64MDCT冠状动脉成像在冠心病诊断中的应用价值

目的探讨64层螺旋CT冠状动脉成像在冠心病诊断中的应用价值。方法随机选择我院2010年10月～2011年12月46例由于胸痛、胸闷就诊的患者，分别给予64层螺旋CT冠状动脉成像与选择性冠状动脉造影，以选择性冠状动脉造影检查的结果为“金标准”，分析64层螺旋CT冠状动脉成像在冠心病诊断中的敏感性、特异性及准确率。结果MDCTCA共检查节段586个，直径在1．5mm以上有504个，检出狭窄程度≥50％的28例，漏诊1例，误诊2例。与冠状动脉造影检查结果相比，64层螺旋CT冠状动脉成像检查的敏感性为96．3％（26／27例），特异性为89．5％（17／19例），准确性为93．5％（43／46例），阳性预测值为92．9％（26／28），阴性预测值为94．4％（17／18），差异无统计学意义（P〉0．05）。结论64层螺旋CTCA具有无创、安全、经济且操作简便的优点，对冠状动脉病变诊断具有良好的敏感度和特异性，是一种可广泛应用于冠心病的筛选和诊断的检查方法。

The value of 64 multi-detector CT Coronary Artery Angiography in the diagnosis of coronary heart disease

Objective To observe the clinical value of 64 multi-detector CT coronary angiography in the diagnosis of cor- onary heart disease. Methods Randomly selected 46 patients who suffered from symptoms of chest pain and chest tight- ness from our clinic during the period of 2010.10~2011.12. All the cases were given 64 multi-detector CTCA and selec- tive coronary angiography. Selective coronary angiography was taken as gold standard for calculations of diagnostic accura- cy. Results Of 586 segments, 504 vessels with a diameter≥1.5 mm were analysed and a lumen restriction of ≥ 50 % was considered a significant stenosises. 28 patients were diagnosed coronary heart disease. One patient was notable and two patients were misdiagnosed. Compared with SCA, the sensitivity of 64multi-detector CTCA to diagnose significant stenosis was 96.3 % （26/27）, specificity was 89.5 % （17/19）, positive predictive value （PPV） was 92.9 % （26/28）, neg- ative predictive value （NPV） was 94. 4 % （17/18）, and accuracy was 93. 5 % （43/46）. Conclusion As a noninvasive method for assessing coronary artery disease, 64 multi-detector CTCA has many other advantages ; safety, low-cost, and easy to operate. Because of high sensitivity and specificity, it is a prospective method that should be widely used in screen- ing and diagnosis for coronary artery disease.