64排螺旋CT冠脉成像在冠心病中的应用

目的:探讨64排螺旋CT冠状动脉成像(64SCTCA)在冠状动脉病变诊断中的临床应用价值。方法:对52例临床疑为冠心病的患者,行64排螺旋冠脉CT和选择性冠状动脉造影CAG检查,以CAG结果为金标准,将二者进行对照分析,了解64排螺旋CT诊断冠心病的敏感性和特异性。结果:三维重建64SCTCA诊断冠状动脉病变总的敏感性为92.1%,特异性为95.8%,64SCTCA检查显示520段血管中489段血管获得了较好的显影,显示率为94%。结论:64排SCTCA是一种简单易行、安全可靠、风险小的无创性检查,做为筛查冠心病的手病,其结果可靠。     

64层螺旋CT冠状动脉成像与冠状动脉造影的对比研究

目的 评价64层螺旋CT冠状动脉造影对冠状动脉疾病的临床诊断价值.方法 59例临床诊断或可疑冠心病患者行64层螺旋CT冠状动脉成像检查,并以冠状动脉造影结果作为对照,分段评价结果,冠状动脉狭窄≥50%为阳性病变.分析64层螺旋CT冠状动脉血管成像(CTA)诊断冠状动脉狭窄的敏感性、特异性、阳性预测值及阴性预测值.结果 共评价741段冠状动脉,64层螺旋CT冠状动脉血管成像用于诊断冠心病的敏感性、特异性、阳性预测值、阴性预测值分别为58.8%、97.7%、76.9%、94.8%.结论 64层螺旋CT冠状动脉血管成像有较高的诊断准确性,可以作为评价冠状动脉狭窄的一种无创检查方法.     

64层螺旋CT冠状动脉成像与冠状动脉造影的对比研究

目的评价64层螺旋CT冠状动脉成像诊断冠状动脉狭窄的准确性。方法 50例患者先后进行64层螺旋CT冠状动脉成像和冠状动脉造影检查,以冠状动脉造影为诊断冠状动脉疾病的"金标准",比较CT冠状动脉成像的符合率,评价64层螺旋CT冠状动脉成像诊断冠心病的准确性。结果 64层螺旋CT冠状动脉成像评价冠状动脉狭窄程度大于或等于50%的敏感性为98.6%,诊断狭窄程度小于50%的敏感性为87.0%,诊断冠状动脉狭窄的特异性为92.5%,阴性预测值为97.7%。结论 64层螺旋CT冠脉成像诊断冠状动脉狭窄有很高的准确率。     

64排螺旋CT冠脉成像在冠心病诊断中的临床价值分析

目的:分析64排螺旋CT冠脉成像在冠心病诊断中的临床价值.方法:将120例病理试验证实为冠心病的患者作为研究对象,所有患者均采用64排螺旋CT冠脉成像和冠状动脉造影进行诊断,比较两种诊断方法的敏感性、特异性、阳性预测率及阴性预测率.结果:以冠状动脉造影的诊断结果为金标准,64排螺旋CT的诊断敏感性为95.77％、特异性为96.47％、阳性预测率为93.15％、阴性预测率为97.85％.结论:冠心病患者采用64排螺旋CT冠脉成像诊断具有较高的诊断敏感性、特异性、阳性预测率及阴性预测率,值得推广.     

64排螺旋CT冠脉成像与选择性冠脉造影的对照分析

目的：探讨64排螺旋CT冠脉成像对冠状动脉评价的价值。方法：回顾分析2011-01～2012-05在本院既进行64排螺旋CT冠脉成像检查又行冠脉造影术的46例患者的影像学资料,将64排CT冠脉成像结果与冠脉造影结果进行比较,评价其敏感性和特异性。结果：64排螺旋CT冠脉成像判断血管≥50%狭窄的敏感性为95.8%,特异性为98.2%。结论：64排螺旋CT冠脉成像对冠心病的诊断有很高的敏感性和特异性,具有很高的临床应用价值。     

