冠状动脉病变自身因素对CTA评估冠状动脉狭窄准确性的影响分析

目的探讨冠状动脉病变自身因素对CT血管造影(CTA)评估冠状动脉狭窄准确性的影响。方法对120例冠心病的患者采用64层螺旋CTA冠状动脉血管造影(coronary angiography,CAG)。结果分析CTA诊断冠状动脉狭窄的准确性可以发现CTA评价重度狭窄的敏感性明显高于轻度狭窄和中度狭窄,且差异具有统计学意义。评估冠状动脉各种程度狭窄的特异性与阴性预测值均较高。本研究分析了不同冠状动脉病变对评价冠状动脉狭窄准确性的影响,结果显示钙化斑块是导致CTA评价冠状动脉狭窄假阳性最重要的原因,占64.29%(36/56)。对于冠状动脉和其分支的狭窄程度的低估占假阴性结果的66.67%(40/60),另外还有一部分壁冠状动脉和心肌桥在CTA评价冠状动脉狭窄中被漏诊。而在诸多因素中非钙化和混合斑块以、支架对CTA评价冠状动脉狭窄的影响较小。结论冠状动脉血管造影操作便捷、准确性高,可作为一种无创检查技术对冠状动脉狭窄进行筛查。     

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.     

CTA与DSA评估冠心病冠状动脉狭窄程度的临床价值

目的 探讨CT血管成像(CTA)与数字减影血管造影(DSA)评估冠心病(CHD)冠状动脉狭窄程度的临床价值。方法选取78例疑似CHD患者，首先行CTA检查，并在随后7天内行DSA检查。将DSA作为诊断金标准，分析CTA对冠状动脉阳性病变的诊断结果。结果 经DSA金标准诊断阳性65例，阴性13例，其中CTA诊断阳性64例，阴性12例。CTA对冠状动脉阳性病变诊断的阴性预测值为92.31%、阳性预测值98.46%、灵敏度98.46%、特异度92.31%、符合率97.44%,一致性分析Kappa值分别为0.890,0.932,0.890,0.932,0.928。DSA与CTA对CHD冠状动脉狭窄程度的检查结果比较，差异无统计学意义(P>0.05)。结论 CTA对于CHD具有较高的诊断价值，能够有效识别冠状动脉狭窄程度与斑块类型。     

64层螺旋CT对冠状动脉粥样硬化血管狭窄的评价

目的:探讨64层螺旋CT对冠状动脉粥样硬化各种程度血管狭窄的评估价值.方法:120例患者行64层螺旋CT血管造影(CTA)检查评价冠状动脉各段的狭窄程度,并与冠状动脉血管造影(CAG)比较,统计64层螺旋CTA诊断冠状动脉各种程度狭窄的敏感性、特异性、阳性预测值(PPV)和阴性预测值(NPV).结果:64层螺旋CTA评...     

无常规心率控制下64排螺旋CT诊断冠状动脉狭窄的应用价值

目的 以有创性冠状动脉造影(ICA)为"金标准",评估无常规心率控制下64排螺旋CT冠状动脉成像(CTA)诊断冠状动脉狭窄的可靠性.资料与方法 35例患者先后行64排螺旋CT冠状动脉CTA和ICA,CTA扫描前所有患者均未常规控制心率.在未获知ICA结果的情况下,两位观察者独立对CTA结果作出评价.以冠状动脉管腔狭窄程度≥50%作为确定冠状动脉狭窄存在的标准.结果 ICA共显示75处冠状动脉管腔狭窄.64排螺旋CT冠状动脉CTA诊断冠状动脉狭窄的敏感度、特异度、阳性预测值及阴性预测值分别为:97.3%(73/75), 98.9%(468/473),93.6%(73/78)和99.6%(468/470).结论 在无常规心率控制条件下,64排螺旋CT冠状动脉CTA诊断冠状动脉狭窄仍具有很高的准确性.     

