64层螺旋CT冠状动脉成像判定冠状动脉狭窄的价值

目的: 探讨64层螺旋CT冠状动脉成像（MSCTCA）判定冠状动脉狭窄的临床价值。方法: 回顾性研究在我科治疗并于2周内先后行MSCTCA和冠状动脉造影（CAG）的临床拟诊冠心病患者30(男21,女9)例;年龄49～74（62±7）岁,以CAG结果为准,计算评价指标。结果: 依节段计算的MSCTCA准确性,其灵敏度、特异度分别为50%、97%。若去除38个冠脉节段由于严重钙化而影响诊断的因素,则其灵敏度、特异度分别为74%、99%。结论: MSCTCA判断冠状动脉中、重度狭窄具有较高的准确性,对诊断冠心病尤其对筛选冠心病而言有较好的前景,但严重钙化病变影响冠状动脉狭窄程度的判断。     

64层螺旋CT冠状动脉成像与心血管疾病危险分层的相关性

目的 探讨64层螺旋CT(64MSCT)冠状动脉(冠脉)成像与心血管病危险分层的相关性.方法 收集疑诊冠心病患者470例,按64MSCT冠脉成像结果根据冠脉有无病变、病变范围、钙化积分、冠脉狭窄程度、斑块性质分组;其中80例患者同时行冠脉造影术,按冠脉造影结果根据冠脉有无病变、病变范围、冠脉狭窄程度分组.470患者按心血管病危险分层分为极高危、高危、中高危、中危、低危5组,观察各危险分层中冠脉病变情况,并分析相关性.结果 470例患者中同时行MS CT冠脉成像与冠脉造影者80例,判断冠脉病变范围(χ2=3.631,P=0.067)与狭窄程度(χ2=1.639,P=0.200)两种方法间差异无统计学意义.随着危险分层的增高,冠脉病变范围增加(极高危多支血管病变值分别为1.09、高危双支血管病变值分别为0.91、低危单支血管病变值分别为1.07,冠脉狭窄程度也增加、极高危重度狭窄值分别为0.96、高危中度狭窄值分别为1.03、低危.轻度狭窄值分别为0.78,各心血管危险分层之间冠脉病变钙化积分差异有统计学意义(F=256.20、123.76、62.50、98.24、52.36,P＜0.01).在极高危的患者中软斑块比例最高,随着危险分层降低钙化斑块比例增高或无斑块极高危软斑值分别为1.01、低危钙斑值分别为1.17.结论 64MSCT冠脉成像可作为心血管病危险分层的依据,患者冠脉病变复杂,狭窄程度、钙化积分程度严重,软斑块比例较高,危险分层越高;随着危险分层的降低,冠脉病变支数减少,钙化积分降低,狭窄程度减轻,斑块以钙化斑块比例增高或无斑块.     

64层螺旋CT冠状动脉成像与心血管疾病危险分层的相关性

Objective To investigate the relationship between the risk stratification of cardiovascular diseases and the outcome of 64-slice helical computed tomography (MSCT) coronary angiography. Methods A total of 470 cases suspected to have coronary heart disease were enrolled.They all received 64-slice MSCT coronary angiography, and they were divided into groups according to the range of disease, degree of calcium scoring, degree of stenosis and characteristic of plaque. Among them, 80 patients underwent both MSCT and selective coronary angiography (CAG) at one time, and they were grouped according to the range of disease and degree of stenosis. All the 470 cases were classified as five levels according to the risk stratification of cardiovascular diseases. The lesions of coronary artery in different risk stratifications were observed, and the correlations were analyzed.Results In the 80 patients who underwent both MSCT and selective CAG, there were no significant differences in the range of coronary artery diseases(χ2=3.631, P=0.067) and coronary arterystenosis (χ2=1.639, P=0.200) between MSCT and CAG. Along with the increased level of the risk stratification, there were the more ranges of the coronary artery diseases (λvery high risk. multi-vessel disease=1.09,λhigh risk. double-vessel disease=0.91, λlow-risk. single-vessel disease=1.07)and the more degrees of coronary artery stenosis(λvery high risk. severe stenosis=0.96,λhigh risk. moderate stenosis=1.03,λlow-risk. mild stenosis=0.78). The degrees of calcium scoring in different risk stratifications of cardiovascular diseases showed significantly differences (F=256.20,123.76,62.50, 98. 24,52.36,P＜0.01). There was the highest percentage of soft plaque in very high risk patients.Higher percentages of fiber plaque, calcified plaque and mixed plaque were found in moderate risk and low risk patients(λvery high risk. soft plaque=1.01,λlow-risk. calcium plaques=1.17). Conclusions The 64-slice MSCT coronary angiography could provide a basis for assessing risk stratification of cardiovascular diseases. The complicated coronary artery disease, moderate-severe calcification, more severe stenosis, higher percentage of soft plaque are found in the very high risk patients. The lower level of the risk stratification is found in patients with the less range of the coronary artery disease and less severe degree of the coronary artery calcification and stenosis. The calcified plaque and mixed plaque are found in moderate risk and low risk patients.     

