双源CT对冠状动脉桥血管的评价

【目的】评价双源螺旋CT对冠脉搭桥术后桥血管开通的诊断价值。【方法】对57例冠状动脉搭桥术后的患者行双源螺旋CT冠状动脉成像检查。【结果】所有141支桥血管均重建成功。其中内乳动脉桥39支,大隐静脉桥102支,通畅的桥血管102支（72．3％）,不同程度狭窄15支（10．63％）,完全闭塞24支（17．02％）。39支内乳动脉桥支33支通畅（84．62％）,102支大隐静脉桥支69支通畅（67．65％）,两种桥血管间相比较差异显著（P〈0．05）。【结论】双源螺旋CT是评价冠状动脉搭桥术后桥血管开通的有价值的无创检查方法。     

64层螺旋CT对先天性冠状动脉异常起源的显示

目的总结冠状动脉异常起源的螺旋CT影像表现。方法回顾性分析2005年5月1日-2006年5月1日行冠状动脉检查的患者的CTA结果,共2274人,其中冠状动脉异常起源者共24例,发生率为1.06%。其中男22例,女2例,年龄36~79岁,平均52.8岁。对患者图像分别行多平面重建(MPR)、最大密度投影(MIP)和容积重现(VR)法重建图像。结果右冠状动脉开口于左冠窦6例,开口高位5例;左主干开口高位4例,开口于左冠窦后缘2例;左前降支与左回旋支分别开口于左冠窦5例;左回旋支开口于右冠窦1例;左右冠状动脉共干1例。所有图像通过不同的重建方法可以清晰直观地显示异常血管的起始和行程。结论64层螺旋CT可清晰显示冠状动脉异常起源及行程异常,可为心血管医生提供有价值的影像。     

双源CT冠状动脉造影评价冠状动脉狭窄

目的 评价双源CT(DSCT)冠状动脉造影诊断冠状动脉狭窄的准确性.方法 收集104例临床疑诊或确诊冠心病并于30日内先后接受DSCT冠状动脉造影检查和导管法冠状动脉造影(CAG)患者,以CAG诊断结果作为金标准,分别评估DSCT诊断冠状动脉狭窄性病变(＜50％、≥500％和≥75％)的价值.结果 CAG显示1296段冠状动脉.DSCT可评估的冠状动脉为1217段,可评估率为93.90％(1217/1296);诊断＜500％、≥50％和≥75％狭窄的敏感度分别为79.12％ (144/182) 、84.73％ (172/203)和89.83％(106/118),特异度分别为97.33％(802/824) 、99.21％(1006/1014)和99.82％(1097/1099),阳性预测值为86.75％(144/166)、95.56％(172/180)和98.15％(106/108),阴性预测值为95.48％(802/840) 、97.01％(1006/1037)和98.92％(1097/1 109),准确率为94.04％(946/1006) 、96.80％ (1178/1217)和98.85％(1203/1217).钙化斑块是导致血管不可评估及误诊的主要原因.结论 DSCT冠状动脉造影判断冠状动脉狭窄程度的准确性较高,可作为临床筛查冠心病的较为可靠的方法.     

多层CT冠状动脉造影临床价值的初步探讨

目的　初步探讨无创性多层CT冠状动脉造影 (MSCTCA)的临床应用价值及局限性。方法　收集进行多层CT冠状动脉造影患者 2 0例 (临床疑诊为冠心病者 15例 ,冠状动脉血管成形术并置入支架者 5例 )。以管腔直径减少≥5 0 %作为判定狭窄的标准 ,对各冠状动脉主要分支进行节段分析 ,并与传统冠状动脉造影结果进行对比。结果　 84.4%的冠脉节段图像质量可以进一步评价。MSCTCA检出冠状动脉病变的敏感度为 75 % ( 6/ 8) ,特异度为 94.9% ( 13 1/ 13 8)。对于支架节段 ,MSCTCA可准确显示支架位置、形态及远端血流情况 ,可排除支架闭塞及高度狭窄。结论　多层CT冠状动脉造影可显示较长节段的冠状动脉 ,较为准确地认定冠状动脉病变 ,有潜力成为无创性诊断冠状动脉疾病的有力工具。     