CT冠状动脉成像在冠心病诊断中的应用

目的:研究CT冠状动脉成像在冠心病早期诊断冠状动脉狭窄定性定量判读的作用。方法:对34例临床未发生急性冠脉综合征的冠心病患者,先后进行冠状动脉造影、128排双源CT冠状动脉成像。以冠状动脉造影为"金标准",计算CT冠状动脉成像敏感性、特异性、阳性预测值、阴性预测值。结果:①与冠状动脉造影相比,CT冠状动脉成像的敏感性为68%,特异性为97%,阳性预测值为89%,阴性预测值为90%。②CT冠状动脉成像有65个血管段图像质量差,约占12%,造成图像质量差的原因主要为钙化,心跳、呼吸伪影,少部分为管腔显示不良。结论:冠心病早期诊断中,CT冠状动脉成像可用作冠状动脉造影前筛选,CT冠状动脉成像阴性的患者不必行冠状动脉造影检查;CT冠状动脉成像阳性的患者,可行冠状动脉造影进一步确认病变。     

64排128层螺旋CT冠状动脉成像与冠脉造影比较分析

目的 探讨64排1 28层螺旋CT在冠状动脉病变中的应用价值.方法 选择2011年6月～2012年10月间在我院影像中心接受螺旋CTA检查的冠心病患者100例为研究对象,所有患者均于入院3d内完成冠状动脉螺旋CTA检查及冠脉造影.观察冠状动脉螺旋CTA图像特征,以冠脉造影为金标准,分析64排128层螺旋CTA对冠脉狭窄诊断的敏感性、特异性、阳性预测率及阴性预测率.结果 100例患者64排128层螺旋CT冠脉成像均取得满意的检查图像.以冠脉造影为金标准,64排128层螺旋CT冠脉成像显示轻度冠脉狭窄数量多于冠脉造影,中度及重度冠脉狭窄数量少于冠脉造影,经卡方检验,无统计学差异（P＞0.05）.64排128层螺旋CT冠脉成像共显示146处冠状动脉狭窄（≥50％）.以冠脉造影为金标准,64排128层螺旋CT冠脉成像对冠状动脉狭窄（≥50％）诊断的敏感性为96.4％（137/142）,特异性为96.8％（274/283）,阳性预测率为93.8％（137/146）,阴性预测率为98.2％（274/279）.结论 64排128层螺旋CT冠脉成像可以与冠脉造影相媲美,具有很高的敏感性、特异性、阳性预测率及阴性预测率,值得临床推广应用.     

64层螺旋CT冠状动脉血管成像与冠脉造影结果对照研究

目的:评价多层螺旋CT(MSCT)冠状动脉血管成像方法显示管腔≥50%狭窄的准确性,分析改善成像质量的方法.方法:对72例临床诊断或可疑冠心病的患者在心电门控下采用64层螺旋CT进行冠状动脉血管成像.其中56例在2周内行导管法冠状动脉造影.结果:本组56例与冠状动脉造影结果相对照,冠状动脉血管成像诊断≥50%血管狭窄的敏感性为91.5%,特异性为97.5%,阳性预测值为82.3%,阴性预测值为98.9%.结论:64层螺旋CT冠状动脉血管成像具有较高的敏感性和特异性,同时具有无创和简便的特点,可以作为临床对高危人群筛查的首选方法.     

64层螺旋CT评价冠状动脉狭窄的敏感性和准确性研究

目的评价64层螺旋CT冠状动脉成像（64SCTCA）对探测冠状动脉狭窄的敏感性和准确性。方法搜集36例患者64SCTCA的完整资料,并以近期实施的冠状动脉成像（CAG）结果为金标准进行对比,对64层螺旋CT冠状动脉主干及分支进行分析评估。结果所有病例可用于评估的342支中,共显示病变166支,其中134支得到证实;32支64SCTCA诊断存在病变而CAG显示正常;10支CAG确诊的病变在64SCTCA未能显示。64SCTCA显示冠状动脉病变的敏感性为80.7%,特异性94.3%,准确性为87.7%,阳性预测值93.0%,阴性预测值83.8%。采用成组配对χ2检验,P=0.05,证明64SCTCA和CAG两种检查方法在确诊冠状动脉病变上差异没有统计学意义。在对不同程度病变的评估上,轻度狭窄的敏感性为85.7%,准确性为83.0%;中度狭窄的敏感性为96.9%,准确性为98.5%;重度狭窄的敏感性为91.4%,准确性为95.9%。结论 64SCTCA在评价不同程度的冠状动脉狭窄时,具有较高的敏感性和准确性,因而它适用于冠心病的前期筛查及诊断。     