64层螺旋CT冠状动脉成像与心血管疾病危险分层的相关性

Objective To investigate the relationship between the risk stratification of cardiovascular diseases and the outcome of 64-slice helical computed tomography (MSCT) coronary angiography. Methods A total of 470 cases suspected to have coronary heart disease were enrolled.They all received 64-slice MSCT coronary angiography, and they were divided into groups according to the range of disease, degree of calcium scoring, degree of stenosis and characteristic of plaque. Among them, 80 patients underwent both MSCT and selective coronary angiography (CAG) at one time, and they were grouped according to the range of disease and degree of stenosis. All the 470 cases were classified as five levels according to the risk stratification of cardiovascular diseases. The lesions of coronary artery in different risk stratifications were observed, and the correlations were analyzed.Results In the 80 patients who underwent both MSCT and selective CAG, there were no significant differences in the range of coronary artery diseases(χ2=3.631, P=0.067) and coronary arterystenosis (χ2=1.639, P=0.200) between MSCT and CAG. Along with the increased level of the risk stratification, there were the more ranges of the coronary artery diseases (λvery high risk. multi-vessel disease=1.09,λhigh risk. double-vessel disease=0.91, λlow-risk. single-vessel disease=1.07)and the more degrees of coronary artery stenosis(λvery high risk. severe stenosis=0.96,λhigh risk. moderate stenosis=1.03,λlow-risk. mild stenosis=0.78). The degrees of calcium scoring in different risk stratifications of cardiovascular diseases showed significantly differences (F=256.20,123.76,62.50, 98. 24,52.36,P＜0.01). There was the highest percentage of soft plaque in very high risk patients.Higher percentages of fiber plaque, calcified plaque and mixed plaque were found in moderate risk and low risk patients(λvery high risk. soft plaque=1.01,λlow-risk. calcium plaques=1.17). Conclusions The 64-slice MSCT coronary angiography could provide a basis for assessing risk stratification of cardiovascular diseases. The complicated coronary artery disease, moderate-severe calcification, more severe stenosis, higher percentage of soft plaque are found in the very high risk patients. The lower level of the risk stratification is found in patients with the less range of the coronary artery disease and less severe degree of the coronary artery calcification and stenosis. The calcified plaque and mixed plaque are found in moderate risk and low risk patients.     

64排螺旋CT冠状动脉成像在冠状动脉病变诊断中的临床研究

目的探讨和评价64排螺旋CT（MSCT）在冠心病诊断中的有效性。方法选取在3周内行64排MSCT和冠状动脉造影（CAG）检查的临床可疑或确诊冠心病的患者（两项检查平均间隔时间9d）114例，其中男性62例，平均年龄65岁。将MSCT和CAG检查结果进行分析，管腔狭窄≥50％定义为明显狭窄。结果在114例患者中，CAG检出至少有1处明显狭窄的患者106例，其中单支病变占33％（38例），多支病变占60％（68例）。MSCT检出其中的104例（诊断准确度95％）。按节段分析，MSCT诊断冠状动脉明显狭窄的灵敏度、特异度、阳性预测值、阴性预测值分别为87％、96％、86％、96％。以各冠状动脉分析，MSCT诊断冠状动脉明显狭窄的灵敏度、特异度、阳性预测值、阴性预测值分别为96％、94％、95％、96％。MSCT与CAG在发现冠状动脉明显狭窄上差异无统计学意义（P〉0．05）。结论64排MSCT诊断冠状动脉狭窄的准确度较高，作为一种冠心病诊断的无创筛查手段，有广泛的临床应用价值。     

