CT诊断冠状动脉狭窄的价值和意义

目的探讨64排128层螺旋CT对冠状动脉狭窄诊断的准确性及可靠性。方法选取24例冠心病患者,先行CT检查,后进行冠状动脉造影检查;比较CT、冠状动脉造影检查结果。结果以冠状动脉造影作为冠状动脉狭窄诊断的金标准,64排128层螺旋CT诊断冠状动脉狭窄的灵敏度为91.7%,特异度为4.2%。两种方法检测冠状动脉狭窄效果比较,差异无统计学意义(P>0.05)。结论 CT检查诊断冠状动脉狭窄准确率、灵敏度和特异度均很高,具有极大临床价值和意义。     

冠状动脉影像学与心电图检查诊断老年冠心病价值的对比研究

目的：比较冠状动脉CT血管造影（CTA）与心电图对老年冠心病（CHD）患者的诊断价值。方法选择拟诊冠心病的老年住院患者148例,分别行冠状动脉CTA和心电图检查。其中有96例同时行冠状动脉造影检查。按冠状动脉造影结果分析冠状动脉CTA及心电图诊断冠心病的敏感度（阳性率）、特异度（阴性率）。结果冠状动脉CTA的敏感度为90.1%、特异度为88.1%、符合率为88.8%。心电图诊断CHD的敏感度为72.0%、特异度为57.1%、符合率为68.8%。冠状动脉造影狭窄程度≥90%的病变,心电图的敏感度最高,假阴性率最低;狭窄程度＜90%者与≥90%者比较,心电图敏感度较低,差异显著（均P＜0.01）。结论冠状动脉CTA发现有意义血管狭窄的敏感度、特异度较高,可作为老年冠心病诊断的有效方法;心电图对老年患者严重冠脉狭窄有一定的诊断价值。     

冠状动脉CTA评估冠状动脉狭窄程度的准确性及误差分析

目的:探讨冠状动脉CT血管造影(CTA)评估冠状动脉狭窄程度的准确性及误差分析。方法:回顾性选取2019年7月—2022年6月就诊于我院心内科的病人92例,所有病人因疑诊冠心病,均先后成功接受冠状动脉CTA及冠状动脉造影(CAG)检查,并以CAG为诊断金标准,评价冠状动脉CTA筛查冠心病冠状动脉狭窄程度的准确性及误差。结果:92例病人以CAG为金标准诊断,冠状动脉CTA诊断冠心病的敏感度为89.86%,特异度为91.30%,准确度为90.22%,阳性预测值为96.88%,阴性预测值为75.00%;冠状动脉CTA评估轻度、中度、重度狭窄的敏感度分别为72.16%、65.38%、62.89%,诊断轻度、中度、重度狭窄的特异度、阴性预测值、准确度均较高;冠状动脉CTA、CAG在评估左前降支(LAD)、右冠状动脉(RCA)不同程度狭窄一致性较好(Kappa值分别为0.788,0.729,P均<0.001),评估左回旋支(LCX)不同程度狭窄一致性一般(Kappa值=0.596,P<0.001);冠状动脉CTA评估LAD、LCX、RCA血管轻度、中度、重度狭窄时,其特异度、准确度、阴...     

64排128层螺旋CT冠脉成像与冠状动脉造影在高龄冠心病患者冠状动脉狭窄病变诊断中的对比

目的对比64排128层螺旋CT冠脉成像(128-SCTA)与冠状动脉造影(CAG)在高龄冠心病患者冠状动脉狭窄病变诊断中的应用价值。方法 2014年10月至2015年6月在该院诊治的疑似高龄冠心病患者30例。接受治疗前所有患者在间隔1个月内先后接受128-SCTA以及CAG检查。对比二者的检查结果,分析128-SCTA在高龄冠心病患者冠状动脉狭窄病变方面的诊断价值。结果 128-SCTA关于血管病变例数、支数、节段的检查结果与CAG诊断结果相比,均无统计学差异(P0.05)。将CAG诊断结果作为金标准,128-SCTA对疑似高龄冠心病患者的诊断敏感度为88.89%,特异度为66.67%,准确度为80.00%。结论 128-SCTCA对高龄冠心病患者的冠脉狭窄病变具有较高的诊断价值,能迅速、准确地获得诊断结果,值得推广。     