64层螺旋CT冠状动脉成像临床应用评价

目的:评价64层螺旋CT冠状动脉成像(64SCTCA)的图像质量和在诊断冠状动脉疾病的临床价值。方法:搜集35例患者64SCTCA的完整资料,并以近期实施的选择性X线冠状动脉成像(SCA)结果为金标准进行对比,对64SCTCA显示的冠状动脉主支及主要分支情况进行分级评估。结果:35例病例可用于评估的冠状动脉共计368支,成功率达95.6%。其中SCA共显示74个节段冠脉有中、重度狭窄(≥50%)。MSCTCA诊断中重度狭窄的敏感性为86.5%,特异性为97.3%,阳性预测值88.9%,阴性预测值96.6%。经配对χ2检验,P>0.05,证明两种检查方法在发现冠状动脉病变方面差异无统计学意义。结论:64层螺旋CT冠状动脉成像是一种无创、快速的成像方法,对诊断冠状动脉≥50%狭窄有较高的敏感性和特异性,适合用于临床怀疑冠心病的患者SCA前的筛选检查。     

16层螺旋CT冠状动脉成像技术的临床应用

目的评价16层螺旋CT在显示冠状动脉病变中的价值和限度。方法2004年4月—2005年9月连续选择300例临床诊断或可疑冠心病的患者做16层螺旋CT冠状动脉成像检查(回顾性心电门控、0.5s螺旋扫描、单或双扇区重建算法和静脉注射对比剂),并对300例患者的2364冠状动脉节段进行影像学评价。其中63例做了冠状动脉造影检查,对该63例患者的446冠状动脉节段进行了16层CT与冠脉造影结果的对照分析。结果在300例患者冠状动脉的2364节段(血管直径≥2mm)中1965(1965/2364,83%)个节段能满足影像评价,399(399/2364,17%)个节段不能满足影像的评价。冠脉造影显示正常或轻度狭窄、中度狭窄(<50%)的节段,CT有179(179/212)84.6%的节段与其分级一致;显示重度狭窄(>70%)的节段,CT有218(218/234)93.2%的节段与其分级一致。结论16层CT冠状动脉成像是一种无创、简便的检查方法,显示有临床意义的冠状动脉狭窄的准确性很高,且在观察冠状动脉的解剖及变异、冠状动脉支架术后、冠状动脉搭桥术后复查以及冠状动脉肌桥的显示等方面具有很高的价值。     

16-detector row computed tomographic coronary angiography in patients undergoing evaluation for aortic valve replacement: comparison with catheter angiography

AIM: To evaluate the diagnostic accuracy of 16-detector row computed tomography (CT) in assessing haemodynamically significant coronary artery stenoses in patients under evaluation for aortic stenosis pre-aortic valve replacement. SUBJECTS AND METHODS: Forty consecutive patients under evaluation for severe aortic stenosis and listed for cardiac catheterization before potential aortic valve replacement underwent coronary artery calcium (CAC) scoring and retrospective electrocardiogram (ECG)-gated multi-detector row computed tomographic coronary angiography (MDCTA) using a GE Lightspeed 16-detector row CT within 1 month of invasive coronary angiography (ICA) for comparative purposes. All 13 major coronary artery segments of the American Heart Association model were evaluated for the presence of > or =50% stenosis and compared to the reference standard. Data were analysed on a segment-by-segment basis and also in "whole patient" terms. RESULTS: A total of 412/450 segments from 35 patients were suitable for analysis. The overall accuracy of MDCTA for detection of segments with > or =50% stenosis was high, with a sensitivity of 81.3%, specificity 95.0%, positive predictive value (PPV) 57.8%, and negative predictive value (NPV) 98.4%. On a "whole-patient" basis, 100% (19/19) of patients with significant coronary disease were correctly identified and there were no false-negatives. Excluding patients with CAC >1000 from the analysis improved the accuracy of MDCTA to: sensitivity 90%, specificity 98.1%, PPV 60%, NPV 99.7%. CONCLUSION: Non-invasive 16-detector row MDCTA accurately excludes significant coronary disease in patients with severe aortic stenosis undergoing evaluation before aortic valve replacement and in whom ICA can therefore be avoided. Its segment-by-segment accuracy is improved further if CAC>1000 is used as a gatekeeper to MDCTA.     

