电子束CT与选择性冠状动脉造影的节段对比分析

目的]探讨电子束CT(EBCT)造影对冠状动脉各节段病变诊断价值的差异.方法]同期行选择性冠状动脉造影和EBCT冠状动脉造影检查的患者38例,对照选择性冠状动脉造影的结果计算EBCT造影检测冠状动脉各节段狭窄病变的准确性.结果]①选择性冠状动脉造影可清晰显影的332个节段中,EBCT造影可清晰显示和评价占264段(79.5%),68段(20.5%)显影不清.左主干和前降支可评价节段的比例显著高于左回旋支和右冠状动脉(P＜0.05或0.01),同一支血管中近段可评价的比例显著高于远段(P＜0.05或0.01).②EBCT造影检测节段病变总的敏感性、特异性、准确性、阳性和阴性预测值分别为81.0%、95.9%、93.6%、79.1%和96.4%;EBCT造影对诊断左主干和左前降支各节段病变的价值高于左回旋支和右冠状动脉,检测冠状动脉近段病变的价值高于远段.结论]电子束CT冠状动脉造影对冠状动脉的评价和病变检测受解剖部位和血管大小的影响,检测左主干和左前降支各节段病变的价值高于左回旋支和右冠状动脉,对冠状动脉近段病变的诊断价值高于远段.

Comparison of Electron Beam Computed Tomographic Coronary Angiography and Selective Coronary Angiography for Segmental Analysis of Coronary Artery Stenosis

Objective]By comparing intravenous coronary angiography using electron beam computed tomography (EBCT) and selective coronary angiography, to investigate the segmental differences of EBCT coronary angiography for analysis of significant coronary stenosis. Methods] Intravenous EBCT and selective coronary angiography were performed during the same period in 38 patients. The value of EBCT angiography for identifying and localizing significant coronary artery stenosis was evaluated on a segmental basis. Results] Of the 332 segments assessable by selective coronary angiography, 264 (79.5%) were visualized and technically adequate to evaluate by EBCT angiography. Significantly more segments in the left main and left anterior descending coronary arteries were adequately visualized than in the left circumflex and right coronary arteries (P< 0.05 or 0.01). Significantly more proximal segments were adequately visualized than distal segments (P< 0.05 or 0.01). The sensitivity, specificity, accuracy, positive and negative predictive value of EBCT angiography for segmental coronary stenosis were 81.0%, 95.9%, 93.6%, 79.1% and 96.4%, respectively. Conclusion] Intravenous electron beam computed tomographic coronary angiography may be used for evaluating segmental coronary stenosis. Its diagnostic accuracy is significantly higher in the left main and left anterior descending coronary artery and the proximal segments, but it is influenced by the coronary artery anatomy and vessel size.