64层螺旋CT冠状动脉成像评价冠状动脉支架通畅性

目的探讨64层螺旋CT冠状动脉成像评价冠状动脉支架通畅性的临床应用价值。方法对29例冠状动脉支架植入术后患者的59枚支架行64层螺旋CT回顾性心电门控增强扫描,扫描与支架植入术的平均间隔是(28.4±21.2)个月。采用5分制计分法评价支架的轴位多平面重建(MPR)图像及通过支架内腔中心的曲面重建(CPR)图像质量,同时测量支架内管腔直径。计算支架内管腔直径与支架近端的管腔直径比值以评价支架内腔可见度。其中5位患者有常规冠状动脉造影对照,共9个支架的通畅性得到评价。结果图像平均质量达到优良水平(1.94±0.84)分]。图像质量与心率、呼吸运动及支架位置有关。所有59枚支架内腔均为可见,平均支架内腔可见直径比率为(76.1±11.1)%。有常规冠状动脉造影对照的9个支架均诊断为通畅,与常规冠状动脉造影结果吻合。结论64层螺旋CT冠状动脉成像可有效评价冠状动脉支架的通畅性。

Assessment of coronary stent lumen visibility and patency by 64-slice spiral CT angiography

OBJECTIVE: To evaluate the clinical value of assessment of coronary stent patency by 64-slice spiral CT coronary angiography. METHODS: Totally 29 patients (59 stents) were investigated using a retrospective ECG-gated enhanced scan by 64-slice spiral CT at a mean interval of (28.4 +/- 21.2) months after coronary stent implantation. Axial multi-planar reconstruction (MPR) of the stents and curved-planar reconstruction (CPR) through the stents were evaluated for image quality on a 5-point scale (1 = excellent, 5 = uninterpretable) and lumen diameter. Stent lumen diameter was compared with the vessel diameter proximal of the stents to assess the in-stent lumen visibility. Conventional coronary angiography was performed in 5 patients, and 9 stents were evaluated. RESULTS: The image quality was good to excellent on average (scores: 1.94 +/- 0.84), depending on heart rate, breath movement, and stent location. Stent lumen was visible, on average a percentage off (76.1 +/- 11.1)% of the lumen diameter. All the 9 stents were correctly detected as being patent, which was confirmed by conventional coronary angiography. CONCLUSION: 64-slice spiral CT is a useful tool to assess the coronary stent patency.