冠状动脉CT成像对急性冠状动脉事件的预测价值

自电子束CT问世,CT可以完成冠状动脉成像,对诊断冠心病的价值就得到了肯定[1].随着64排螺旋CT及双源CT的相继问世,通过CT血管成像(CT angiography,CTA),冠状动脉粥样硬化斑块越来越清晰地展示在人们面前.如今后64排CT不但能清晰显示斑块,还能通过能谱信息初步分析斑块的成分.随着CT设备的发展,人们对冠状动脉粥样硬化斑块的认识也随之深入.冠心病作为临床多发,致死率、致残率高的疾病,其防治的目的就是减少急性冠状动脉事件的发生.因此,冠状动脉CTA提供的斑块信息和急性冠状动脉事件之间的关联近年来一直受到关注[2].其目的就是超越传统的危险因素预测体系,利用冠状动脉粥样硬化的直接证据来对患者进行危险评估,更进一步指导冠心病的临床诊治路径.关于冠状动脉CTA预测未来急性冠状动脉事件价值的研究,近年来向纵深发展,概括起来,可归为两大类:(1)冠状动脉钙化积分的预测价值;(2)冠状动脉CTA的预测价值.笔者就此两大问题,复习文献,进行总结提炼.     

双源CT冠状动脉成像对冠状动脉狭窄病变的诊断价值

目的：探讨双源CT（dual-source CT,DSCT）冠状动脉检查对冠状动脉狭窄病变的诊断价值.材料和方法：收集2009-05～2009-12 47例1周内同时做DSCT和冠状动脉造影（coronary angiography,CAG）检查的患者的影像学资料.以冠状动脉病变诊断的＂金标准＂CAG检查结果做对比,分析DSCT对冠状动脉病变诊断的准确性.结果：47例中,DSCT显示的冠状动脉节段共有631个,其中595个冠状动脉节段图像显示良好可以进行评估.DSCT诊断冠状动脉狭窄的灵敏度为79.7%（126/158）,特异度为96.3%（421/437）,阳性预测值为88.7%（126/142）,阴性预测值为92.9%（421/453）,正确率为91.9%（547/595）,DSCT与CAG检查具有中度一致性（Kappa=0.668）.DSCT对冠状动脉钙化、小分支病变诊断准确性欠佳.结论：DSCT冠状动脉成像能准确诊断有意义的冠状动脉狭窄病变,可作为临床上怀疑冠心病患者的CAG术前筛查及支架术后随访的首选方法.     

双源CT冠状动脉成像诊断壁冠状动脉的临床价值

目的：应用双源CT冠状动脉成像探讨壁冠状动脉的检测方法及临床价值。方法：临床怀疑冠心病的500例患者行双源CT冠状动脉成像检查,在工作站进行多平面重组（MPR）、最大密度投影（MIP）及曲面重组（CPR）等后处理并进行分析。结果：在检查的500例患者中190例（38%）有壁冠状动脉存在,其中157例发生在前降支及其分支,16例发生在回旋支及其分支,7例发生在右冠状动脉及其分支,另外10例为多支病变。结论：双源CT冠状动脉成像对壁冠状动脉显示率高,并能对其临床症状进行预测。     

双源CT血管成像对冠状动脉瘘的诊断价值

目的 探讨双源CT血管成像(DSCTA)在先天性冠状动脉瘘(CAF)诊断中的应用价值.方法 分析68例接受回顾性心电门控冠状动脉DSCTA的CAF患者影像资料,进行容积再现(VR)、多平面重建(MPR)、最大密发投影(MIP)、曲面重建(CPR)后确定诊断.结果 68例CAF中,瘘口位于肺动脉18例,右心室31例,左心室16例,上控静脉3例;CAF瘘支血管起源右冠状动脉33例,左冠状动脉30例,左、右冠状动脉双侧起源5例.瘘支血管影像表现为增宽、迂曲28例,扩张、动脉瘤26例,迂曲的血管网18例.结论 冠状动脉DSCTA方便、快捷、无创,可以作为诊断先天性冠状动脉瘘的首选方法.     

