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.

Clinical application of multislice spiral CT coronary angiography in patients with coronary artery disease

Objective: To evaluate the accuracy and feasibility of multislice spiral computed tomography (MSCT) in detecting coronary artery stenoses. Methods: Totally 216 consecutive in-patients with coronary artery diseases underwent MSCT angiography, which was performed by a Somatom Volume Zoom (4-detector-row, Siemens, Germany) with slice thickness 1.0 mm, pitch=1.5 (table feed: 1.5 mm per rotation). The results of selective coronary angiography (SCA) was taken as gold standard for coronary artery stenoses. Multiplanner reconstruction images and axial images of the left main coronary artery (LMCA), left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA) as well as their main branches were obtained and evaluated for luminal narrowing. Results: Of 1 512 coronary arteries evaluated, 160 stenoses were diagnosed by MSCT. Compared with the results of SCA, 139 of 160 were correctly diagnosed, 21 were missed and 9 were misdiagnosed, with the sensitivity, specificity false positive rate, and false negative rate being 87%, 98%, 2% and 13%, respectively. The sensitivity of MSCT for detection of LAD stenoses was the highest(91%). Conclusion: MSCT coronary angiography can accurately detect coronary stenoses. As a non-invasive method it may be used for screening patients with known or suspected coronary artery diseases.