西门子128层螺旋CT诊断冠状动脉狭窄的研究

目的探讨西门子128层螺旋CT冠状动脉成像（CTA）对诊断冠状动脉狭窄的价值。方法收集来我院就诊的疑似冠状动脉狭窄患者36例,均进行128层螺旋CT冠状动脉造影检查和DSA选择性冠状动脉造影检查,观察两种检查方法中冠状动脉狭窄的影像学表现和诊断价值,并与64层以下冠状动脉CTA进行对照。结果 36例冠状动脉狭窄患者的两种检查结果,经统计学分析,西门子128层螺旋CT对冠状动脉狭窄的敏感性为98.08%、特异性为95.69%、准确性为96.43%。与64层以下螺旋CT比较,对患者心率、屏气等方面的要求更加宽松。结论西门子128层螺旋CT对冠状动脉狭窄的诊断价值高,方法简单、快速准确、无创伤,患者易接受,可作为疑似冠状动脉狭窄患者的首选检查手段。     

Multi-detector row CT coronary angiography in patients with cardiomyopathy -- initial single-centre experience

AIMS: To evaluate the diagnostic accuracy of computed tomography (CT) in assessing haemodynamically significant coronary artery stenoses in patients with cardiomyopathy (CM). SUBJECTS AND METHODS: Eighteen patients with CM were approached to undergo CT coronary angiography to evaluate the use of this technique for investigating the presence of significant coronary artery disease (CAD), and also to compare the findings with catheter angiography. RESULTS: On a segment-by-segment analysis the sensitivity, specificity, positive and negative predictive values in the CM group were 66.7, 96.5, 40 and 98.8%, respectively, with 100% accuracy in "whole-patient terms". CONCLUSION: Non-invasive, 16-detector row CT coronary angiography in patients with presumed CM would seem to be a useful clinical tool for the exclusion of significant coronary artery disease. However, the presence of suboptimal contrast opacification in this patient group means that the implication of these results must be interpreted with caution.     

64排螺旋CT冠脉成像中双筒注射技术探讨

目的:探讨64排螺旋CT冠状动脉成像中,应用双筒注射技术消除上腔静脉伪影的作用。方法:182例疑冠心病的患者行64排螺旋CT冠状动脉成像,采用双筒高压注射器,高速注射对比剂后立刻以相同流率注射30~50ml生理盐水。评价上腔静脉伪影对图像质量的影响,图像质量分优、良和差3个等级。结果:本组中CT冠脉成像质量优者占85%,良占14%,差占1%。结论:通过采用双筒高压注射器,可消除上腔静脉和右心房内潴留对比剂而产生的伪影,提高64排螺旋CT冠状动脉成像质量。     

Interpretability of coronary CT angiography performed with a novel whole-heart coverage high-definition CT scanner in 300 consecutive patients with coronary artery bypass grafts

AimsCoronary CT angiography (CCTA) is an accurate non-invasive tool for the evaluation of coronary artery bypass graft (CABG). However, inability to sustain a long breath-hold, high heart rate (HR) and atrial fibrillation may affect image quality. Moreover, radiation exposure is still a matter of some concern. A scanner combining 0.23-mm spatial resolution, new iterative reconstruction and fast gantry rotation time has been recently introduced in the clinical field. The aims of our study were to evaluate interpretability, radiation exposure and diagnostic accuracy of CCTA performed with the latest generation of cardiac-CT scanners compared to invasive coronary angiography (ICA) in the assessment of bypass grafts, and non-grafted and post-anastomotic native coronary arteries.Methods and resultsWe prospectively enrolled 300 patients undergoing clinically indicated CCTA with a 16-cm z-axis coverage, 256-detector rows, and 0.28-sec gantry rotation time scanner. Coronary artery and graft interpretability, image quality and effective dose (ED) were assessed in all patients and diagnostic accuracy was evaluated in a subgroup of 100 patients who underwent ICA.Mean HR during the scan was 69.6 ± 10.8. Sinus rhythm was present in 118 patients with HR < 75 bpm and in 112 patients with HR ≥ 75 bpm, while 70 patients had atrial fibrillation. CABG interpretability was 100%. Compared to ICA, CCTA was able to correctly detecting occlusions or significant stenoses of all CABG segments. Overall interpretability of native coronary segments was 95.6%. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of coronary arteries were 98.3%, 97.4%, 93.1%, 99.3% and 96.5%, respectively. The diagnostic accuracy in a patient based analysis was 95.2%. Mean ED was 3.14 ± 1.7 mSv.ConclusionsThe novel whole-heart coverage CT scanner allows to evaluating CABG and native coronary arteries with excellent interpretability and low radiation exposure even in the presence of unfavorable heart rhythm.     

