64排螺旋CT冠状动脉成像在冠状动脉病变诊断中的临床研究

目的探讨和评价64排螺旋CT（MSCT）在冠心病诊断中的有效性。方法选取在3周内行64排MSCT和冠状动脉造影（CAG）检查的临床可疑或确诊冠心病的患者（两项检查平均间隔时间9d）114例，其中男性62例，平均年龄65岁。将MSCT和CAG检查结果进行分析，管腔狭窄≥50％定义为明显狭窄。结果在114例患者中，CAG检出至少有1处明显狭窄的患者106例，其中单支病变占33％（38例），多支病变占60％（68例）。MSCT检出其中的104例（诊断准确度95％）。按节段分析，MSCT诊断冠状动脉明显狭窄的灵敏度、特异度、阳性预测值、阴性预测值分别为87％、96％、86％、96％。以各冠状动脉分析，MSCT诊断冠状动脉明显狭窄的灵敏度、特异度、阳性预测值、阴性预测值分别为96％、94％、95％、96％。MSCT与CAG在发现冠状动脉明显狭窄上差异无统计学意义（P〉0．05）。结论64排MSCT诊断冠状动脉狭窄的准确度较高，作为一种冠心病诊断的无创筛查手段，有广泛的临床应用价值。

Investigation of 64-slice computed tomography angiography in diagnosis of coronary artery disease

Objective To investigate the accuracy of 64-slice computed tomography compared with CAG in the diagnosis of coronary artery disease. Methods MSCT angiography was performed in 114 patients （62 male, mean age 65 ± 12 years） with suspected or proven coronary artery diseases and CAG was performed in these patients after a mean interval of 9 days. All vessels with diameter 〉 1.5 mm were analyzed （American Heart Association 15-segment model ）. A significant stenosis was assumed if the diameter reductions〉 50%. Results were analyzed for significant stenosis by segment and by artery. Results Coronary angiography demonstrated the presence of significant stenosis in 93% （ 106 of 114） of the patients and among them, 33% （38 of 114） had single-vessle disease and 60% （68 of 114） had multi-vessel diseases. Among the 106 patients having significant coronary stenosis shown by CAG, MSCT identified 104 of them. After exclusion of unevaluable coronary segments, the sensitivity, specificity, positive predictive value,and negative predictive value of MSCT were 87%, 96%, 86% and 96% in per-segment analysis. In per-artery analysis, the sensitivity, specificity, positive predictive value, and negative predictive value of MSCT were 96%, 94%, 95% and 96% respectively. There was no statistical difference in the diagnosis of CAD by means of 64-slice MSCT or CAG （P 〉 0. 05 ）. Conclusion 64-slice CT provided a high diagnostic accuracy in assessing coronary artery stenosis.