动脉图像清晰可靠。     

16层螺旋CT后处理方法在评价冠状动脉狭窄中的应用价值

目的 探讨16层螺旋CT各种后处理方法在诊断冠状动脉中度以上狭窄中的价值。资料与方法 41例患者均行16层螺旋CT冠状动脉成像以及传统冠状动脉造影（CAG），将CT横轴位图像以及后处理图像多平面重建（MPR）、最大密度投影（MIP）、容积重建（VR）以及仿真内镜（VE）分别与CAG对照，分析评价不同后处理图像在诊断冠状动脉中度以上狭窄中的应用价值。结果 MPR、MIP、VR、VE判断冠状动脉中度以上狭窄的敏感度、特异度、阳性预测值、阴性预测值分别为84．5％、94.4％、90．9％、90．3％；45.1％、82．4％、62．7％、69．5％；57．7％、87．0％、74．5％、75．8％；52．1％、85．1％、69．8％、73.0％。结论 MSCT多种后处理方法各有其优缺点，在诊断中应以横轴位图像结合MPR为主，VR、MIP和VE为辅，能准确、立体、直观地显示并判断冠状动脉病变。     

64排128层螺旋CT血管造影成像技术对颈内动脉粥样硬化狭窄性病变的诊断价值简

目的：探讨64排128层螺旋CT血管造影成像技术（MSCTA）在颈内动脉粥样硬化狭窄性病变诊断中的应用价值。方法回顾性分析行颅颈部CTA检查的31例缺血性脑血管病患者的临床资料,患者全部行颅颈部CTA检查,对其颈动脉成像质量进行评价。结果本组31例缺血性脑血管病患者检查共发现病变血管43支,轻度狭窄20支（46％）,中度狭窄14支（33％）,重度狭窄7支（16％）,闭塞2支（5％）。其中1级可评价血管显示率为87％,2级可评价血管显示率为11％,3级可评价血管显示率为2％。结论64排128层MSCTA可用于颈内动脉粥样硬化狭窄性病变的诊断。     

Detection of coronary artery stenoses with multislice helical CT angiography

OBJECTIVES: The authors compared multislice CT angiography and selective angiography for the assessment of coronary artery disease. METHODS: In 28 patients, the presence and degree of coronary artery stenoses were determined in coronary segments prepared with beta-blocker for good image quality with multislice CT. RESULTS: In 187 coronary artery segments, sensitivity, specificity, and negative predictive value for the detection of stenoses >50% with multislice CT angiography were 81%, 90%, and 97%, respectively. The agreement for determining the degree of stenoses with multislice CT angiography and selective coronary angiography was only moderate (kappa = 0.58). CONCLUSIONS: Because of the limited spatial resolution, it is not possible with multislice CT angiography to determine the degree the coronary artery stenoses precisely. However, the high negative predictive value indicates that multislice CT may be a suitable tool to reliably rule out coronary artery disease.     

MR coronary angiography with breath-hold targeted volumes: preliminary clinical results

PURPOSE: To assess the clinical value of a magnetic resonance (MR) coronary angiography strategy involving a small targeted volume to image one coronary segment in a single breath hold for the detection of greater than 50% stenosis. MATERIALS AND METHODS: Thirty-eight patients referred for elective coronary angiography were included. The coronary arteries were localized during single-breath-hold, three-dimensional imaging of the entire heart. MR coronary angiography was then performed along the major coronary branches with a double-oblique, three-dimensional, gradient-echo sequence. Conventional coronary angiography was the reference-standard method. RESULTS: Adequate visualization was achieved with MR coronary angiography in 85%-91% of the proximal coronary arterial branches and in 38%-76% of the middle and distal branches. Overall, 187 (69%) of 272 segments were suitable for comparison between conventional and MR coronary angiography. The diagnostic accuracy of MR coronary angiography for the detection of hemodynamically significant stenoses was 92%; sensitivity, 68%; and specificity, 97%. The sensitivity in individual segments was 50%-77%, whereas the specificity was 94%-100%. CONCLUSION: Adequate visualization of the major coronary arterial branches was possible in the majority of patients. The observed accuracy of MR coronary angiography for detection of hemodynamically significant coronary arterial stenosis is promising, but it needs to be higher before this modality can be used reliably in a clinical setting.     

