双源CT检测和定性冠状动脉粥样硬化斑块的评价

目的　双源CT增强扫描检测和定性冠状动脉粥样硬化斑块的评价。 方法　使用双源CT对冠状动脉进行0.6 mm层厚横断面增强扫描，根据CT值将斑块分为钙化、非钙化和混合斑块。病理分型作为对比标准。 结果　病理切片发现75个斑块,63个斑块被双源CT检测, 双源CT对检测所有斑块的敏感性为84%(63/75),对检测I~III型的敏感性为0%,对检测IV型、Va型、Vb型和Vc型的敏感性分别为77.8%、80%、97.9% 和85.7%。 钙化斑块、混合斑块和非钙化斑块的平均CT值 (分别是：416.5±94.4 HU、142.8±48.6 HU和46.3±34.2 HU；P<0.05) 有明显差异。以脂质为主的斑块（IV型和Va型）和以纤维为主的斑块( Vc型)的平均CT值(分别是：30.4±24.4 HU和73.3±23.3 HU；P<0.05)有显著差异。 结论　双源CT增强扫描能够检测不同类型的冠状动脉粥样硬化斑块，斑块的平均CT值能够代表斑块的主要成分，且与病理分型有很好的一致性。

Ex vivo evaluation of dual-source CT detecting and characterizing the coronary atherosclerotic plaques

Objective To evaluate the ability of dual-source CT contrast enhancement scanning detecting and characterizing the coronary atherosclerotic plaques. Methods Coronary arteries were scanned by contrasted-enhanced DSCT with an axial slice thickness of 0.6 mm. According to the CT attenuation values, plaques were classified as calcified, mixed and non-calcified. Histopathologic classification was considered the standard of reference. Results Histopathology detected 75 plaques, among which 63 plaques were found at DSCT. The sensitivity of DSCT for detecting all plaques was 84%(63/75), for detecting I-III type plaques was 0%, for detecting IV type、Va type、Vb type and Vc type plaques were 77.8% 、80% 、97.9% and 85.7%, respectively. The mean CT attenuation values of calcified、mixed and non-calcified (416.5±94.4 HU, 142.8±48.6 HU, 46.3±34.2 HU, respectively; p<0.05) were significantly different. There was significant difference between the mean attenuation values of predominantly lipid-rich and fiber-rich plaques (30.4±24.4 HU and 73.3±23.3 HU, respectively; P<0.01). Conclusion Dual-source CT contrast enhancement scanning can detect different types of coronary atherosclerotic plaques. The plaque mean CT attenuation values can represent predominant plaque component which were correlated well with histopathologic classification.