Multislice computed tomographic coronary angiography: experience in a UK centre

AIM: To evaluate the technique of coronary angiography with retrospectively electrocardiogram (ECG)-gated four-slice helical computed tomography (CT). MATERIALS AND METHODS: Within 1 month of undergoing routine day-case diagnostic coronary angiography, 30 consecutive patients also underwent retrospectively ECG-gated multislice CT coronary angiography. This enabled direct comparison of seven segments of proximal and mid-coronary artery for each patient by two blinded assessors. Each segment of coronary artery from the multislice CT image was evaluated initially for "assessability" and those segments deemed assessable were subsequently investigated for the presence or absence of a significantly (n=70%) stenotic lesion. RESULTS: Overall 68% of proximal and mid-coronary artery segments were assessable. The sensitivity and specificity of four-slice CT coronary angiography in assessable segments for detecting the presence or absence (n=70%) of stenoses were 72 and 86%, respectively. These results correspond to a positive predictive value of 53% and a 93% negative predictive value. If the 32% of non-assessable segments are added into the calculation then the sensitivity and specificity fall to 49 and 66%, respectively. CONCLUSION: Although multislice CT coronary angiography is a promising technique, the overall assessability and diagnostic accuracy of four-slice CT acquisition is not sufficient to justify routine clinical use. Further, evaluation should investigate the benefit of the reduction in temporal and spatial resolution offered by 16 and 32 slice acquisition.     

64层螺旋CT冠状动脉成像的心率变化及其对图像质量的影响

目的探讨64层螺旋CT冠状动脉成像的心率变化及心率变化对图像质量的影响。方法回顾性分析138例64层螺旋CT冠状动脉成像资料,记录扫描期间的心率变化,根据不同的心率变化分组。A组心率变化0~4次/min,B组心率变化5~9次/min,C组心率变化10~20次/min,D组心率变化>20次/min。比较不同组间的冠状动脉各节段图像质量差异。结果64层螺旋CT冠状动脉成像心率变化在10次/min以内者占89%,RCA1、RCA3、PDA、LMA、LAD、LCX1及LCX2的图像质量A、B、C组间无显著差异(P>0.05),D组与A、B、C组对比图像质量明显下降(P<0.05);RCA2的A、B、C、D组间对比图像质量有显著差异(P<0.05),呈下降趋势。结论64层螺旋CT冠状动脉成像心率变化幅度小,心率变化>20次/min,才引起冠状动脉成像质量明显下降,RCA2段图像质量易受心率波动的影响。     

64层螺旋CT冠状动脉成像临床应用

目的：探讨64层螺旋CT（MSCT）冠状动脉成像方法显示冠状动脉狭窄的能力及可靠性。方法：对26例临床怀疑冠心病的患者行心脏冠状动脉CT成像（CTA）并与常规冠状动脉造影（CAG）结果进行比较分析。结果：以冠状动脉血管造影（CAG）为金标准,冠状动脉CTA影像判断血流动力学相关性冠状动脉狭窄（≥50%）的敏感度0.933、特异度0.974、准确度0.968、阳性预测值0.857、阴性预测值0.989。结论：64层螺旋CT冠状动脉成像是一种无创、简便、优良的冠状动脉成像方法,可作为冠状动脉粥样硬化的筛选手段及冠状动脉术后复查的首选方法。