64排螺旋CT冠状动脉造影与传统冠状动脉造影的对照研究

目的探讨64排螺旋CT冠状动脉造影（computed tomography coronary angiography, CTCA）,，对冠状动脉疾病的诊断价值。方法56例确诊或怀疑为冠心病的患者均行64排螺旋CT冠状动脉成像和传统冠状动脉造影（conventional coro-nary angiography，CCA）检查，并以CCA的诊断结果作为金标准，采用美国心脏协会冠状动脉改良分段法，分析共825个冠状动脉节段CTCA图像质量及其对冠状动脉狭窄的显示情况，得出CTCA诊断有意义病变（冠状动脉狭窄≥50％）fl＇,J正确性，并分析影响CTCA图像质量的主要因素。结果798个冠状动脉节段图像可以满足诊断要求，12个节段中因运动伪影或15个节段管壁严重钙化无法对血管腔进行评估。64排螺旋CT冠状动脉成像诊断≥50％狭窄总的敏感性、特异性、阳性预测值、阴性预测值、准确性分别为88．1％、97．8％、89．9％、97．4％和96％。影响图像质量主要因素为快心率、严重钙化。结论64排螺旋CT冠状动脉成像图像质量高，对冠状动脉疾病的诊断十分准确，可作为一种简便易行、安全可靠的无创性筛查冠心病的有效方法。

Comparative Study between 64-slice Computed Tomographic Angiography and Coronary Angiography for Detecting Coronary Artery Disease

Objective To study the diagnostic value of 64-slice spiral CT coronary angiography （CTCA） in coronary artery stenoses.Methods Patients with known or suspected coronary artery disease underwent both 64- slice spiral coronary angiography and conventional coronary angiography （CCA）.Conventional coronary angiogra- phy was taken as golden standard,and a 15-segrnent modified AHA classification was used to evaluate the image quality of 825 available coronary segments of CTCA and the performance in detecting coronary artery lesions. The method is also applied to obtain the diagnostic accuracy of CTCA of significant lesions（a lumen restriction of~〉 50%）,and to analyze the main factor that impact image quality of CT coronary angiography.Resuits There were 798 coronary segments considered to have diagnostic image quality,but 27 segments could not be evaluated for motion artifacts（12 segments） and severe calcifications （15 segments）.The sensitivity, specificity,positive predic- tive value and negative predictive value of MSCT in detecting lesions were 88. I%, 97.8%, 89.9% and 97.4%, respectively.The main factors impact image quality were high heart rate and severe calcifications.Conclusion Compared to CCA,64-CTCA with high diagnostic accuracy of coronary artery disease,so 64-CTCA is a simple, convenient,safe and reliable,non-invasive method for effective diagnosis of coronary heart disease.