冠状动脉CTA与冠状动脉造影诊断心肌桥-壁冠状动脉的对比研究

目的观察冠状动脉CTA与冠状动脉造影在诊断心肌桥-壁冠状动脉(MB-MCA)的应用效果。方法选取我院就诊的167例疑似心肌缺血患者,分别进行冠状动脉CTA和冠状动脉造影(CAG)检查。比较两种检查方法对MB-MCA的诊断效果,测量和分析MB-MCA的长度和狭窄程度。结果冠状动脉CTA共检出MB-MCA患者37例,而CAG检查共检出MB患者20例,冠状动脉CTA对于MB-MCA的检出率显著高于CAG检查,差异有统计学意义(P0.05);以CAG检查结果为参照,可计算出冠状动脉CTA诊断MB的敏感性为90%、特异性为87.1%、阳性预测值为48.6%和阴性预测值为98.5%;冠状动脉CTA对MB-MCA测量的长度和狭窄程度结果均大于CAG测量结果,差异有统计学意义(P0.05)。结论冠状动脉CTA在MB-MCA的诊断和测量中具有较高的准确性,具有较好的临床应用及推广价值。     

320排动态容积CT冠状动脉成像诊断冠心病的初步应用

目的探讨320排动态容积CT冠状动脉成像(CTA)诊断冠心病的准确性。方法 2010年3月至2010年9月对临床拟诊为冠心病的82例患者先后行冠状动脉CTA及冠状动脉造影(ICA)检查,并以ICA为金标准,评估320排CTA诊断冠状动脉狭窄≥50%及≥70%的敏感度、特异度、阳性预测值及阴性预测值。结果 CTA成像质量4分71例(86.6%),平均心率为67次/min;3分10例(12.2%),平均心率为74次/min;2分1例(1.2%),心率为83次/min;1分0例,全部病例均无阶梯伪影。CTA发现174个狭窄≥50%的节段,ICA发现144个以ICA为金标准,320排CTA诊断狭窄≥50%的敏感度、特异度、阳性预测值及阴性预测值分别为93.1%、96.0%、77.0%和99.0%。CTA发现40个狭窄≥70%的节段,ICA发现40个。以ICA为金标准,320排CTA诊断狭窄≥70%的敏感度、特异度、阳性预测值及阴性预测值分别为100%、95.6%、45.5%和100%。结论 320排CTA图像质量好,诊断冠心病准确可靠。     

腺苷负荷13N-NH3 PET心肌灌注显像结合冠状动脉CTA诊断冠心病

目的 评价腺苷负荷13N-NH3PET心肌灌注显像(MPI)与CT冠状动脉造影(CTA)相结合对提高冠心病(CAD)诊断准确性的临床应用价值.方法 对25例怀疑CAD的患者同时行腺苷负荷13N-NH3MPI及CTA,1个月内行导管法冠状动脉造影(CAG).结果 (1)25例患者共300个冠状动脉节段,CTA显示良好节段为263个,显示率(显示良好节段所占百分比)达87.7%.(2)25例患者CTA、MPI及CTA+MPI诊断CAD的灵敏度、特异性、准确性、阳性预测值及阴性预测值分别为82.1%(23/28),87.5%(14/16)及93.8%(15/16);93.2%(219/235),8/9及9/9;92.O%(242/263),88.0%(22/25)及96.0%(24/25);58.9%(23/29),93.3%(14/15)及100.0%(15/15);97.8%(219/224),8/10及9/10.结论 PET/CT实现了同机腺苷负荷"N-NH3PET心肌灌注显像与CTA相结合,提高了诊断CAD的准确性.     

320排动态容积CT冠状动脉成像与冠状动脉造影诊断冠状动脉病变的初步对照研究

目的 探讨320排动态容积CT冠状动脉成像(CTA)质量及其对冠状动脉疾病的诊断价值.方法 回顾性分析40例经320排动态容积CTA和冠状动脉造影(coronary angiography,CAG)检查拟诊为冠心病的图像资料.结果 40例520个冠状动脉节段中(每位患者分13个节段),320排动态容积CT图像质量1、2、3级分别为290(55.8%)、194(37.3%)、36(6.9%)个节段.其中l、2级即优良率共484 (484/520、93.1%)个节段,能满足临床诊断;而36(36/520,6.9%)个节段因运动伪影或严重钙化无法对管腔进行评价.以CAG为"金标准",320排动态容积CT发现冠状动脉狭窄的敏感性90.2%,特异性97.5%,阳性预测值92.4%,阴性预测值96.7%.320排动态容积CT对于冠状动脉狭窄检出的准确率为95.7%.结论 CTA对冠状动脉疾病的诊断十分准确,可作为一种简便、易行、安全可靠的无创性筛查冠心病的有效方法.     