320排CT血管成像对冠状动脉瘘的诊断价值

目的探讨320排CT血管成像对冠状动脉瘘的诊断价值。方法回顾性分析34例冠状动脉瘘患者的320排CT血管成像资料及临床资料,其中11例患者同时进行冠状动脉造影检查。结果 26 590例患者中共34例诊断为冠状动脉瘘,发病率为0.13%。34例冠状动脉瘘中冠状动脉-肺动脉瘘26例(76.5%),冠状动脉-左心室瘘3例(8.8%),冠状动脉-右心房瘘3例(8.8%),冠状动脉-左心房瘘1例(2.9%),冠状动脉-右心室瘘1例(2.9%)。起源于左冠状动脉8例(23.5%),起源于右冠状动脉10例(29.4%),同时起源于两侧冠状动脉者16例(47.1%)。16例(47.1%)伴随瘤样扩张。瘘口直径范围2.0~13.0 mm,中位直径2.5 mm。瘘口两端见浓染征15例(44.1%),射血征10例(29.4%),等密度征9例(26.5%)。11例均经冠状动脉造影证实为冠状动脉瘘。结论冠状动脉瘘发病率低,其中冠状动脉-肺动脉瘘是最常见的类型(占76.5%),同时起源于两侧冠状动脉占47.1%。320排CT血管成像能无创、准确地显示冠状动脉瘘的起源、瘘血管走行、瘘口直径及引流部位,可作为诊断冠状动脉瘘的首选检查方法。     

64层螺旋CT在评价冠状动脉桥血管中的价值

目的探讨64层螺旋CT在诊断冠状动脉桥血管的临床价值。方法对21例冠状动脉搭桥术的患者行64层螺旋CT心、胸部血管造影检查。对所有扫描原始数据行冠状、矢状MPR、曲面重建(CPR)以及VR、MIP重建。由两位有经验的放射科医生对所有图像进行观察,对桥血管狭窄进行诊断,并评价其狭窄程度。8例CT诊断桥血管重度狭窄(管腔狭窄>75%)或闭塞的患者同时行选择性血管造影检查。结果21例患者均可清晰地显示冠状动脉各主要分支,并能清晰地显示其斑块和管腔的狭窄。21例患者经螺旋CT心、胸部血管造影检查,可清晰显示52条桥血管,其中13条桥血管出现再狭窄(10条为大隐静脉桥血管,3条为乳内动脉桥血管),狭窄部位均位于桥血管吻合口处;重度狭窄7条,闭塞1条,此8条桥血管均与选择性血管的结果相吻合,CT评价冠状动脉桥血管重度狭窄的准确性为100%。结论64层螺旋CT心、胸血管造影检查不但能显示冠状动脉桥血管,而且能清晰地显示原始的冠状动脉及冠状动脉与桥血管的吻合口,是评价冠状动脉桥血管的一种有效的可靠的检查方法。     

多层螺旋CT 冠状动脉血管造影的临床应用

目的探讨MSCT冠状动脉造影的临床应用价值.方法对56例患者行MSCTA,其中25例患者同时行选择性冠状动脉造影.结果在56例MSCT冠状动脉造影中,54例MSCT冠状造影检查均成功显示冠状动脉各主支,其中28例患者、78支冠状动脉显示有不同程度的钙化与狭窄;行选择性冠状动脉造影检查患者均可显示冠状动脉的各主支及分支,18例可显示冠状动脉不同程度的狭窄,但2例患者术后出现并发征.结论 MSCTA检查是一种安全可靠的检查方法.     

多层螺旋CT血管成像对冠状动脉畸形的诊断价值

目的探讨多层螺旋CT冠状动脉成像在分析诊断先天性冠状动脉畸形中的价值。方法回顾性分析2051例行多层螺旋CT冠状动脉成像影像资料,统计冠状动脉畸形的发生率,并分析冠状动脉畸形的CT影像表现。结果2051例行多层螺旋CT冠状动脉成像的人群中,发现冠状动脉畸形57例,检出率为2.8%,其中51例为冠状动脉起源和走行异常,3例为冠状动脉瘤,3例为冠状动脉瘘。结论多层螺旋CT成像在冠状动脉畸形的诊断和预后判断中有应用价值。     

