64层螺旋CT冠状动脉成像在心肌桥诊断中的价值

目的:探讨64层螺旋CT冠状动脉(冠脉)成像(64-slice CT coronary angiography, 64SCTCA)对心肌桥(MB)的诊断及其临床价值.方法:932例患者均行64SCTCA扫描,所有数据传至工作站进行重建和后处理,观察有无MB,测量MB的长度、厚度、壁冠脉(MC)狭窄程度等.对64SCTCA发现MB的病例均行冠脉造影(CAG)并与64SCTCA的结果进行对比.结果:932例患者经64SCTCA检出MB 356例,MB检出率为38.1%;而64SCTCA 检出的356例MB病例中经CAG仅检出MB 89例,MB检出率10.2%;两者比较差异有统计学意义(P<0.05).64SCTCA发现MB的平均长度及厚度分别为(9.4±5.6)mm、(5.9±4.3)mm,MC狭窄程度为(39±23)%;CAG与64SCTCA对MB的狭窄程度与长度比较, 差异亦有统计学意义(P<0.05).结论:64SCTCA对MB和MC清晰显示,有着特殊的临床价值.     

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.     

64层螺旋CT与冠状动脉造影诊断冠状动脉狭窄的对比研究

目的评价64层螺旋CT冠状动脉成像(64-slice spiral computed tomographic coronary angiography,64-SCTCA)对冠状动脉各节段狭窄病变的诊断价值。方法85例疑诊为冠状动脉性心脏病(冠心病)患者,先后行64-SCTCA和冠状动脉造影(coronary angiography,CAG)检查,评价64-SCTCA诊断冠状动脉各节段狭窄病变的敏感性、特异性、阳性预测值、阴性预测值和准确性。结果①在CAG可清晰显影的744个节段中,64-SCTCA造影可清晰显示和评价的占639段(85.89%),另外105段(14.11%)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(P0.001),同一支血管中近段可评价的比例显著高于远段(P0.001);②64-SCTCA诊断冠心病的敏感度、特异度、准确度、阳性和阴性预测值分别为96.23%、90.63%、94.44%、93.55%、94.12%。按可评价节段计算,64-SCTCA诊断冠状动脉各节段有意义狭窄病变总的敏感性、特异性、准确性、阳性和阴性预测值分别为89.06%、95.89%、84.44%、95.33%、94.32%;③按可评价节段计算,64-SCTCA对诊断左主干、左前降支、左回旋支和右冠状动脉各节段病变的价值相似,但检测冠状动脉近中段病变的价值高于远段(χ2=4.66,P=0.03)。结论64-SCTCA对冠状动脉狭窄病变有较好的诊断价值,其检测左主干和左前降支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,适合于冠心病的筛查。     

64层螺旋CT冠状动脉成像对冠心病诊断的应用价值

目的 通过探讨64层螺旋CT冠状动脉成像(64-SCTCA)对冠心病诊断的应用价值以明确临床上适于该项检查的人群.方法 回顾性分析285例接受64-SCTCA检查、并于4周内接受冠状动脉造影(CAG)检查的冠心病疑诊患者的临床资料.依照冠心病概率Duke模型,将受检者分为冠心病低危(n=80)、中危(n=92)和高危(n=113)3组,以CAG为"金标准",判断64-SCTCA诊断冠心病的准确性以及冠状动脉钙化、不同部位血管节段等因素对诊断准确性的影响.结果 64-SCTCA诊断冠心病的敏感性、特异性、阳性预测值、阴性预测值和诊断准确指\数分别为81.2%、93.3%、68.0%、96.6%和74.5%.冠心病概率Duke模型的低危组、中危组和高危组,其冠心病检出率分别为46.3%、72.8%和82.3%;64-SCTCA在低危组诊断冠心病的敏感性及阳性预测值明显低于中危组和高危组.对于冠状动脉Agatston钙化积分＞400分组,64-SCTCA诊断冠心病的敏感性(95.0%)明显高于0～100分组和101～400分组(77.4%和77.3%,P均＜0.05),特异性(82.2%)明显低于上述两组(94.0%和95.3%,P均＜0.05).其诊断远端血管病变的敏感性、阳性预测值均明显低于近、中段血管(P均＜0.05).结论 64-SCTCA主要适用于冠心病概率Duke模型临床分层的中危人群.其诊断准确性受冠状动脉钙化、病变部位、管腔直径等因素影响.     