64层螺旋CT冠状动脉成像对不典型胸痛冠心病患者的诊断价值

目的评价64层螺旋CT冠脉成像对不典型胸痛患者进行鉴别诊断的价值。方法对72例不典型胸痛患者进行64层螺旋CT冠脉成像,再进行选择性冠脉造影（SCA）,以SCA为标准对64层螺旋CT结果的准确性进行评价。结果64层螺旋CT冠脉成像的敏感度、特异度和准确度分别为96%、79%和90%;64层螺旋CT对中度以上狭窄和轻度狭窄的诊断正确率分别为89%、58%（P<0.01）;64层螺旋CT对左回旋支和右冠状动脉病变的判断能力相对较差。结论64层螺旋CT能够胜任不典型胸痛冠心病患者的筛查。     

64层螺旋CT冠状动脉成像在诊断冠状动脉疾病中的临床价值

目的:评价64层螺旋CT冠状动脉成像(64SCTCA)在诊断冠状动脉疾病中的临床价值.方法:收集82例行64层螺旋CT冠状动脉成像并在一周内做冠状动脉造影(CAG)患者,将结果进行对照分析.结果:可用于评估的336支冠状动脉中,SCTCA显示病变共232支,经CAG证实226支;SCTCA诊断冠状动脉病变的敏感性为97.8%,特异性为90.0%,阳性预测值为95.3%,阴性预测值为95.2%.64SCTCA和CAG两种检查方法在发现冠状动脉病变上差异无统计学意义.其中56%(46/82)患有冠心病(1支或1支以上冠脉狭窄>50%),44%(36/82)无明显冠心病或正常(其中<50%狭窄者29例,各支均正常者7例).结论:64SCTCA对于冠状动脉狭窄的评估具有较高敏感性和特异性,适用于冠心病的筛查.     

心率及心率波动对64层螺旋CT冠状动脉成像质量的影响

目的回顾性分析心率及心率波动对64层螺旋CT冠状动脉图像质量的影响。方法将129例疑为冠心病的患者行64层螺旋CT冠状动脉检查的原始数据在心动周期的40%～80%时相上进行图像重组。对直径>1.5mm冠状动脉节段进行评分(≤3分为满足临床诊断)。采用Pearson相关分析方法分析平均心率及心率波动对图像质量的影响。结果扫描时所有患者心率33～108次/min,平均62.2次/min。心率波动0.2～46.9次/min,平均4.4次/min。在最佳重组时相上,可满足诊断的图像占93.9%。图像质量与平均心率及心率波动显著相关。心率<69.7次/min及心率波动<15.7次/min时,可获得优良的图像质量;心率<63次/min时,舒张期重组的图像质量佳;心率>67次/min时,收缩期重组的图像质量佳。重组时相窗从舒张期切换至收缩期的心率范围为63～67次/min。结论心率及心率波动对64层螺旋CT冠状动脉图像质量有重要影响,减低心率及心率波动可提高图像质量。     

