CT冠状动脉成像在冠心病诊断中的应用

目的:研究CT冠状动脉成像在冠心病早期诊断冠状动脉狭窄定性定量判读的作用。方法:对34例临床未发生急性冠脉综合征的冠心病患者,先后进行冠状动脉造影、128排双源CT冠状动脉成像。以冠状动脉造影为"金标准",计算CT冠状动脉成像敏感性、特异性、阳性预测值、阴性预测值。结果:①与冠状动脉造影相比,CT冠状动脉成像的敏感性为68%,特异性为97%,阳性预测值为89%,阴性预测值为90%。②CT冠状动脉成像有65个血管段图像质量差,约占12%,造成图像质量差的原因主要为钙化,心跳、呼吸伪影,少部分为管腔显示不良。结论:冠心病早期诊断中,CT冠状动脉成像可用作冠状动脉造影前筛选,CT冠状动脉成像阴性的患者不必行冠状动脉造影检查;CT冠状动脉成像阳性的患者,可行冠状动脉造影进一步确认病变。     

双源CT血管造影评价冠状动脉狭窄的临床价值

目的:评价双源CT定量诊断冠状动脉狭窄的准确性及临床价值。方法:对30例临床拟诊冠心病患者分别进行双源CT和传统冠状动脉造影检查,并将双源CT判定冠状动脉狭窄程度与冠脉造影结果进行对比分析。结果:30例共计450冠脉节段,双源CT均获得满意的评价图像(3例进行心电编辑)。双源CT判定轻度狭窄38个节段,中度狭窄23个节段,重度狭窄36个节段;与冠状动脉造影结果对比,双源CT诊断冠脉狭窄的敏感性、特异性和准确性分别为94.12%、95.34%和95.11%。结论:与冠状动脉造影对比,双源CT在定量诊断冠脉狭窄方面具有较高的敏感性和特异性,可为临床诊断冠心病提供一项准确可靠的无创手段。     

64层螺旋CT冠状动脉CTA在冠状动脉疾病诊断中的应用

近年来随着我国社会经济的发展,人们的生活水平的不断提高以及生活习惯及饮食习惯的改变,冠状动脉性疾病的发病率呈现不断上升的趋势,且发病患者的年龄也越来越趋于年轻化。冠状动脉疾病临床上主要为冠状动脉硬化,此外还包括冠状动脉畸形、冠状动脉痉挛等。目前对冠状动脉疾病的诊断主要依赖于影像学检查[1],为了探讨64层螺旋 CT 冠状动脉CTA 在冠状动脉疾病的诊断中的应用价值,特作以下研究。     

Electron beam CT and cost-efficient diagnosis of coronary artery disease

Summary Background: Electron beam CT (EBCT) can acquire rapid, multiple thin-section tomograms of the beating heart in synchrony with the electrocardiogram and quantify coronary calcification without intravenous contrast. Coronary calcification is an active process exclusively associated with atherosclerotic plaque formation and regulated in a manner similar to the calcification of bone. Clinical studies have demonstrated that EBCT coronary calcification (1) follows a pattern similar to the epidemiology of coronary artery disease (CAD), (2) has a high sensitivity (90–95 %) for coronary plaque and significant angiographic coronary stenoses, and (3) has the potential to assess the prognosis of patients with coronary atherosclerotic disease. Coronary calcium area or “score” correlates best with overall plaque burden within the coronary system. However, coronary calcium is of limited value in distinguishing coronary stenosis on a segment-by-segment basis. EBCT and CAD: Due to spiraling health care costs, there is a need for cost-efficient strategies in the diagnosis and stratification of patients with known or suspected CAD. There are two major patient groups in which EBCT calcium scanning has a potential for cost-efficient application: (1) in asymptomatic, high-risk patients, identification of significant plaque burden may direct judicious use of long-term drug therapy or further investigation to those individuals most likely to benefit from an aggressive risk factor modification and medical program; (2) in patients with chest pain syndromes but no prior CAD, EBCT calcium scanning compares favorably with conventional diagnostic methods. In particular, using receiver operating characteristic analysis, the sensitivity and specificity of an EBCT calcium score of 80 in detecting obstructive CAD are both about 85 %. Using a theoretical model, EBCT calcium scanning was found to be the most cost-effective approach to diagnosis in populations with a low-to-moderate likelihood of obstructive CAD when compared with treadmill exercise, stress thallium, and stress echocardiography. Conclusions: EBCT calcium scanning is not a substitute for coronary angiography, but it has clear advantages over other more traditional diagnostic methods for CAD. In particular, it can be performed conveniently and inexpensively in most patients. Additionally, the site and extent of calcification are intimately related to the atherosclerotic plaque burden. The analyses presented suggest that it may also provide a cost-effective clinical alternative in specific subsets of the population. Eingegangen am 15. Januar 1996 Angenommen am 27. Februar 1996     

