多排螺旋CT冠状动脉成像在诊断冠状动脉狭窄中的价值

目的:探讨多排螺旋CT(MSCT)冠状动脉成像(MSCTA)在冠状动脉狭窄的诊断中的临床应用价值.方法:37例临床疑为冠心病的患者同时行MSCTA和传统选择性冠状动脉造影DSA(CAG)检查,以CAG结果为"金标准",将二者进行对照分析,了解MSCTA诊断冠心病的敏感性和特异性.结果:37例患者行CAG检查均能显示冠状动脉的各主支及其各段血管,与其相比,MSCTA检查可显示370段血管中的352段血管,显示率为95.2%.各节段冠脉重建图像中左主干、左前降支近中段和右冠近段显示率最高.经CAG证实,37例患者中确诊为冠心病者26例,冠脉未见明显病变者11例.行MSCTA检查有28例显示冠脉明显狭窄,9例未见冠脉明显病变.MSCTA判断冠状动脉狭窄假阳性者3例,假阴性者1例,敏感性96.2%,特异性72.7%,阳性预测值89.3%,阴性预测值88.9%,符合率91.7%.结论:MSCTA是一种简便易行、安全可靠的无创性检查方法,可作为临床诊断冠心病的有效筛选手段.

Clinical application of coronary angiography by MSCT

Objective:To evaluate the applied value in clinics of MSCTA diagnostic accuracy in determining coronary artery stenosis. Methods:Thirty-seven patients suspected clinically to be coronary heart disease were examined with MSCTA and conventional angiography(CAG).The CT data were obtained within a single breathhold,and isocardiophasic slices were reconstructed by means of retrospective electrocardiographic gating in left main(LMA),left anterior descending(LAD),left circumflex(LCX),right coronary artery(RCA)and branches respectively. All cases were performed with coronary angiography which was regarded as a gold standard to study sensitivity and specificity after comparing the results of two experiments. Results: In 370 segments of main arteries in 37 cases with MSCT examinations,352 arteries(95.2%) could be analysed for diagnosis.The demonstration of LMA,the proximal-middle segment of LAD and the proximal one of RCA were best in reconstruction images.26 patients in 37 were diagnosed as the stenosis of coronary arteries in CAG.Meanwhile,28 patients by means of MSCTA investigation,were found to be stenosis.The total sensitivity of MSCTA was 96.2% and specificity 72.7%. Conclusion: Coronary angiography with MSCT can be used as a non-invasive screening method to diagnose stenosis of coronary artery.