多层螺旋CT对冠状动脉桥血管的评价

目的评价16层螺旋CT对冠状动脉桥血管的显示能力。方法回顾性分析17例冠状动脉搭桥术(CABG)后患者的CT和选择性桥血管造影的资料,男15例,女2例,年龄51～78岁,平均(67±7)岁,术后6～85个月,平均(32±19)个月。共40支桥血管,原位乳内动脉13支,游离桡动脉11支,游离大隐静脉16支。由两位有丰富心血管影像诊断学经验的医生采用双盲法阅片,并取得一致结果。评价指标包括CT成像中桥血管的可评价性、有无闭塞或狭窄(管径缩小50%～99%)。结果所有40支桥血管均可评价,CT准确诊断5支桥血管闭塞和1支狭窄外,各有1例假阳性,其诊断桥血管闭塞与狭窄的敏感性、特异性达100%和97%,准确率分别为97.5%和97.1%。发生闭塞的血管与桥血管的类型和分布无关。结论16层螺旋CT是一种值得信赖的无创性随访研究桥血管通畅性的影像学方法。     

64层螺旋CT冠状动脉成像对壁冠状动脉的诊断价值

目的 探讨64层螺旋CT冠状动脉成像对壁冠状动脉(MCA)的诊断价值.方法 528例可疑冠心病患者行64层螺旋CT冠状动脉成像,回顾性分析VCT确诊的65例MCA的CTA表现.结果 65例共83段壁冠状动脉,其发生率为12.3%.其中前降支占78%,左旋支占13.5%,右冠状动脉最少,约占8.5%.MCA 肌桥长度为7～32 mm,平均21 mm,厚度2～5 mm,平均2.6 mm.结论 64层螺旋CTA作为一种无创性的检查,在壁冠状动脉的诊断中具有很高的临床应用价值.     

Coronary artery fistula in a patient with coronary artery disease: evaluation by coronary angiography and multidetector computed tomography

A 54-year-old man with acute miyocardial infarction was successfully treated with coronary artery stenting. Coronary angiography is the preferred diagnostic method for imaging the coronary arteries, but coronary artery fistulas origin and course may not be apparent. New tomographic cardiovascular imaging tests such as, multidetector computed tomography (MDCT) can be used to precise delineation of coronary fistulas. An erratum to this article can be found at     

Noninvasive coronary angiography using computed tomography

While noninvasive imaging of the coronary lumen remains challenging, great strides have been made with computed tomography. Two variations of computed tomography are used in the study of the coronary tree: multislice or multidetector computed tomography and electron-beam computed tomography. Both have high spatial and temporal resolutions as well as excellent signal-to-noise ratios, which allows major branches of the coronary tree to be depicted. Impaired image quality, due to dense calcifications and multiple image artifacts including coronary artery motion and breathing artifacts, limits the clinical utility of noninvasive coronary angiography. Early studies with electron-beam angiography demonstrated an overall sensitivity of 85% and specificity of 89% for the detection of obstructive coronary artery disease. With early diastolic imaging, the sensitivity and specificity increases to 92 and 93%, respectively (rather than 80% of the cardiac interbeat interval, where coronary motion is more pronounced). Multidetector computed tomography, with improved spatial resolution but decreased temporal resolution, produces results that vary depending on the equipment. Four-slice scanners have an average sensitivity of only 61%, and only 38% of patients have all four vessels or 15 segments available for analysis, due to both cardiac motion and calcification. Thinner slice collimation with eight and 16 slices have allowed for improved detection. Sensitivity and specificity improve to 80 and 86%, respectively. Furthermore, the number of assessable segments with eight-2011; to 16-2011;slice scanners improves significantly, compared with four-slice scanners (85 vs. 73%; p < 0.001). If only assessable segments are included in analysis, sensitivity and specificity for multidetector-row computed tomograpy improves to nearly 90%. Compared with magnetic resonance imaging, with a reported accuracy of 72% in the only multicenter study, computed tomography has great promise to become the primary method of noninvasive coronary angiography.     

少见先天性冠状动脉变异的冠状动脉造影分析

目的 分析少见的先天性冠状动脉变异的冠状动脉造影的表现,探讨冠状动脉造影的诊断价值。方法 收集1997－1999年410例冠状动脉造影中的先天性冠状动脉变异共16例,其中壁冠状动脉8例,冠状动脉瘘6例及先天性右冠状动脉缺如2例。冠状动脉造影,动态下观察,并进行必要的测量。结果 8例壁冠状动脉均表现为收缩期狭窄,1级3例,2级4例,3级1例。狭窄段长度17．2mm,其中3级1例行冠状动脉旁路移植术。6例冠状动脉瘘,5例源自左冠状动脉,1例源自双侧冠状动脉,2例引流入肺动脉干,4例引流入右心室。2例右冠状动脉缺如,经冠状动脉造影及主动脉造影证实。结论 冠状动脉造影是诊断少见先天性冠状动脉变异的重要手段,动态下观察是发现病变的关键。     

