冠状动脉造影三维重建与造影平面定量对比分析

目的研究冠状动脉造影三维重建定量分析冠状动脉狭窄病变的准确性，并与传统冠状动脉造影平面图像比较。方法收集2006年9月至200／年3月于解放军总医院接受冠状动脉造影和冠状动脉血管内超声检查（IVUS）的20处血管段（19例患者）的影像资料。以IVUS为参照，回顾性分析比较冠状动脉三维重建和传统平面图像对狭窄病变血管段最窄处管腔直径／面积、参考血管直径／面积、最窄处截面积狭窄率等的测量值。结果全部20处病变中，在三维重建和平面图像两种测量方法与IVUS各参数值差异无统计学意义；进一步分成偏心斑块组和向心斑块组，向心斑块组中三者测量值差异仍无统计学意义，而在偏心斑块组中冠状动脉三维重建对病变狭窄率测量比传统平面图像更准确（两组病变血管最窄处面积狭窄率为56．42％±11．02％比43．69％±21．41％，P〈0．05）。结论冠状动脉造影三维重建能够准确定量分析冠状动脉狭窄病变，对偏心性狭窄病变的准确性比传统造影平面图像更高。

Comparative analysis with three dimentional reconstruction coronary angiography and conventional quantitative coronary angiography

Objective To investigate the diagnostic accuracy of 3-dimensional reconstruction （3DR） coronary angiography in the evaluation of coronary artery disease compared with conventional quantitative coronary angiography with IVUS result as the reference standard. Methods Twenty vessel segments in nineteen patients who underwent coronary angiography and IVUS were studied. With the IVUS result as the reference standard, the 3D reconstruction images and the single plane （2D） images of each angiograph were retrospectively studied and compared. Results In all the 20 segments, the minimal vessel diameter/area rate of the stenosed vessels and the reference vessels, and the minimal cross-sectional stenosis rate had no significant differences among the conventional 2D angiograph the 3DR angiograph and the IVUS results. According to the IVUS results, all the 20 vessel/segments were further divided into two groups which were： the eccentric stenosis group （n =7） and the centripetal stenosis group （n = 13）. In the centripetal stenosis group, all the angiographic parameters detected by the three methods had no statistical difference. In the eccentric stenosis group, the 3DR angiograph showed more consistent results as detected by IVUS compared with the 2D angiograph in terms of cross-sectional stenosis rate. Conclusion Three dimentional reconstruction of coronary angiography showed higher accuracy in the quantitative analysis of coronary artery stenosis compared with conventional coronary angiography, especially in eccentric stenosis.