护理干预在双源CT冠状动脉成像的价值

目的：探讨护理干预在双源CT冠状动脉成像中的应用价值。方法：收集我院2009年6月~11月双源CT冠状动脉成像病例共1000例（男563例,女437例）,年龄27~83岁,平均62.4岁。所有患者扫描前、中、后进行细致的护理干预,均未使用药物控制心率。结果：双源CT冠状动脉成像病例成功率为95.6%。影响成功率的因素主要为呼吸运动及吞咽运动（23例）和心律失常（11例）,全部病例检查无并发症发生。结论：对患者在检查双源CT前、中、后进行细致科学的护理干预,可消除患者的恐惧心理,保证呼吸和吞咽的配合,保持患者心率平稳,从而提高检查成功率,并有助于避免并发症发生。     

冠状动脉的双源CT血管成像

双源CT的时间分辨率为83ms,可进行不依赖心率的冠状动脉数据采集,即使对于高心率的病人也可获得满意的影像质量,不需要服用降低心率的药物,真正满足了冠状动脉CT成像进人临床的需求,能可靠评价冠状动脉病变.综述双源CT的基本原理和在冠状动脉成像中的应用.     

双源CT冠状动脉成像的护理

目的：探讨冠心病患者行双源CT冠状动脉筛查过程中的护理问题。方法：对1 145例行双源CT冠状动脉成像检查患者的相关资料进行回顾性分析。结果：1 145例患者无1例推注造影剂过程中出现渗漏。检查后进行图象处理后,达到优良诊断标准的为1 078例,优良率达到94.15%。结论：细致、科学有效地做好护理工作是协助医师顺利完成双源CT冠状动脉筛查的重要保障。     

冠状动脉的双源CT血管成像

双源CT的时间分辨率为83ms，可进行不依赖心率的冠状动脉数据采集，即使对于高心率的病人也可获得满意的影像质量，不需要服用降低心率的药物，真正满足了冠状动脉CT成像进入临床的需求，能可靠评价冠状动脉病变。综述双源CT的基本原理和在冠状动脉成像中的应用。     

双源CT冠状动脉成像的临床研究

目的评价双源螺旋CT冠状动脉成像（DSCTA）的临床价值。方法对1278例临床可疑冠心病患者（男830例,年龄（57.7±9.3）岁,女448例,年龄（50.3±10.5）岁）的临床资料进行回顾性分析,其中,24例合并主动脉瓣损害（钙化或增厚）,35例合并二尖瓣损害,4例合并肺栓塞,5例合并主动脉壁内血肿,1例合并主动脉夹层,房颤63例,房性早搏27例,室性早搏13例,均经DSCT心电门控增强扫描,60例同期行冠状动脉造影。结果 485例心率小于75次/min,503例心率在75～85次/min之间,290例心率大于85次/min,最高心率127次/min。平均心率小于75次/min的患者,最佳重建时相在40%～80%R-R间期内。平均心率大于等于75次/min的患者,最佳重建时相在20%～80%R-R间期范围内。1278例扫描图像中,1例由于主动脉瓣重度关闭不全,血管显影淡,不能满足诊断。6例心律不齐患者图像质量差,不能满足诊断。60例与选择性冠状动脉造影对照,灵敏度89.23%,特异度91.75%,阳性预测值92.06%,阴性预测值88.83%。结论 DSCTA基本不受心率限制,可清楚显示由于钙化或纤维斑块引起的冠状动脉狭窄程度,可作为冠心病筛查首选,特别是对合并有心律不齐或合并心脏瓣膜病患者。     

双源CT冠状动脉成像评估冠状动脉狭窄准确性的应用价值

目的对照选择性冠状动脉造影(selective coronary angiography,SCA),评价双源CT(dual-source CT,DSCT)冠状动脉成像在冠状动脉病变诊断中的应用价值。方法选择DSCT冠状动脉检查有异常的患者100例,评价其冠状动脉的狭窄程度,并作SCA检查,结果进行对比分析。结果对于狭窄程度≥50%节段,DSCT诊断的敏感性为94.2%,特异性为99.8%,阴性预测值为99.3%,阳性预测值为98.0%。与SCA对照,进行Spearman等级相关分析,相关系数为r=0.83。运用Bowker test检测DSCT评价冠脉的高估及低估程度,差异具有统计学意义(P0.05)。结论DSCT可作为冠状动脉狭窄程度诊断的常规临床检查方法。     