Noninvasive coronary angiography: agreement of multi-slice spiral computed tomography and selective catheter angiography

Background: Technology advances in multislice detector computed tomography (MSCT) cardiac scanning, specifically in the application of intravenous injected contrast coronary angiography with EKG gating have led to the availability of this procedure in every day outpatient cardiac medicine. Objective: The aim of this study is to test the head to head direct coronary angiography with MSCT coronary angiography in clinical situations where cardiac cath is traditionally utilized for management decisions. Methods: We limited our analysis to vessels felt to be 1.5 mm or greater in diameter, recognizing diagnostic accuracy and medical importance of smaller vessels is low. All 50 patients (52% men, 48% women age range 34–78) were studied because of the clinical suspicion of obstructive coronary atherosclerosis. Blinded experts in direct and in MSCT independently read the studies and resolved disparities by a subsequent discussion. Standard protocols for direct and for MSCT angiography were used including use of IV and oral beta blockade to keep the heart rate at or below 60 beats per minute. Results: 392 vessels were evaluated. MSCT provided images of sufficient technical quality to permit diagnosis in 98% (49/50) of cases. MSCT was 96% accurate in identifying patients as having either no disease, single vessel disease, or multiple vessel disease. For all vessels, MSCT identification of stenotic lesions of > 50% were as follows: sensitivity 87%, specificity 97%, positive predictive value 80%, and negative predictive value 98%. Pearson correlation results between direct catheter and MSCT for absolute stenotic percentages were left main (0.92 p < 0.0001), left anterior descending (0.94 p < 0.0001), circumflex (0.94 p < 0.0001), first obtuse marginal (0.85 p < 0.0001), and right coronary artery (0.89 p < 0.0001). Conclusion: The accuracy of MSCT angiography compared favorably with that of direct cardiac cath in this cohort of patients. The high specificity of these findings suggest that one particular use of this technique will be to eliminate many unnecessary cardiac catheterization procedures by excluding obstructive, and therefore potentially PCI requiring, coronary artery disease. The medical cost savings of such an application may be very significant and bears further study.     

冠状动脉 CT 成像对女性冠心病评估的临床价值

冠心病是严重危害人类健康的主要心血管疾病之一。与男性相比,女性冠心病患者因其特殊的病理生理特点,在症状识别、采取治疗措施以及预后等方面均存在不同程度差异,因此,加强对女性冠心病的早期识别和干预尤为重要。与其他常用无创检查相比,冠状动脉 CT 成像在女性冠心病的危险分层和预后中具有重要价值,对女性冠心病的评估具有潜在优势,其临床应用价值逐渐提高。     

64排CT冠状动脉成像诊断冠状动脉狭窄的临床价值

目的 评价64排CT冠状动脉成像(CTCA)技术诊断冠状动脉显著狭窄(≥50%管腔狭窄)的临床价值.方法 采用CTCA对61例临床疑诊冠心病患者进行检查,并于CTCA检查后2周内行选择性冠状动脉造影(SCA).结果 1例患者因冠状动脉严重钙化4支血管CTCA不可评估,其余60例患者240支冠状动脉血管CTCA均可良好显影,240支血管显著狭窄诊断的灵敏度、特异度、阳性预测值及阴性预测值分别为90.0%(72/80)、91.9%(147/160)、84.7%(72/85)、94.8%(147/155).结论 CTCA显示了较高的阴性预测值,可以作为排除冠状动脉显著病变的一种无创标准性检查.     

Visual assessment of coronary artery stenosis with electrocardiographically-gated multislice computed tomography

BACKGROUND: With faster image acquisition times and thinner slice widths, multislice detector computed tomography (MSCT) allows visualization of human coronary arteries. Significantly improved image quality, with high resolution and new software for three-dimensional post-processing, has made noninvasive examination of the cavities within human body possible. OBJECTIVE: The aims of this study are to evaluate the diagnostic accuracy of ECG-gated MSCT for the detection of significant coronary artery stenosis and occlusions. METHODS: In 25 patients (19 male and 6 female aged 65+/-9 years) with suspected obstructive coronary artery disease, ECG-gated MSCT angiography was performed with an 8-slice MSCT scanner. Visual coronary arteries were simulated in three coronary arteries. Conventional coronary angiographies were performed in all patients. And coronary lesions in MSCT were estimated by two observers, who did not know the results of the coronary angiography. RESULTS: Current MSCT allows visual coronary artery with good image quality. The overall sensitivity for diagnosing significant coronary stenosis were 75.0%, the specificity was 95.6%. The positive and negative predictive values were 84.9 and 92.2%, respectively. The accuracy of MSCT for detecting coronary stenosis is the highest in the left main tranck and left anterior descending coronary artery, and lowest in the circumflex coronary artery. CONCLUSION: MSCT was feasible for the detection of coronary artery stenosis.     

