离体冠状动脉粥样硬化斑块64层MSCT、MRI及病理对照研究

目的与组织学对照,评价64层螺旋CT和1.5TMRI在显示离体冠状动脉粥样硬化斑块成分的作用。材料与方法对13例尸检患者的心脏,行冠状动脉前降支近段CT及MRI检查,并与病理学相对照。采用诊断试验分析CT、MRI诊断各型斑块的敏感性和特异性,评价CT、MRI对斑块分类的准确性。结果94个CT、MRI层面可与相应的组织学层面相对应。CT对于各型斑块分类的敏感性和特异性分别为:Ⅰ～Ⅱ型,0%和100%;Ⅲ型,0%和100%;Ⅳ～Ⅴ型,92.3%和86.8%;Ⅵ型,0%和100%;Ⅶ型,100%和100%;Ⅷ型,100%和97.8%。MRI对于各型斑块分类的敏感性和特异性分别为:Ⅰ～Ⅱ型,60%和100%;Ⅲ型,80%和100%;Ⅳ～Ⅴ型,96.2%和86.8%;Ⅵ型,100%和98.9%;Ⅶ型,93%和100%;Ⅷ型,100%和98.9%。结论CT、MRI可显示冠状动脉粥样硬化斑块的特点,对斑块进行分型MRI优于CT。

64-Slice Spiral CT and MRI Study of Coronary Atherosclerotic Plaques in Vitro: Comparison with Pathology

Objective To assess the values of 64-slice CT and MRI in demonstrating the component of coronary athero-sclerotic plaques in vitro.Materials and Methods Thirteen consecutive autopsy hearts were examined.CT was performed with 120 kV,200 eft.mAs,pitch 1.0,slice collimation 64 x0.6 ram,0.5s/r,scan time 3s,thickness 0.6 mm,increment 0.4 ram.4 ml contrast agent (Omnipaque 350mgI/ ml )was infused into 100 ml saline and then was injected into LAD before scanning.MRI was performed with 3D FIESTA sequence which was used to locate left anterior descending artery (LAD) and then the cross-sectional images of 2D T_1,WI,PDW,frFSE T_2WI perpendicular to long axis of LAD were obtained.Resovist (0.5 mmol Fe/ml )was infused into 100 ml saline and then injected into LAD before PDW and T_2WI started.Standard path-ologie sections were obtained corresponding to the MRI and CT images perpendicular to LAD.CT,MRI images and pathologic sections were independently reviewed,categorized and compared.The sensitivities and speeificities of CT and MRI for plaque classification were analyzed respectively using diagnostic test.Results Ninety-four histological sections were matched with CT and MRI images.The sensitivities and specificities of CT for categorizing different lesion types were as follows:type Ⅰ-Ⅱ,0% and 100% ;type Ⅲ,0% and 100% ;type Ⅳ-Ⅴ,92.3% and 86.8% ;type Ⅵ,0% and 100% ;type Ⅶ,100% and 100% ;type Ⅷ,100% and 97.8%.The mean CT values for different lesion types were as follows: type Ⅳ-Ⅴ ,53.7±17.8HU ;type Ⅶ,1065±418HU;type Ⅷ,89.3±1.2HU.The sensitivities and specificities of MRI for categorizing different lesion types were as follows :type Ⅰ-Ⅱ,60% and 100% ; type Ⅲ,80% and 100%;type Ⅳ-Ⅴ,96.2% and 86.8%;type Ⅵ,100% and 98.9% ;type Ⅶ,93% and 100% ; type Ⅷ,100% and 98.9%.Conclusion MRI is superior to CT for demonstrating the characteristics of coronary atherosclerotic plaques and plaque classification.