大螺距双源CT冠脉成像和冠状动脉造影的对比研究

目的探讨第二代双源CT对冠状动脉狭窄的准确性的诊断价值。方法 60例临床可疑或已知冠心病患者行双源CT冠状动脉成像(CTCA)检查,入选采用Flash spiral模式扫描并于10天内行冠状动脉造影(CAG)检查,以CAG结果作为金标准,评价双源CT对冠状动脉狭窄程度的的敏感度、特异度、阳性预测值及阴性预测值,评价第二代双源CT对冠状动脉狭窄的诊断价值。结果 60例患者显示冠状动脉240支共740节段,以冠状动脉造影为参考标准,基于节段水平分析,CTCA诊断冠状动脉狭窄的敏感性、特异性、阳性预测值、阴性预测值及准确率分别为84.4%、97.0%、86.4%、96.50%、94.7%;基于血管分析,CTCA诊断冠状动脉狭窄的敏感性、特异性、阳性预测值、阴性预测值及准确率分别为85.5%、92.3%、90.4%、88.2%、89.2%。结论大螺距双源CT Flash spiral模式作为一项新的成像方法,检出冠状动脉狭窄的准确率较高,作为冠心病的一种无创筛查手段有较高的临床应用价值。     

64排128层螺旋CT在不同程度冠状动脉狭窄诊断中的应用价值

目的研究64排128层螺旋CT在不同程度冠状动脉狭窄诊断中的应用价值。方法本次研究对象为2019年8月至2020年7月期间在本院就诊的疑似冠状动脉狭窄症状患者62例,先采用64排螺旋CT进行检查,后接受冠状动脉造影检查,观察两种检查方式的诊断结果、诊断效能、诊断方法的一致性。结果 64排128层螺旋CT检查的不同冠状动脉狭窄程度检出率与冠状动脉造影检查数据进行比较,差异无统计学意义(P0.05),两种检查方法的诊断一致性良好(Kappa=0.85);64排128层螺旋CT检查诊断冠状动脉轻度、中度、重度狭窄的敏感度分别为70.83%、81.08%、92.31%,特异度分别为99.20%、99.23%、98.64%,准确度分别为94.63%、96.98%、96.98%。结论 64排128层螺旋CT能够对冠状动脉狭窄程度进行准确判断,能够为临床治疗方案的制定提供参考。     

320排动态容积CT冠状动脉成像诊断冠状动脉狭窄的价值

目的 以冠状动脉造影作为诊断冠状动脉狭窄的金标准,评价320排动态容积CT冠状动脉成像诊断冠状动脉狭窄的准确性.方法 应用320排动态容积CT对85例可疑冠心病患者行冠状动脉成像检查,同期行冠状动脉造影.结果 320排动态容积CT冠状动脉成像可获得较好的图像质量,可用于诊断冠状动脉狭窄.320排动态容积CT诊断冠状动脉轻度狭窄的敏感度为90.9％,特异度为99.2％,阳性预测值为89.6％,阴性预测值为99.3％,准确率为98.6％;诊断冠状动脉中度狭窄的敏感度为92.8％,特异度为98.9％,阳性预测值为90.9％,阴性预测值为99.2％,准确率为98.3％;诊断冠状动脉重度狭窄的敏感度为87.4％,特异度为98.8％,阳性预测值为89.2％,阴性预测值为98.6％,准确率为97.6％;诊断冠状动脉闭塞病变的敏感度为50.0％,特异度为99.9％,阳性预测值为66.7％,阴性预测值为99.8％,准确率为99.7％;诊断冠状动脉中度以上狭窄的敏感度为94.1％,特异度为97.2％,阳性预测值为89.2％,阴性预测值为98.5％,准确率为96.6％.结论 320排动态容积CT冠状动脉成像是一种无创、有效诊断冠状动脉狭窄的方法.     