64排螺旋CT冠状动脉成像在冠状动脉狭窄诊断中的价值分析

目的探讨64排螺旋CT冠状动脉成像在冠状动脉狭窄诊断中的临床效果。方法选取我院冠状动脉狭窄患者100例,通过64排螺旋CT冠状动脉成像造影检查。结果冠状动脉CTA诊断冠状动脉狭窄的敏感度、特异性、阳性预测值和阴性预测值都明显优于冠状动脉造影诊断,两组相比差异具有统计学意义(P0.05)。两组诊断方法就冠状动脉狭窄诊断出的中度及中度以上的准确性均较高,差异无统计学意义(P0.05),对轻度动脉狭窄的诊断有统计学意义差异(P0.05)。结论 64排螺旋CT冠状动脉CTA诊断冠状动脉狭窄的准确度及灵敏度都较高,对患者治疗具有重要作用。     

Non-invasive assessment of coronary artery geometry using coronary CTA

AimTo assess the association of coronary artery geometry with the severity of coronary artery disease (CAD).Methods73 asymptomatic individuals at increased risk of CAD due to peripheral vascular disease (18 women, mean age 63.5 ± 8.2 years) underwent coronary computed tomography angiography (coronary CTA) using first generation dual-source CT. Curvature and tortuosity of the coronary arteries were quantified using semi-automatically generated centerlines. Measurements were performed for individual segments and for the entire artery. Coronary segments were labeled according to the presence of significant stenosis, defined as >70% luminal narrowing, and the presence of plaque. Comparisons were made by segment and by artery, using linear mixed models.ResultsOverall, median curvature and tortuosity were, respectively, 0.094 [0.071; 0.120] and 1.080 [1.040; 1.120] on a per-segment level, and 0.096 [0.078; 0.118] and 1.175 [1.090; 1.420] on a per-artery level. Curvature was associated with significant stenosis at a per-segment (p < 0.001) and per-artery level (p = 0.002). Curvature was 16.7% higher for segments with stenosis, and 13.8% higher for arteries with stenosis. Tortuosity was associated with significant stenosis only at the per-segment level (p = 0.002). Curvature was related to the presence of plaque at the per-segment (p < 0.001) and per-artery level (p < 0.001), tortuosity was only related to plaque at the per-segment level (p < 0.001).ConclusionCoronary artery geometry as derived from coronary CTA is related to the presence of plaque and significant stenosis.     

Influence of coronary dominance on coronary artery calcification burden

ObjectiveTo evaluate the influence of coronary artery dominance on observed coronary artery calcification burden in outpatients presenting for coronary computed tomography angiography (CCTA).MethodsA 12-month retrospective review was performed of all CCTAs at a single institution. Coronary arterial dominance, Agatston score and presence or absence of cardiovascular risk factors including hypertension (HTN), hyperlipidemia (HLD), diabetes and smoking were recorded. Dominance groups were compared in terms of calcium score adjusted for covariates using analysis of covariance based on ranks. Only covariates observed to be significant independent predictors of the relevant outcome were included in each analysis. All statistical tests were conducted at the two-sided 5% significance level.Results1223 individuals, 618 women and 605 men were included, mean age 60 years (24–93 years). Right coronary dominance was observed in 91.7% (n = 1109), left dominance in 8% (n = 98), and codominance in 1.3% (n = 16). The distribution of patients among Agatston score severity categories significantly differed between codominant and left (p = 0.008), and codominant and right (p = 0.022) groups, with higher prevalence of either zero or severe CAC in the codominant patients. There was no significant difference in Agatston score between dominance groups. In the subset of individuals with coronary artery calcification, Agatston score was significantly higher in codominant versus left dominant patients (mean Agatston score 595 ± 520 vs. mean 289 ± 607, respectively; p = 0.049), with a trend towards higher scores in comparison to the right-dominant group (p = 0.093). Significance was not maintained upon adjustment for covariates.ConclusionsWhile the distribution of Agatston score severity categories differed in codominant versus right- or left-dominant patients, there was no significant difference in Agatston score based on coronary dominance pattern in our cohort. Reporting and inclusion of codominant subsets in larger investigations may elucidate whether codominant anatomy is associated with differing risk.     