Practicality, safety and accuracy of computed tomography coronary angiography in the evaluation of low TIMI-risk score chest pain patients: a pilot study

Objectives: The present pilot study aimed to assess the practicality, safety and accuracy of performing CT coronary angiography (CT‐CA) in the evaluation of acute chest pain of patients with low thrombolysis in myocardial infarction (TIMI) risk scores. Methods: The present prospective observational study was undertaken in a university teaching hospital between November 2004 and December 2005. Participants were a convenience sample of patients admitted to hospital for investigation of chest pain with TIMI risk scores <3. Consenting patients underwent CT‐CA within 48 h of presentation. Outcomes of interest were practicality (proportion of diagnostic quality scans obtained and preparation time for CT‐CA), rate of serious adverse events, and accuracy at the patient level using selective coronary angiography as the reference standard. Results: Thirty‐four patients were recruited. Diagnostic quality scans were obtained in 26/34 or 76% of patients (four failed CT‐CA and four non‐diagnostic scans). The median CT preparation time was 1.9 h (range 0.17–4.0). No serious adverse events were found. Fourteen of those 26 patients with diagnostic CT‐CA subsequently had selective coronary angiography, of which nine were positive. The sensitivity and specificity of CT‐CA in identifying patients with significant coronary artery disease were 9/9 (100%; 95% confidence interval 72–100%) and 4/5 (80%; 95% confidence interval 28–100%), respectively. Conclusions: The majority of acute chest pain patients with low TIMI risk scores were successfully scanned with a 16‐slice CT to produce CT‐CA studies with good diagnostic quality and accuracy. No major adverse events were found. The place of CT‐CA in diagnostic workup for chest pain remains to be defined.     

Prevalence of left main coronary artery disease among patients referred to multislice computed tomography coronary examinations

We have evaluated the prevalence of left main coronary artery disease (LMCAD) among patients referred to multislice computed tomography (MSCT) coronary angiography examinations. The study Group comprised of 1,000 consecutive patients (750 male and 250 female; mean age 53±12 years) who underwent successful 64-slice MSCT examinations. Left main coronary artery (LMCA) was classified into three Groups: normal LMCA; nonsignificant LMCAD with coronary plaques resulting in obstructions ≤50%; and significant LMCAD corresponding to obstructions >50%. We have found that 24 patients (2.4%) had significant LMCAD. Additional 200 patients (20%) had nonsignificant LMCAD. Univariate analysis revealed that LMCAD was associated with age, male gender, diabetes, hypertension, hyperlipidemia, typical symptoms, history of previous myocardial infarction and previous percutaneous coronary intervention. Only age and male gender were found as independent predictors for LMCAD in multivariate analysis (P < 0.001 and P = 0.001, respectively,). Angiographic follow-up was avaliable for the 24 patients with significant LMCAD, and conventional coronary angiography confirmed the presence of significant LMCAD in all of these patients. Significant LMCAD was found in 2.4% of the 1,000 patients referred to 64-slice MSCT examinations. Age and male gender were the independent predictors for LMCAD.     

冠状动脉旁路移植术后移植血管64排螺旋CT血管成像与选择性血管造影对比研究

目的:探讨64排螺旋CT血管成像对冠状动脉旁路移植血管诊断的准确性和应用价值。方法:对20例实施冠状动脉旁路移植5 a以上冠心病患者进行随访。冠状动脉及移植血管同时行64排螺旋CT血管成像和选择性血管造影,比较分析2种检查结果。结果:共移植血管58支。以选择性移植血管造影结果为标准,64排螺旋CT血管成像对移植血管闭塞诊断的敏感性为77.27%,特异性为97.22%,阳性预测值为94.44%,阴性预测值为87.50%,准确性为89.66%;对于闭塞加狭窄诊断的敏感性为81.48%,特异性为93.55%,阳性预测值为91.67%,阴性预测值为85.29%,准确性为87.93%。结论:64排螺旋CT血管成像对移植血管病变具有较高敏感性和特异性,可作为冠状动脉旁路移植手术后检查方法,尤其适用于选择性血管造影检查困难的移植血管。