128层螺旋CT冠状动脉成像在冠心病诊断中的应用价值

目的评价128层螺旋CT(128-SCT)冠状动脉成像在冠心病诊断中的应用价值。方法入选临床诊断为冠心病并行128-SCT冠脉成像检查的患者60例,在128-SCT检查后的4周内行冠状动脉造影(CAG)检查。以CAG检查结果为金标准,以冠状动脉节段为单位,对比分析各节段128-SCT及CAG检查结果,评估128-SCT诊断冠状动脉狭窄程度的准确性,同时计算128-SCT诊断冠心病的敏感性、特异性、阳性预测值、阴性预测值、诊断指数、诊断符合率及Kappa值等统计学指标。结果共评估60例患者的715个冠状动脉节段,对比CAG的结果,128-SCT有664个节段检查结果与CAG相符合,符合率达92.87%。128-SCT诊断冠心病的灵敏度为79.05%,特异度为98.52%,阳性预测值为90.22%,阴性预测值为96.47%,诊断符合率为95.66%,Kappa值为0.818。结论 128-SCT冠状动脉成像检出冠心病准确性较好,可作为诊断与排除冠心病的无创性检查方法。     

64层螺旋CT对冠状动脉狭窄的诊断价值分析

目的分析64层螺旋CT对冠状动脉狭窄的诊断价值。方法选取2013年9月—2016年1月黄冈市英山县人民医院收治的冠心病患者80例,均行64层螺旋CT检查和冠状动脉造影检查,以冠状动脉造影检查结果为金标准,分析64层螺旋CT对冠状动脉狭窄的诊断效能。结果 80例患者共发现1 078段病变,其中有180段病变轻微,经64层螺旋CT检查无法评估,其余898段均可评估。99段轻度冠状动脉狭窄中发现斑块60块(60.61%),94段中度冠状动脉狭窄中发现斑块77块(81.92%),222段重度冠状动脉狭窄中发现斑块221块(99.55%)。64层螺旋CT诊断轻度冠状动脉狭窄的灵敏度为74.44%,特异度为98.95%,正确率为94.43%;诊断中度冠状动脉狭窄的灵敏度为85.45%,特异度为99.37%,正确率为97.10%;诊断重度冠状动脉狭窄的灵敏度为96.52%,特异度为98.05%,正确率为96.21%。结论 64层螺旋CT诊断冠状动脉狭窄的灵敏度、特异度、准确率均较高,并可初步判断斑块性质,可作为临床筛查和诊断冠状动脉狭窄的检查方法之一。     

老年人多层螺旋CT冠状动脉成像诊断冠状动脉狭窄的研究

目的评价64层螺旋CT冠状动脉成像在诊断老年患者冠状动脉狭窄中的临床应用价值。方法回顾性分析39例患者行64层螺旋CT冠状动脉造影的老年患者(>65岁)的影像资料,在15段分段法的基础上,评价每段冠状动脉CT造影的图像质量;以传统X线冠状动脉造影为“金标准”,评价CT血管造影诊断冠状动脉狭窄及其程度的价值。结果多层螺旋CT冠状动脉造影(MSCTA)评价冠状动脉狭窄的敏感度、特异度、阳性预测值和阴性预测值分别为98.9%(90/91)、98.2%(426/434)、91.8%(90/98)和99.8%(426/427)。冠状动脉MSCTA与传统X线冠状动脉造影(CAG)对血管狭窄程度评价具有很好的一致性。结论多层螺旋CT冠状动脉成像在诊断老年人冠心病中具有重要的临床应用价值。     

CT血管造影在冠状动脉狭窄程度及其斑块类型评估中的应用价值

背景 CT血管造影(CTA)已成为影像学研究的热点,近年被越来越多地应用于临床.目的 探讨CTA在冠状动脉狭窄程度及其斑块类型评估中的应用价值.方法 选取东南大学附属中大医院江北院区2018年8月至2020年8月收治的冠心病(CHD)患者98例,均接受CAG和CTA检查.记录CTA对冠状动脉管腔的评价结果,以CAG为诊...     

64排螺旋CT冠状动脉成像对冠心病合并糖尿病患者冠脉病变的诊断价值研究

目的评价64排螺旋CT冠状动脉成像在冠心病（CAD）合并糖尿病患者冠状动脉病变诊断中的价值。方法345例应用64排螺旋CT疑诊为CAD的糖尿病患者,以冠状动脉造影（CAG）结果为金指标,评价64排螺旋CT在CAD诊断中的价值。对3568支冠状动脉血管进行选择性CAG检查,将两种方法的检查结果进行对照分析。结果64排螺旋CT对冠状动脉狭窄的诊断与CAG比较,差异无统计学意义（P〉0．05）。64排螺旋CT显示多排螺旋CT血管造影（MSCTA）诊断冠状动脉狭窄有较高的敏感性、特异性、阳性预测值及阴性预测值。结论64排螺旋CT冠状动脉成像技术是一项可靠的CAD诊断方法,作为一项非创伤性检查技术,是评价冠状动脉病变的重要手段。     