64层螺旋CT成像与导管法造影检测冠状动脉狭窄的对照研究

目的探讨64层螺旋CT对冠状动脉粥样硬化病变的显示情况及临床价值。方法对69例临床诊断或疑诊冠心病的患者行64层螺旋CT冠状动脉成像检查及导管法冠状动脉造影。冠状动脉管腔内径减少>50%定义为显著狭窄。结果在69例患者冠状动脉的788节段(血管直径≥1.5mm)中,CT图像能够满足管腔评价者为778节段(98.7%),其中64层螺旋CT显示中度或中度以上狭窄(≥50%)的敏感性和特异性分别为81.9%和99.0%,阳性预测值和阴性预测值分别为95.9%和95.1%。如果在方法学上进行校正,敏感性将达91.8%。结论64层螺旋CT显示冠状动脉狭窄的准确性(95.2%)较高,在冠状动脉疾病的初步诊断以及介入治疗的筛选方面,是一种颇具潜力的无创性检查方法,但尚不能完全取代传统的导管法冠状动脉造影。     

64层螺旋CT冠状动脉成像与血管内超声评估冠状动脉临界病变的对比研究

目的评价64层CT冠状动脉成像(SCTCA)对冠状动脉临界病变狭窄程度和斑块性质判断的准确度。方法 50例拟诊或确诊冠心病患者分别行64层SCTCA和血管内超声(IVUS),并以IVUS结果作为标准进行对比分析。结果 64层SCTCA诊断冠状动脉临界狭窄的敏感性、特异性、准确性分别为88.9%、96.6%、94.8%;准确检出了28处脂质斑块中的23处、15处纤维斑块中的12处及11处钙化性斑块中的10处。结论 64层SCTCA评估冠状动脉临界病变具有较高的准确性,值得推广。     

不同类型冠状动脉斑块支架植入术的比较

目的 回顾性分析冠状动脉支架术前已行64层螺旋CT冠状动脉成像的病例,比较不同类型冠状动脉斑块支架术的差异.方法 选择2007年至2009年支架术前已行64层螺旋CT检查的患者86例,共植入支架137处.依据冠状动脉斑块平均CT值将冠状动脉斑块分为非钙化斑块组和钙化斑块组.比较两组的临床特征、预扩张球囊规格、预扩张球囊充盈压力、支架规格和支架释放压力.结果 与非钙化斑块组相比,钙化斑块组年龄相对较高,低密度脂蛋白更低,单支病变较少.两组的预扩张球囊和支架规格无明显差异.钙化斑块组预扩张球囊充盈压力(898.93±159.67 kPa)明显高于非钙化斑块组(810.22±112.61 kPa,P<0.01).钙化斑块组支架释放压力(1 403.90±273.12 kPa)明显高于非钙化斑块组(1 243.79±254.12 kPa,P<0.01).结论 与非钙化斑块相比,钙化斑块对预扩张和支架成形有较大阻力,硬度较高,术前识别斑块类型对支架术有一定意义.     

64排螺旋CT冠状动脉成像对女性及男性冠状动脉狭窄诊断价值的对比

目的评价64排螺旋CT冠状动脉成像(64-DSCTCA)对女性、男性冠状动脉狭窄的诊断价值是否相同。方法选择行心脏64-DSCTCA检查并同时行选择性冠状动脉造影检查怀疑为冠心病或已确诊为冠心病的男、女患者各75例。以冠状动脉造影结果作为金标准,分别计算64-DSCTCA诊断女性、男性冠心病(冠状动脉狭窄程度≥50%)、冠状动脉中度狭窄(狭窄程度50%~75%)、重度狭窄及完全闭塞(狭窄程度76%~100%)的灵敏度、特异度、阳性预测值、阴性预测值。采用统计学方法对比分析64-DSCTCA诊断女性、男性冠心病、冠状动脉中度狭窄、重度狭窄及完全闭塞的灵敏度、特异度、阳性预测值及阴性预测值是否不同。结果 64-DSCTCA诊断女性、男性冠心病的灵敏度、特异度、阴性预测值差异无统计学意义(P0.05),诊断女性冠心病的阳性预测值低于男性(P0.05)。64-DSCTCA诊断女性、男性冠状动脉中度狭窄的灵敏度、特异度、阳性预测值、阴性预测值差异无统计学意义(P0.05)。64-DSCTCA诊断女性、男性冠状动脉重度狭窄及完全闭塞的灵敏度、特异度、阴性预测值差异无统计学意义(P0.05),诊断女性冠状动脉重度狭窄及完全闭塞的阳性预测值低于男性(P0.05)。结论 64-DSCTCA对女性、男性冠状动脉狭窄的诊断价值不尽相同,诊断女性冠心病、冠状动脉重度狭窄及完全闭塞的阳性预测值低于男性。     