第二代双源CT前门控冠状动脉成像与冠状动脉造影比较的初步研究

目的:探讨第二代双源CT前门控冠状动脉成像(CTCA)对冠状动脉狭窄病变的诊断价值。方法:连续44例同期行第二代双源CT前门控CTCA(其中前门控序列扫描35例,前门控大螺距螺旋扫描9例)及选择性冠状动脉造影(SCA)检查的患者,按冠脉病变狭窄程度分为:无狭窄;轻度狭窄(狭窄≤50%);中度狭窄(狭窄50%～75%);重度狭窄(狭窄≥75%);闭塞(狭窄100%),将中度及中度以上狭窄定义为有意义狭窄。以SCA为金标准,分析第二代双源CT前门控CTCA诊断冠状动脉狭窄的敏感性、特异性、阳性和阴性预测值及准确度,同时计算第二代双源CT前门控CTCA的辐射剂量。结果:44例患者冠脉直径2mm以上的节段共570个,其中12段图像质量较差,无法评估,可评估节段占97.89%。第二代双源CT前门控CTCA按冠脉节段计算,诊断冠状动脉狭窄的敏感度、特异度、阳性和阴性预测值、准确度分别为90.18%、93.05%、76.52%、97.42%、92.47%,诊断冠状动脉有意义狭窄的敏感度、特异度、阳性和阴性预测值、准确度分别为90.14%、95.69%、75.29%、98.52%、94.98%。第二代双源CT前门控CTCA与SCA比较对冠状动脉狭窄评价的差异无统计学意义(χ2=2.10,P>0.05),对冠状动脉有意义狭窄评价的差异无统计学意义(χ2=1.46,P>0.05)。第二代双源CT前门控CT-CA的平均辐射剂量为(3.36±1.59)mSv,其中前门控序列扫描的平均辐射剂量为(3.99±1.18)mSv,前门控大螺距螺旋扫描的平均辐射剂量为(1.11±0.44)mSv。结论:第二代双源CT前门控成像对诊断冠状动脉狭窄的准确度稍低于SCA,但其阴性预测值较高,同时其辐射剂量较低,可作为临床冠心病筛查的无创性检查手段。     

64层螺旋CT冠状动脉成像临床应用评价

目的:评价64层螺旋CT冠状动脉成像(64SCTCA)的图像质量和在诊断冠状动脉疾病的临床价值。方法:搜集35例患者64SCTCA的完整资料,并以近期实施的选择性X线冠状动脉成像(SCA)结果为金标准进行对比,对64SCTCA显示的冠状动脉主支及主要分支情况进行分级评估。结果:35例病例可用于评估的冠状动脉共计368支,成功率达95.6%。其中SCA共显示74个节段冠脉有中、重度狭窄(≥50%)。MSCTCA诊断中重度狭窄的敏感性为86.5%,特异性为97.3%,阳性预测值88.9%,阴性预测值96.6%。经配对χ2检验,P>0.05,证明两种检查方法在发现冠状动脉病变方面差异无统计学意义。结论:64层螺旋CT冠状动脉成像是一种无创、快速的成像方法,对诊断冠状动脉≥50%狭窄有较高的敏感性和特异性,适合用于临床怀疑冠心病的患者SCA前的筛选检查。     

Three-dimensional respiratory-gated coronary MR angiography with reference to X-ray coronary angiography

Purpose: To assess the clinical value of three-dimensional coronary MR angiography (CMRA) in the detection of significant coronary artery stenosis using conventional X-ray angiography as the standard reference.