冠状动脉双源CT与冠状动脉造影成像对急诊胸痛患者诊断冠心病的价值

目的:以常规冠状动脉造影(CAG)为"金标准",探讨急诊胸痛患者双源CT(DSCT)冠状动脉血管成像诊断冠心病的价值,分析DSCT诊断冠心病的准确度、灵敏度、特异度、阳性预测值和阴性预测值。方法:对115例以胸痛为主诉的急诊就诊、临床怀疑冠心病拟行CAG的患者[男60例,女55例,平均年龄(66.37±10.29)岁]进行DSCT冠状动脉成像,统计分析DSCT对诊断冠状动脉不同程度狭窄冠心病的准确度、灵敏度及特异度,并与CAG结果对比。结果:共获得92例有诊断价值的病例,DSCT诊断冠状动脉中重度狭窄的准确度为94.6%,灵敏度、特异度、阳性预测值和阴性预测值分别为96.7%、90.6%、95.1%和93.5%。对于诊断轻度狭窄冠心病的灵敏度为70.6%,特异度为63.9%,阳性预测值为34.3%,阴性预测值为91.2%。结论:DSCT冠状动脉成像可作为临床冠心病可疑患者CAG手术前的预筛手段,当患者的冠状动脉为中重度狭窄时,诊断的准确度、灵敏度、特异度较高,DSCT与CAG有很好的一致性,其对是否需进一步CAG检查有较大的指导意义。DSCT对于冠状动脉轻度狭窄患者的阴性预测值较高,提示如果DSCT判定患者无冠状动脉病变,基本上无进一步行CAG的必要。     

Quantitative evaluation of coronary stenosis by coronary magnetic resonance angiography

Coronary magnetic resonance angiography (coronary MRA) can detect, noninvasively, a high proportion of severe stenotic lesions found on coronary angiograms. However, quantitative evaluation of coronary artery stenosis by coronary MRA has been performed only in a small number of patients. This study was designed to determine whether coronary MRA can assess the degree of stenosis using the two-dimensional segmented turbo-FLASH method (2D method). We studied 108 patients with technically adequate coronary MRA images. The blood flow signal intensity on coronary MRA was classified as markedly decreased, moderately decreased, or normal. The severity of coronary artery stenosis was determined by the caliper method, and coronary stenosis was rated using a seven-point scale (0%, 25%, 50%, 75%, 90%, 99%, and 100%) in accordance with the American Heart Association classification system. Patients were classified into three groups: normal coronary artery (0%–25% stenosis), moderate stenosis (50%–75% stenosis), and severe stenosis (90%–100% stenosis). The degree of stenosis on coronary angiography and the decrease in coronary MRA signal intensity were compared. The right coronary artery was evaluated in 64 patients and the left coronary artery in 73 patients. When a marked or moderate decrease in coronary MRA blood flow signal intensity was defined as indicating stenosis, the sensitivity and specificity of coronary MRA for detecting angiographically severe stenosis were 85% and 80%, respectively. A moderate decrease in coronary MRA blood flow signal intensity detected angiographically moderate stenoses with a sensitivity of 38% and a specificity of 83%. Coronary MRA can detect a high proportion of severe stenoses but only a low proportion of moderate stenoses. Technical improvements are required before coronary MRA can be used clinically. Received: June 23, 2000 / Accepted: December 16, 2000     