64层螺旋CT冠状动脉血管成像与冠状动脉造影对照研究

目的评价64层螺旋CT诊断冠状动脉粥样硬化性心脏病的临床应用价值。方法40例临床诊断或可疑冠心病患者行64层螺旋CT心电门控平扫及增强扫描,并以冠状动脉造影结果作为对照。得出64层螺旋CT冠状动脉CT血管成像(CTA)诊断冠状动脉狭窄的准确性、敏感性、特异性。结果64层螺旋CT冠状动脉血管成像用于诊断冠心病的敏感性为87.1%,特异性为67.5%,准确性为80.0%。结论①64层螺旋CT检查是一种无创、快捷的冠状动脉血管检查方法,对冠心病的诊断有较高的准确性。②与冠状动脉造影术相比,64层螺旋CT冠状动脉血管成像对冠状动脉血管狭窄程度判断仍有一定差异。     

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(64SCTCA)诊断冠状动脉狭窄的准确性及临床应用价值。方法入选B6例安贞医院住院患者,平均年龄(62.64±11.47)岁,临床高度怀疑不典型胸痛、心绞痛(稳定或不稳定型)或非ST段抬高心肌梗死患者,行64SCTCA,并在CT检查后2w接受传统的冠状动脉造影(CAG)。分析所有直径≥1.5mm冠状动脉脉,识别狭窄<50%、≥50%及≥75%的所有冠脉病变,并将其与CAG结果进行对比。结果将所有冠状动脉按狭窄<50%、≥50%及≥75%进行分级,CAG结果:冠脉无明显病变占8.1%(7/86),单支病变占27.9%(24/ 86),多支病变占59.3%(51/86);基于患者病变程度分析,64SCTCA显示狭窄<50%、≥50%及≥75%的敏感性分别为:100%、95%、92%;特异性为85.7%.结论64.SCTCA诊断冠心病具有安全、无创、快捷的优点,可用于诊断临床表现不典型胸痛、稳定或不稳定型心绞痛及非ST段抬高心肌梗死患者的中、高度狭窄病变,具有较高的敏感性及特异性。     

多层面螺旋CT冠状动脉成像在冠心病中的应用

目的　评价多层面螺旋CT(MSCT)行冠状动脉血管造影和三维重建在冠心病中的应用价值。方法　对 30例冠心病患者进行了心电门控MSCT增强扫描 ,在工作站对图像资料进行了最大密度投影法 (MIP)三维重建 ,并与冠状动脉造影结果相对照。结果　 30例患者中对 12 0支冠状动脉血管 (左主干、左前降支、回旋支、右冠状动脉 )进行了MSCT三维重建 ,图像质量良好者为 84支 (70 % ) ,影响图像质量的主要因素是心脏搏动造成的伪影 ;9例冠状动脉支架和 5例冠状动脉搭桥术后均可清晰显示支架和血管桥的位置及远端血流情况 ,对于显示近中端高度 (>75 % )或完全梗阻性病有一定的准确性 (敏感性 80 % ,特异性 79.8% )。而不能显示轻度狭窄病变、远端或细小分支病变。结论　MSCT血管造影和三维重建在冠心病诊断和对病变血管的评价 ,以及血运重建术后复查等方面有一定的应用价值。     

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。     

320排螺旋CT冠状动脉成像与冠脉造影对冠心病诊断的的对比研究（英文）

目的：探讨320排螺旋CT冠状动脉成像对冠心病诊断的临床应用价值。方法：85例病人先后进行320排螺旋CT冠状动脉成像（SCTCA）和选择性冠状动脉造影（CAG）。以CAG为诊断冠心病（CHD）的＂金标准＂,比较320排螺旋CT检出CHD的敏感度,特异度,阳性预测值,阴性预测值和准确度。结果：320排螺旋CT诊断CHD的敏感性,特异性,阳性预测值,阴性预测值,准确度分别是：95.65%（44/46）、74.36%（29/39）、81.48%（44/54）、93.55%（29/31）、85.9%（73/85）。结论：320排螺旋CT冠状动脉成像是一种简单易行、安全可靠的无创性检查,可作为冠心病的筛选及术后复查的方法。     