Material and Methods: Sixty-nine patients underwent X-ray coronary angiography and CMRA because of suspected or previously diagnosed coronary artery disease. MRI was performed with a 1.5-T whole body imaging system using ECG-triggered 3D gradient echo sequence with retrospective navigator echo respiratory gating and fat suppression.

Results: A total of 276 coronary artery segments were analyzed. The X-ray coronary angiography was normal in 22 patients. Significant proximal stenoses (exceeding 50%) or occlusions were present in 102 coronary artery segments. In all, 120 stenoses or occlusions were identified in CMRA. Sixteen percent of the coronary artery segments had to be excluded because of poor image quality. The overall sensitivity and specificity for MRA for identification of significant stenosis were 75% and 62%, respectively. CMRA correctly detected 89% of patients with at least one vessel disease, but 6 patients with coronary artery disease would have been missed.

Conclusions: Because of the high data exclusion and false- negative case rate, CMRA with retrospective navigator echo triggering is at present not suitable as a clinical screening method in coronary artery disease.     

多层螺旋CT在评价冠状动脉支架中的价值

目的：探讨多层螺旋CT冠状动脉造影（multi slice spiral computed tomographic angiog raphy,MSCTA）在冠状动脉支架评价中的价值.方法：对 28例冠状动脉支架患者行冠状动脉M SCTA检查,利用MSCT的各种先进的后处理功能对冠状动脉进行重建,以显示冠状动脉支架的形态、位置及有无支架术后的再狭窄.结果：在28 例多层螺旋CT冠状动脉造影中2例由于患者有严重的窦性心率不齐,多层螺旋CT检查重建图像质量欠佳,其余患者多层螺旋CT冠状造影检查均成功的显示冠状动脉各主支 （左主支、回旋支、前降支右支冠状动脉）,且可显示所有冠状动脉支架的形态、位置,其中9例患者的10个支架术后出现再狭窄,所有患者行MSC T冠脉造影检查无1例患者出现并发征,所有MSCT冠脉造影检查怀疑支架再狭窄的患者均同时行选择性血管造影检查,其中8例患者的8个支架诊断与MSCT冠脉造影检查结果相一致,其符合率为88.89%.结论：冠状MSCTA是一种安全可靠的检查方法,可作为冠状动脉一种无创检查方法,是评价冠状动脉支架有无再狭窄的重要检查手段之一.     

Noninvasive coronary angiography using 64-detector-row computed tomography in patients with a low to moderate pretest probability of significant coronary artery disease

PURPOSE: To evaluate the value of 64-detector-row computed tomography for ruling out high-grade coronary stenoses in patients with a low to moderate pretest probability of significant coronary artery disease. MATERIAL AND METHODS: The study included 61 patients with a suspicion of coronary artery disease on the basis of atypical angina or ambiguous findings in noninvasive stress testing and a class II indication for invasive coronary angiography (ICA). All patients were examined by 64-detector-row computed tomography angiography (CTA) and ICA. On a coronary segmental level, the presence of significant (> or = 50% diameter) stenoses was examined. RESULTS: In a total of 915 segments, CTA detected 62 significant stenoses. Thirty-four significant stenoses were confirmed by ICA, whereas 28 stenoses could not be confirmed by ICA. Twenty-two of them showed wall irregularities on ICA, and six were angiographically normal. Accordingly, on a coronary segmental basis, 28 false-positive and 0 false-negative findings resulted in a sensitivity of 100%, a specificity of 96.8%, a positive predictive value of 54.8%, and a negative predictive value of 100%. The diagnostic accuracy was 96.9%. CONCLUSION: Sixty-four-detector-row computed tomography reliably detects significant coronary stenoses in patients with suspected coronary artery disease and appears to be helpful in the selection of patients who need to undergo ICA. Calcified and non-calcified plaques are detected. Grading of stenoses in areas with calcification is difficult. Frequently, stenosis severity is overestimated by 64-detector-row computed tomography.