单一影像与融合影像对比评价2型糖尿病冠状动脉病变对心肌血供影响的研究

目的:比较单一影像即核素心肌灌注显像(MPI)与融合影像即MPI/冠状动脉(冠脉)计算机断层摄影术(CT)成像(CCTA)技术,评价2型糖尿病冠脉病变对心肌血供的影响及两种影像技术的诊断效能。方法:确诊2型糖尿病且怀疑或确诊合并冠心病85例,1个月内均行常规二日法腺苷负荷/静息MPI和冠脉造影,其中38例利用单光子发射计算机断层摄影术/CT,完成同机CCTA即MPI、MPI/CCTA。MPI采用心肌17分段5级评分法,及负荷总评分(SSS)对心肌血供做定性及半定量评价;冠脉造影和CCTA按常规将冠脉病变程度分为正常;轻、中、重度;以冠脉造影、冠脉造影联合MPI为参考标准评价MPI、MPI/CCTA融合影像诊断致心肌血供异常的冠脉病变的效能。结果:85例患者,MPI提示正常/异常为22/63例;MPI的诊断效能为:敏感性、特异性、准确性、阳性预测值和阴性预测值分别为80.19%、88.59%、85.10%、83.33%和86.27%;轻度20例(24%),中度12例(14%),严重31例(36%)。38例完成同机CCTA的患者中,以冠脉造影、冠脉造影联合MPI为对照标准,单一的MPI与MPI/CCTA融合影像评价2型糖尿病冠脉病变与心肌血供关系的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为74.55%与96.97%、81.36%与91.67%、78.07%与94.74%、78.85%与94.12%和77.42%与95.65%。MPI/CCTA融合影像示:正常40.35%[46/114(段/支)],中度以上狭窄冠脉59.65%[68/114(段/支)]。结论:MPI/CCTA融合影像评价2型糖尿病冠脉病变对心肌血供影响的效能明显高于单一MPI,对2型糖尿病早期冠心病诊断有重要临床价值。     

Flash双源CT大螺距冠状动脉成像与冠状动脉造影对比的临床研究

目的评价Flash双源CT大螺距前瞻性心电门控扫描模式（flashspril）诊断冠状动脉狭窄的准确性。方法30例患者行Flash双源CT冠状动脉成像（CTCA）后进行冠状动脉造影术（CCA）检查。以冠状动脉造影术结果作为金标准,统计Flash双源CTCA显示冠脉病变的敏感性、特异性、阳性预测值和阴性预测值,统计冠状动脉各段图像质量评分及有效射线剂量。结果①准确性评价：基于节段水平分析,敏感性93．2％,特异性96．8％,阳性预测值86．0％,阴性预测值98．5％。基于血管水平分析,敏感性97．9％,特异性83．8％,阳性预测值88．7％,阴性预测值96．8％。基于患者水平分析,敏感性、特异性、阳性预测值、阴性预测值均为100％。CTCA显示冠状动脉狭窄结果与CCA高度一致。②图像质量：右冠状动脉不可诊断血管节段占右冠状动脉的3．4％,左冠状动脉主干、前降支不可诊断血管节段为0,回旋支不可诊断血管节段低于1．0％。③射线剂量：平均有效射线剂量（1．72±0．10）mSv。结论Flash双源CTflashspril模式CTCA评价冠状动脉狭窄的准确性高,图像质量好,运动伪影小,有效射线剂量低。     

CT冠状动脉造影结合腺苷负荷核素心肌灌注显像诊断冠心病的应用价值

目的 探讨CT冠状动脉造影(CTCA)结合腺苷负荷核素心肌灌注显像(MPS)、解剖学成像结合功能学成像,无创全面诊断冠心病的可行性与准确性.方法 105例怀疑或诊断为冠心病的患者,在有创性冠状动脉造影(CAG)检查前4周内完成CTCA与腺苷负荷MPS检查.以CAG结果为参照,分别评价CTCA、负荷/静息MPS及CTCA结合MPS诊断冠心病的可行性、准确性及特点.结果 CTCA诊断冠状动脉阻塞性病变的敏感性为97.1%,特异性为75.0%,阳性预测值为8 8.2%,阴性预测值为93.1%,准确性为89.5%;负荷/静息MPS诊断冠状动脉阻塞性病变的敏感性为79.7%,特异性为63.9%,阳性预测值为80.9%,阴性预测值为62.2%,准确性为74.3%;CTCA结合MPS诊断阻塞性冠状动脉病变的敏感性为97.2%,特异性为98.5%,阳性预测值为98.5%,阴性预测值为89.7%,准确性为95.2%.结论 CTCA结合腺苷负荷MPS可以明显提高CTCA诊断冠心病的特异性及阳性预测值,且解剖学结合功能学成像可全面提供冠心病的诊断信息.