2型糖尿病患者冠状动脉粥样硬化与视网膜病变的关系

目的采用64层螺旋CT血管造影(MDCT),探讨2型糖尿病患者冠状动脉粥样硬化(CAs)与糖尿病视网膜病变(DR)的关系。方法诊断为CAs的2型糖尿病患者114例,无CAs的患者124例,受试者均进行眼底彩色照相、MDCT检查和体格检查,并测定空腹血糖、糖化血红蛋白、血脂、肾小球滤过率估计值和尿白蛋白排泌率等,分析检查和检测结果间的相关关系。结果 CAs患者DR发生率为67.5%,显著高于无CAs患者(33.1%,P<0.001)。在调整传统心血管病危险因素后CAs与DR独立相关,仍然具有统计学意义(OR=5.0,95%CI:2.6~9.8);发生CAs的血管数在无DR患者、增殖型DR前期患者及增殖型DR患者中逐渐增加(P<0.01);CAs发生率、有3支以上血管受损的CAs发生率、有意义CAs(管腔狭窄超过50%)发生率以及受损血管百分比也随DR的发生与发展而显著增加(无DR、增殖型DR前期、增殖型DR比较,P值均小于0.01)。结论 CAs发生范围和严重程度随DR的发生与发展而增加,CAs和DR仍然是多因素作用所致,可能有共同发病机制。     

64层螺旋CT冠状动脉成像在冠状动脉支架置入术后随访中的价值研究

目的以冠状动脉造影为金标准,评价64层螺旋CT冠状动脉成像（64SCTCA）在冠状动脉支架术后随访中的临床价值。方法对33例支架术后患者共57个支架行CT冠状动脉成像,观察冠状动脉支架处是否再狭窄并与冠状动脉造影（CAG）结果对照。结果 64SCTCA检查显示57个支架部位再狭窄8处,与CAG相比误判3处,漏判一处,但两者差别无统计学意义。其敏感度和特异度分别达到了83.3%和94.1%。结论 64SCTCA能够较准确判断冠状动脉支架术后是否发生了再狭窄,可作为支架术后随访的重要手段。     

Impact of 64-Slice Multidetector Computed Tomography on Other Diagnostic Studies for Coronary Artery Disease

Background

The clinical role of cardiovascular multidetector computed tomography (CT) remains in evolution, and application varies widely. Understanding its impact on the utilization of other cardiovascular diagnostic modalities could help define best practices.

Methods

Utilization of diagnostic testing was examined for the initial 1053 consecutive patients who underwent cardiovascular multidetector CT examinations after scanner installation in 2005. Yearly procedural volumes in the invasive catheterization and noninvasive stress laboratories were assessed before and after the introduction of multidetector CT.

Results

Ninety-one patients (8.6%) of the 1053 required invasive diagnostic catheterization; of these, nearly half subsequently underwent percutaneous or surgical intervention. Diagnostic catheterization and interventional volumes maintained their previous rates of annual increase, while the volume of stress testing decreased once multidetector CT became available.

Conclusions

The major impact of multidetector CT in initial cardiovascular practice is on the need and frequency of stress testing, with far less impact on utilization of cardiac catheterization and coronary interventions.     