冠心病患者冠状动脉侧支循环形成的形态学特点分析

目的:分析国人冠状动脉侧支循环的形态学特点。方法:将265例冠心病病人的冠状动脉造影结果进行分析,按Levin的方法进行分类,并与之比较。结果:不同狭窄程度两组间侧支循环开放率差别有高度统计学意义(X2=14.43,P<0.001)。三支血管间侧支循环开放率差别均有统计学意义(X2=3.96,X2=4.28,P<0.05)。东、西方组冠状动脉各支病变的侧支分布的比较差别有高度统计学意义(右冠状动脉X2=9.68,P<0.01;左冠状动脉X2=41.73,P<0.001;左冠状动脉旋支X2=8.54,P<0.01。结论:冠状动脉侧支循环的形成与冠状动脉狭窄程度及病变血管有关。中国人的冠状动脉侧支循环具有独特性。     

Small coronary vessel disease and sudden coronary death

In an attempt to determine the importance of atherosclerosis in medium-sized coronary arteries, the hearts of 20 patients dying of cardiac disease, within 24 hours of the onset of symptoms, were compared with 19 controls. Post-mortem coronary angiograms were performed and the coronary arteries dissected in detail. Severe stenoses, or complete occlusions, were present in 34 of 80 major coronary arteries in the sudden cardiac death (SCD) group and 5 of 76 in the controls. Medium-sized branch vessels were severely stenosed or occluded in 20.5 per cent (37 of 180 vessels) in the SCD group and 6.4 per cent (11 of 171 vessels) in the controls. Forty of the 48 diseased branch vessels arose from the left anterior descending artery. In the SCD group, 18 patients died from major coronary artery atheroma, one from hypertensive heart disease and only one from disease of a branch vessel. We conclude that, in most cases of SCD, careful macroscopic examination of the major coronary vessels will provide an adequate explanation for death. Detailed dissection of all medium-sized branch vessels is unlikely to be of value as a routine procedure but, at the very least, pathologists should identify and dissect the first septal and diagonal branches of the left anterior descending artery in every post-mortem.     

Relationship of epicardial fat volume to coronary plaque,severe coronary stenosis,and high-risk coronary plaque features assessed by coronary CT angiography

BackgroundAssociations of epicardial fat volume (EFV) measured on noncontrast cardiac CT (NCT) include coronary plaque, myocardial ischemia, and adverse cardiac events.ObjectivesThis study aimed to define the relationship of EFV to coronary plaque type, severe coronary stenosis, and the presence of high-risk plaque features (HRPFs).MethodsWe retrospectively evaluated 402 consecutive patients, with no prior history of coronary artery disease, who underwent same day NCT and coronary CT angiography (CTA). EFV was measured on NCT with the use of validated, semiautomated software. The coronary arteries were evaluated for coronary plaque type (calcified [CP], noncalcified [NCP], or partially calcified [PCP]) and coronary stenosis severity ≥70% with the use of coronary CTA. For patients with NCP and PCP, 2 high-risk plaque features were evaluated: low-attenuation plaque and positive remodeling.ResultsThere were 402 patients with a median age of 66 years (range, 23–92 years) of whom 226 (56%) were men. The EFV was greater in patients with CP (112 ± 55 cm³ vs 89 ± 39 cm³), PCP (110 ± 57 cm³ vs 98 ± 45 cm³), and NCP (115 ± 44 cm³ vs EFV 100 ± 52 cm³). In the 192 patients with PCP or NCP, on multivariable analysis, after adjusting for conventional cardiovascular risk factors, EFV was an independent predictor of ≥70% coronary artery stenosis (odds ratio [OR], 3.0; 95% CI, 1.3–6.6; P = 0.008), any high-risk plaque features (OR, 1.7; 95% CI, 0.9–3.4; P = 0.04), and low attention plaque (OR, 2.4; 95% CI, 1.1–5.1; P = 0.02) but not of positive remodeling.ConclusionsEFV is greater in patients with CP, PCP, and NCP. In patients with NCP and PCP, EFV is significantly associated with severe coronary stenosis, high-risk plaque features, and low attenuation plaque.     

双源CT冠脉成像在冠脉狭窄诊断中的价值

价节段达到94.98%(625/658),图像优良率95.52%(597/625).DSCT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分别为91.8%、98.3%、94.4%、97.5%,其中对左主干、左前降支及右冠状动脉的敏感性及特异性达到95%,对角支、左回旋支分支及有冠状动脉远端的诊断敏感性有所下降,分别为86.0%、71.4%、76.9%.结论 在不控制心率的情况下,DSCT诊断冠脉狭窄安全可靠,可广泛用于冠心病患者的筛查、冠状动脉手术/支架术前评估及术后随访.