Abstract：

Objective To assess the accuracy and feasibility of combination of CT coronary angiography (CTCA) and adenosine stress myocardial perfusion scintigraphy (MPS) for diagnosis of coronary artery disease (CAD). Methods CTCA, MPS were performed in 105 patients with suspected or diagnosed CAD within 4 weeks before coronary angiography (CAG) examination. Results The sensibility,specificity, positive predictive value ( PPV ), negative predictive value ( NPV ) and accuracy were 97. 1%,75.0%, 88.2%, 93.1% and 89. 5%, respectively, for CTCA; 79.7%,63.9%,80.9%,62.2% and 74. 3%, respectively, for MPS and 97. 2% ,98. 5% ,98. 5% ,89. 7% and 95.2%, respectively, for CTCA +MPS. Conclusion Combination of CTCA and adenosine stress MPS, which provided both anatomical and functional information of coronary vessels, could significantly increase the specificity and PPV of diagnosing CAD with CTCA.     

Diagnostic accuracy of coronary in-stent restenosis using 64-slice computed tomography: comparison with invasive coronary angiography.

OBJECTIVES: This study sought to evaluate the diagnostic accuracy of coronary binary in-stent restenosis (ISR) with angiography using 64-slice multislice computed tomography coronary angiography (CTCA) compared with invasive coronary angiography (ICA). BACKGROUND: A noninvasive detection of ISR would result in an easier and safer way to conduct patient follow-up. METHODS: We performed CTCA in 81 patients after stent implantation, and 125 stented lesions were scanned. Two sets of images were reconstructed with different types of convolution kernels. On CTCA, neointimal proliferation was visually evaluated according to luminal contrast attenuation inside the stent. Lesions were graded as follows: grade 1, none or slight neointimal proliferation; grade 2, neointimal proliferation with no significant stenosis (<50%); grade 3, neointimal proliferation with moderate stenosis (> or =50%); and grade 4, neointimal proliferation with severe stenosis (> or =75%). Grades 3 and 4 were considered binary ISR. The diagnostic accuracy of CTCA compared with ICA was evaluated. RESULTS: By ICA, 24 ISRs were diagnosed. Sensitivity, specificity, positive predictive value, and negative predictive value were 92%, 81%, 54%, and 98% for the overall population, whereas values were 91%, 93%, 77%, and 98% when excluding unassessable segments (15 segments, 12%). For assessable segments, CTCA correctly diagnosed 20 of the 22 ISRs detected by ICA. Six lesions without ISR were overestimated as ISR by CTCA. As the grade of neointimal proliferation by CTCA increases, the median value of percent diameter stenosis increased linearly. CONCLUSIONS: Binary ISR can be excluded with high probability by CTCA, with a moderate rate of false-positive results.     

Aortic valve replacement in patients with mild or moderate aortic stenosis and coronary bypass surgery

PURPOSE: To assess whether there is survival benefit for patients with mild or moderate aortic stenosis if they undergo aortic valve replacement at the time of coronary artery bypass surgery. METHODS: From 1985 to 1995 we evaluated all patients at our institution who underwent coronary artery bypass surgery and who had the echocardiographic diagnosis of mild (mean gradient <0 mm Hg and/or valve area >1.5 cm(2)) or moderate (mean gradient > or =30 and < or =40 mm Hg and/or valve area >1.0 < or =1.5 cm(2)) aortic stenosis. Using propensity analysis, survival was compared between 129 patients who underwent coronary artery bypass surgery alone and 78 patients who underwent concomitant coronary artery bypass surgery and aortic valve replacement. RESULTS: Perioperative mortality was similar among patients who underwent coronary artery bypass surgery alone compared with patients who underwent concomitant coronary artery bypass surgery and aortic valve replacement. By Kaplan-Meier analysis, 1-year and 8-year survival were better at 90% and 55% for patients who underwent concomitant coronary artery bypass surgery and aortic valve replacement compared with 85% and 39% for patients who underwent coronary artery bypass surgery alone (P <0.001). This benefit was limited to patients with moderate aortic stenosis (propensity-adjusted relative risk = 0.43; 95% confidence interval: 0.20 to 0.96; P = 0.04). CONCLUSION: Concomitant aortic valve replacement at the time of coronary artery bypass surgery for mild or moderate aortic stenosis appears to convey a survival advantage for patients with moderate aortic stenosis but not for those with mild aortic stenosis.