心率波动对冠状动脉运动及64层螺旋CT冠状动脉成像质量的影响

目的探讨心率波动对冠状动脉运动及64层螺旋CT冠状动脉成像质量的影响。方法选取本院;临床中请多层螺旋CT冠状动脉成像（MSCTCA）且同意参加试验者34例为试验组,根据两次扫描心率变化分为三组,A组：≤5次／minBMP,B组：6～10次／minBMP,C组：〉10次／minBMP。分别测量心脏收缩末期和舒张末期右冠状动脉和左前降支间的距离,计算两次扫描的距离变化差。回顾性收集同期64SCTCA资料完整者137例为临床组,根据心率波动程度分成三组：Ⅰ组：0～2次／minBMP,Ⅱ组：3～6次／minBMP,Ⅲ组：〉7次／minBMP。按5分法评价不同心率波动情况下的图像质量。结果试验组两次扫描右冠状动脉与左前降支的间距差以舒展期变化较大,同收缩期比较差异有统计学意义（P〈0．05）;心率变化越大,距离的变化值也越大（P〈0．05）。临床组137例患者共有83．2％冠状动脉图像质量可满足诊断要求。不同心率波动组间冠状动脉图像质量有显著差异,心率变化越小图像质量越好（P〈0．05）。结论心率波动时数据匹配错误是导致图像质量降低的根本因素,稳定心率有助于提高图像质量。     

应用64层CT评价左冠状动脉前降支动脉硬化狭窄程度与左心功能的相关性

目的 利用64层CT对左冠状动脉前降支动脉硬化狭窄与左心功能变化之间的相关性进行评估.方法 经64层CT确诊的左冠状动脉前降支动脉硬化狭窄共104例,正常对照20例,均行64层螺旋CT心功能分析,分别计算出左心室质量、左心室射血分数、左心室舒张期末容积和左心室收缩期末容积等参数.根据管腔狭窄程度把104例左冠状动脉前降...     

不同类型非钙化冠状动脉斑块对支架成形阻力的比较

目的 回顾性分析冠状动脉支架术前已行64层螺旋CT冠状动脉成像的病例,比较不同类型非钙化冠状动脉斑块在支架术中对扩张的阻力。方法 选择2007年至2012年冠状动脉支架术前已行冠状动脉64层螺旋CT检查的患者116例。依据冠状动脉血管重构系数将非钙化冠状动脉斑块分为正性重构组和非正性重构组。比较两组的临床特征、靶斑块内是否检测出脂质核心、预扩张球囊规格、预扩张球囊充盈压力、支架规格、支架释放压力。结果 正性重构组的高敏C反应蛋白水平较高。和非正性重构组比较,脂质核心在正性重构组中检出更多。症状典型的病例中,不稳定型心绞痛在正性重构组多见,稳定型心绞痛在非正性重构组多见。两组预扩张的应用比例相似,两组预扩张球囊规格和预扩张压力无差异。两组支架的规格无差异。正性重构组支架释放压力为1 121.64±213.68 kPa,低于非正性重构组的1 232.56±201.95 kPa（P<0.01）。结论 和非正性重构组相比,正性重构组斑块内脂质核心更常见,支架植入时对支架成形阻力较小。术前识别冠状动脉重构类型对能否选择支架直接植入有一定指导意义。     

Ramus Circumflexissimus—A Rare Coronary Anomaly Detected by Coronary Computed Tomography Angiography

We present a case of L‐1 type solitary (left) coronary artery that was detected with coronary computed tomography angiography and confirmed by invasive coronary angiography in a female patient with atypical chest pain. Solitary coronary artery anomalies are rare. The L‐1 subtype is thought to be a benign type.     

64层螺旋CT对冠状动脉病变的评价

目的 探讨64层螺旋计算机X射线断层造影（64-slice spiral computed tomography,64-sCT）评价稳定型心绞痛病人冠状动脉病变的准确性.方法 拟诊稳定型心绞痛34例,男28例,女6例;年龄（66±12）岁,行64-sCT冠状动脉扫描,并于检查15 d内行冠状动脉造影.对所有病人的冠状动脉544节段分析,将结果与冠状动脉造影结果对比.结果 64-sCT显示冠状动脉狭窄的敏感度为52%,特异度为96%,阳性预测价值74%,阴性预测价值90%.对每条冠状动脉进行分析,诊断敏感度为76%,特异度为99%,阳性预测价值98%,阴性预测价值83%.对病人进行评价,诊断敏感度为97%,特异度为33%,阳性预测价值94%,阴性预测价值50%.结论 64-sCT评价冠状动脉病变的准确性高,有临床应用价值.