冠状动脉钙化积分与冠心病危险因素的相关性

目的经多层冠状动脉CT检查测定的冠状动脉钙化积分对冠心病的诊断具有一定预测价值。而冠心病的危险因素与冠心病的发生、发展、结局和预后密切相关。我们旨在探讨冠状动脉钙化积分与冠心病诸多危险因素之间是否具有相关性。方法入选2001年1月至2007年3月在全国20家医院住院疑诊冠心病患者,采用16排或64排螺旋CT进行冠状动脉增强扫描,并运用自动分析软件进行冠脉钙化积分分析,共入选患者311例,根据冠状动脉钙化积分值分为低分值组（0～12）、中分值组（13～445）和高分值组（446以上）,比较冠状动脉钙化积分与冠心病危险因素之间的关系。结果不同冠状动脉钙化积分分组之间,平均年龄、冠心病家族史比例、高密度脂蛋白数值和糖尿病比例等方面存在差异,P〈0.05。多元Logistic回归分析显示,疑诊冠心病患者年龄（OR=1.061,95%CI1.004～1.121,P=0.036）和低HDL-C水平（OR=0.321,95%CI0.113～0.909,P=0.032）是冠状动脉钙化积分的显著相关危险因素。结论年龄、冠心病家族史、低HDL和糖尿病等冠心病危险因素与冠状动脉钙化密切相关,合并多种冠心病危险因素的患者,尤其是老年和低HDL-C患者,行多层冠状动脉CT检查及冠状动脉钙化积分测定,对冠心病的早期诊断具有一定帮助。     

64层CT冠状动脉成像的前瞻性与回顾性心电门控比较

目的 比较前瞻性心电门控和回顾性心电门控64层CT冠状动脉成像的辐射剂量和成像质量,探讨低剂量前瞻性心电门控CT冠状动脉成像的可行性.方法 两组心率≤65次/min各100例患者分别进行前瞻性和回顾性心电门控扫描,并采用多平面重组(MPR)、最大密度投影(MIP)、曲面重组(CPR)及容积再现(VR)多种重组技术显示冠状动脉,图像质量根据运动伪影影响分为优、良、差,使用剂量长度计算各自的有效辐射剂量,并进行统计学分析.结果 前瞻性组平均辐射剂量为(2.81±0.48)mSv明显低于回顾性组的(10.16±1.09)mSv(P＜0.01);前瞻性组诊断性冠状动脉节段和非诊断性冠状动脉节段为95.2%(1165/1224)和4.8%(59/1224),与回顾性组的94.1%(1186/1261)和5.9%(75/1261)比较,差异无统计学意义.结论 对于心率稳定在65次/min以下的患者,前瞻性心电门控64层CT冠状动脉成像,能以较低的辐射剂量达到回顾性心电门控诊断质量的影像,是切实町行的方法.     

Evaluation of coronary atheroma by 64-slice multidetector computed tomography: Comparison with intravascular ultrasound and angiography

BACKGROUND:

Recent improvements in multidetector computed tomography (MDCT) with 64-slice scanners have allowed acquisition of a coronary study in 5 s to 6 s, with good temporal and spatial resolution. Previous studies have reported an underestimation of plaque burden by MDCT. Whether shorter scan times can allow correct assessment of plaque volume requires comparison with intravascular ultrasound (IVUS).

METHODS:

Patients (n=30) scheduled for coronary angiography also underwent MDCT and IVUS examinations within 96 h. MDCT examination was performed with a 64-slice scanner. Nitroglycerin was administered before all imaging procedures. MDCT, quantitative coronary angiography (QCA) and IVUS analyses were performed by observers blinded to other results. Plaque volumes were determined by MDCT and IVUS in one vessel, and maximum percentage diameter stenosis was identified in each coronary segment by MDCT and QCA.

RESULTS:

The mean (± SD) plaque volume was determined to be 179.1±78.9 mm³ by MDCT and 176.1±87.9 mm³ by IVUS. There was a strong positive correlation for plaque volume between MDCT and IVUS (r=0.84, P<0.0001). Percentage diameter stenosis assessed by MDCT and QCA also correlated well (r=0.88 per patient and r=0.87 per vessel, P<0.0001 for both). The maximum percentage diameter stenosis per vessel was 38.1±30.2% with MDCT and 34.1±27.6% with QCA. The sensitivity and specificity of MDCT in detecting stenoses above 50% per vessel were 100% and 91.0%, respectively.

CONCLUSIONS:

Plaque volumes measured by 64-slice MDCT and IVUS correlate well, without systematic underestimation. The sensitivity and specificity of MDCT to detect stenoses greater than 50% by QCA are excellent with the administration of nitroglycerin before imaging.     

国内外64层螺旋CT诊断冠心病研究差异的荟萃分析

目的 用荟萃分析方法评价64层螺旋CT诊断冠心病的价值,比较国内外研究的差异.方法 检索Cochrane图书馆、Medline、OVID数据库以及中国期刊网1998至2009年公开发表的国内外文献,按照纳入标准筛选文献.对纳入的研究进行异质性检验,并选择相应的效应模型对所有研究定量合并,计算汇总敏感度、特异度及其95%...