Coronary CT angiography with dual source computed tomography in 170 patients

Introduction

In preliminary studies DSCT provides robust image quality over a wide range of heart rates and excludes CAD with high accuracy.The aim of the present study was to evaluate the reproducibility of these results in a large, unselected and consecutive group of patients scheduled for invasive coronary angiography (ICA).

Material and methods

170 patients (124 men, 46 women; mean age: 64 ± 9 years) with known CAD (101 patients) or suspected CAD (69 patients) scheduled for ICA were examined by coronary CTA prior to ICA. All coronary segments were assessed for image quality (1: excellent; 5: non-diagnostic). The presence of significant vessel stenosis (>50%) was calculated using ICA as standard of reference.

Results

A total of 680 vessels were analyzed. Despite of 45 arrythmic patients all analyzed coronary segments were diagnostically evaluable. Mean Agatston score equivalent was 686 (range 0-4950). ICA revealed 364 lesions with ≥50% diameter stenosis. DSCT correctly identified 336 of these lesions. 115 lesions with a diameter stenosis ≤50% were overestimated by DSCT and thus considered as false-positive findings. On a per-segment basis, sensitivity was 92%, specificity 93%, positive predictive value (PPV) was 75% and negative predictive value (NPV) 98%. On a per-vessel basis DSCT revealed a sensitivity of 93%, a specificity of 88%, a PPV of 78% and a NPV of 97%. On a per-patient basis sensitivity was 94%, specificity 79%, PPV 88% and NPV 90%.

Conclusions

Initial results of preliminary studies showing robust image quality and high accuracy in DSCT cardiac imaging could be approved with the present study enclosing a large consecutive population. However severe coronary calcifications and irregular heart rate still remain limiting factors for coronary CTA.Despite improved image quality and high accuracy of coronary DSCT angiography, proof of indication is necessary, due to still remaining limiting factors.     

The value of computed tomography for predicting empyema-associated malignancy

OBJECTIVE: To determine the value of computed tomography (CT) scanning in detecting associated malignancy in patients with chronic empyema. METHODS: Two radiologists retrospectively reviewed CT scans of 112 consecutive patients with chronic empyema and arrived at a consensus about the findings. Among these patients, 6 were confirmed by pathology evaluation to have empyema-associated malignancy (EAM), including 4 lymphomas. The CT scans were evaluated for the presence of the following findings: a mass in the empyema sac; mass involvement of the extrapleural fat, chest wall, rib, and lung; bulging of the empyema sac; nodular pleural thickening; empyema involvement of the mediastinal pleura; presence of lung nodules (>1 cm); and mediastinal lymph node enlargement. The association between the CT findings and the EAM was analyzed with the Fisher exact test. A multiple logistic regression analysis was used to determine the predictive variables for EAM. Sensitivity, specificity, and positive predictive value were calculated for each finding. RESULTS: All CT findings, except rib involvement and bulging of empyema sac, were significantly associated with EAM (P<0.05). The finding of the presence of a mass, extrapleural fat, and mediastinal involvement showed relatively high sensitivity (100%, 67%, 67%, respectively) and specificity (81%, 87%, 91%, respectively). A bulging of the empyema sac and nodular pleural thickening showed 100% sensitivity, but low specificity (39% and 44%, respectively). Findings from the multiple logistic regression analysis revealed that the presence of a mass and empyema of the mediastinal pleura were significant variables associated with EAM (P<0.05). CONCLUSIONS: Although many CT findings are associated with EAM, most showed either low positive predictive value or low sensitivity. A variety of CT findings should be considered when evaluating CT image-based detection of EAM.     

The value of computed tomography in patients with mucopolysaccharidosis

Summary Cranial computed tomography (CT) was performed on 11 cases of mucopolysaccharidosis (MPS) IVA (Morquio syndrome). Our results suggest that although the patients may have normal intelligence CT changes may be seen with increasing age. In two cases white matter low density was found and in a third there was gross dilatation of the ventricles, basal cisterns and subarachnoid space. Nine other patients with various types of mucopolysaccharidosis also had cranial CT performed and in general those types associated with mental retardation showed changes although there was an interesting exception involving a case of MPS IIIA who had a normal CT scan.     

双源CT对先天性心脏病肺静脉异常连接的诊断价值

目的：探讨双源CT（DSCT）在先天性心脏病肺静脉异常连接（APVC）中的诊断价值。方法：35例患者中男25例,女12例。22例经手术证实,对DSCT诊断APVC类型进行分析。结果：双源CT诊断APVC的符合率为100%（22/22）,对伴发畸形的诊断符合率为90.9%（20/22）。DSCT诊断完全型APVC 20例57.1%（20/35）,最常见异常连接血管为上腔静脉48.9%（23/47）、垂直静脉42.6%（20/47）,多数存在伴发畸形95%（19/20）,房间隔缺损最常见52.6%（10/19）。DSCT诊断部分型APVC 42.9%（15/35）,最常见异常连接为右肺静脉连接至右心房占51.6%（16/31）,多数存在伴发畸形86.7%（13/15）,房间隔缺损最常见46.2%（6/13）。结论：DSCT可以满足APVC的诊断。     

Prognostic value of coronary computed tomography angiography in diabetic patients without chest pain syndrome

Aims

Diabetic patients with coronary artery disease (CAD) are often free of chest pain syndrome. A useful modality for non-invasive assessment of CAD is coronary computed tomography angiography (CTA). However, the prognostic value of CAD on coronary CTA in diabetic patients without chest pain syndrome is relatively unknown. Therefore, the aim was to investigate the long-term prognostic value of coronary CTA in a large population diabetic patients without chest pain syndrome.

Methods

Between 2005 and 2013, 525 diabetic patients without chest pain syndrome were prospectively included to undergo coronary artery calcium (CAC)-scoring followed by coronary CTA. During follow-up, the composite endpoint of all-cause mortality, non-fatal myocardial infarction (MI), and late revascularization (>90 days) was registered.

Results

In total, CAC-scoring was performed in 410 patients and coronary CTA in 444 patients (431 interpretable). After median follow-up of 5.0 (IQR 2.7-6.5) years, the composite endpoint occurred in 65 (14%) patients. Coronary CTA demonstrated a high prevalence of CAD (85%), mostly non-obstructive CAD (51%). Furthermore, patients with a normal CTA had an excellent prognosis (event-rate 3%). An incremental increase in event-rate was observed with increasing CAC-risk category or coronary stenosis severity. Finally, obstructive (50-70%) or severe CAD (>70%) was independently predictive of events (HR 11.10 [2.52;48.79] (P = .001), HR 15.16 [3.01;76.36] (P = .001)). Obstructive (50-70%) or severe CAD (>70%) provided increased value over baseline risk factors.

Conclusion

Coronary CTA provided prognostic value in diabetic patients without chest pain syndrome. Most importantly, the prognosis of patients with a normal CTA was excellent.

     

Prognostic value of computed tomography derived fractional flow reserve for predicting cardiac events and mortality in kidney transplant candidates

BackgroundCardiac screening using coronary computed tomography angiography (CCTA) in kidney transplant candidates before transplantation yields both diagnostic and prognostic information. Whether CT-derived fractional flow reserve (FFRCT) analysis provides prognostic information is unknown.This study aimed to assess the prognostic value of FFR_CT for predicting major adverse cardiac events (MACE) and all-cause mortality in kidney transplant candidates.MethodsAmong 553 consecutive kidney transplant candidates, 340 CCTA scans (61%) were evaluated with FFR_CT analysis. Patients were categorized into groups based on lowest distal FFR_CT; normal >0.80, intermediate 0.80–0.76, and low ≤0.75. In patients with ≥50% stenosis, a lesion-specific FFR_CT was defined as; normal >0.80 and abnormal ≤0.80.The primary endpoint was MACE (cardiac death, resuscitated cardiac arrest, myocardial infarction or revascularization). The secondary endpoint was all-cause mortality.ResultsMedian follow-up was 3.3 years [2.0–5.1]. MACE occurred in 28 patients (8.2%), 29 patients (8.5%) died.When adjusting for risk factors and transplantation during follow-up, MACE occurred more frequently in patients with distal FFR_CT ≤0.75 compared to patients with distal FFR_CT >0.80: Hazard Ratio (HR): 3.8 (95%CI: 1.5–9.7), p ?< ?0.01.In the lesion-specific analysis with <50% stenosis as reference, patients with lesion-specific FFR_CT >0.80 had a HR for MACE of 1.5 (95%CI: 0.4–4.8), p ?= ?0.55 while patients with lesion-specific FFR_CT ≤0.80 had a HR of 6.0 (95%CI: 2.5–14.4), p ?< ?0.01.Abnormal FFR_CT values were not associated with increased mortality.ConclusionIn kidney transplant candidates, abnormal FFR_CT values were associated with increased MACE but not mortality. Use of FFR_CT may improve cardiac evaluation prior to transplantation.     

The value of computed tomography in evaluating patients with prolactinomas.

The use of computed tomography (CT) in 28 patients with surgically proved prolactinomas is described. The authors' experience suggests that in evaluating patients with galactorrhea-amenorrhea syndrome, CT in combination with pluridirectional tomography usually provides sufficient information to make further invasive studies unnecessary. In selected cases with low-density areas within the sella as seen on CT, pneumoencephalography is still advisable to distinguish between the empty sella and the necrotic tumor. Angiography is still necessary to exclude vascular causes for suprasellar and parasellar masses such as aneurysms and meningiomas.     

双源CT对先天性心脏病心外畸形的诊断价值

目的:探讨双源CT(DSCT)在先天性心脏病心外畸形中的诊断价值。方法:回顾性分析、对比117例先天性心脏病心外畸形的术前DSCT和超声心动图(Echo)的影像资料,并与手术结果对照。结果:全部检查均符合诊断要求,发现心外结构异常304处,DSCT可清晰显示先心病心外畸形特点及侧枝循环情况,DSCT、Echo及二者联合对心外结构异常诊断准确率分别为96.7%(294/304)、78.9%(240/304)9、7.7%(297/304),DSCT对心外畸形的诊断准确率明显高于Echo,二者差异具有统计学意义(P0.001),而DSCT与二者联合对心外结构异常的诊断准确率差异无统计学意义(P0.05)。结论:DSCT是先天性心脏病的一项重要无创检查技术,各种重建图像能够实时、全面、直观地显示先天性心脏病各种心外结构异常,检出优于Echo,对先心病特别是复杂型先心病的手术方案制定有重要的临床意义。     

DSCTA对颈动脉斑块特征与急性缺血性脑卒中的相关性研究

目的 探讨双源CT血管成像（DSCTA）对颈动脉斑块的诊断价值,评估颈动脉狭窄<50%的斑块特征与急性缺血性脑卒中的关系。方法 选取符合纳入标准患者64例,回顾性分析颈动脉分叉处斑块特征,急性脑卒中侧为实验组,无急性脑卒中侧为对照组。分析内容包括斑块类型、斑块表面形态、钙化分布、钙化数目,对两组颈动脉斑块特征进行统计学分析。结果 实验组颈动脉斑块较对照组更容易出现以下特征且差异有统计学意义,包括非钙化性和混合性斑块出现率更高（Z=-2.39,P=0.02）,斑块表面不规则和溃疡出现率更高（Z=-6.04,P<0.01）,浅层钙化（Z=-2.06,P=0.04）和多发钙化出现率更高（Z=-2.52,P=0.01）。结论 DSCTA可更好的显示斑块特征,颈动脉非钙化性和混合性斑块、斑块表面不规则或溃疡形成、浅层钙化和多发钙化可能为急性缺血性脑卒中的危险因素。