动态容积320排冠状动脉CT血管成像诊断冠状动脉疾病的意义

目的：研究320排动态容积冠状动脉CT成像（CCTA）诊断冠状动脉疾病（CAD）的可行性。方法：5961例临床诊断CAD的患者进行CCTA检查,其中186例接受常规X线冠状动脉造影术（CAG）,对照分析其检查结果。1490例接受CCTA检查的健康查体者作为对照。结果：成像质量均在I～III级,无呼吸伪影图像。在186例CAD患者中,CCTA诊断冠状动脉狭窄（狭窄度≥50％）的敏感性为96．72％,特异性98．95％,阳性预测值95．16％,阴性预测值99．30％,准确度98．56％。结论：320排动态容积CT冠状动脉成像图像清晰,对诊断CAD具有重要的临床价值。     

Diagnostic pathway of integrated SPECT/CT for coronary artery disease

Treatment strategy in patients with suspected coronary artery disease (CAD) is driven by symptomatology in combination with diagnostic evaluation of the extent and/or severity of atherosclerosis in the coronary arteries and ischemia in the myocardium, i.e., the anatomic and functional correlates of CAD. Whereas multislice row computed tomography (MSCT) has the advantage of detecting coronary atherosclerosis at its earliest stages, thereby allowing initiation of appropriate therapeutic measures well before development of obstructive CAD, myocardial perfusion imaging (MPI) SPECT can clarify the hemodynamic consequences of the anatomic findings on MSCT based on a functional assessment of myocardial blood flow. There is a lack of correlation between coronary artery calcium (CAC), coronary artery stenosis, and MPI SPECT. Therefore CAC scoring and stress MPI should be thus considered complementary approaches rather than exclusionary in the evaluation of the patient at risk for CAD. The integration of anatomic and functional information may provide additional information for the clinician by the improved risk stratification and diagnostic accuracy of integrated techniques. The majority of previous studies are based on a sequential flowchart, starting with either SPECT or CAC scoring that finally directs the therapeutic strategy. Patients at low risk for CAD can be selected for primary prevention, and patients at high risk for CAD can be directly selected for coronary angiography (CAG). The remaining group of patients at intermediate risk for CAD can be substratified into lower- and higher-risk categories based on the presence or absence of stress-induced ischemia on MPI SPECT and CAC scoring. An integration of SPECT and CAC as a starting point for CAD detection in symptomatic patients at intermediate risk for CAD may facilitate a tailored diagnostic as well as therapeutic approach. Finally, using SPECT/CT, MPI SPECT, and CAC findings may be completed with CT angiography. The development of SPECT/CT hybrid systems is therefore of important value for the nuclear cardiology armamentarium. This editorial commentary outlines a diagnostic pathway of integrated SPECT/CT for CAD assessment in symptomatic patients at intermediate risk for CAD.     

冠状动脉疾病多层面螺旋CT成像初探

目的　评价多层面螺旋CT在冠状动脉疾病诊断中的作用。方法　 30例患者分为心率≤ 6 0次 /min和 >6 0次 /min 2组 ,进行了多层面螺旋CT扫描 ,对CT数据进行最大密度投影 (MIP) ,容积重建 (VR)和多平面重建 (MPR) ,观察其对冠状动脉病变的显示 ,其中 11例与冠状动脉造影对照。结果　心率≤ 6 0次 /min(12例 )和大于 6 0次 /min(16例 )在显示左冠状动脉主干 (分别为 12 /12、13/16例 )和左前降支 (分别为 12 /12、10 /16例 )上差异无显著性意义 (P =0 197和 0 12 8,精确 χ2 检验 ) ,显示回旋支 (分别为 10 /12、6 /16例 )差异有显著性意义 (χ2 =5 88,0 0 5 >P >0 0 1) ,显示右冠状动脉(分别为 10 /12、3/16例 )差异有极显著性意义 (χ2 =11 5 0 ,P <0 0 0 1) ,2例架桥患者未作统计。 7例冠状动脉内支架术后患者中 ,1例由于图像质量差 ,未能很好显示支架内狭窄 ,其余患者在CTMIP、VR和MPR上均能较好显示支架位置和形态。CT显示 11例钙化的冠状动脉由钙化和非钙化斑块引起的狭窄均由冠状动脉造影证实。结论　多层面螺旋CT能显示冠状动脉钙化和狭窄以及进行术后评价 ,是冠状动脉影像诊断和随访很有潜力的非创性检查方法     

128层螺旋CT冠状动脉成像对冠心病诊断的临床价值

目的:探讨128层螺旋CT冠状动脉成像(128-SCTCA)在冠心病中的临床应用价值。方法:对349例疑似冠心病患者行128-SCTCA筛查,对其中59例患者同时作选择性冠状动脉血管造影(CAG)检查,分析比较128-SCTCA诊断冠心病的敏感性、特异性、阳性预测值、阴性预测值和准确率。结果:341例患者成功完成了128-SCTCA检查,并可清晰显示冠脉主干及其主要分支,193例患者的596支冠脉伴有不同性质的斑块和不同程度的狭窄,对其中59例冠心病患者以CAG为金标准,得出128-SCTCA诊断冠脉狭窄的敏感性、特异性、阳性预测值、阴性预测值及准确率分别为100%、90.23%、92.57%、100%、95.59%。从59例患者的295支冠脉中检测出136个斑块,脂质软斑块、纤维斑块及钙化硬斑块分别占18%、11%、71%。结论:128层CT冠脉成像是一种无创的成像方法,检出冠心病的准确程度高,对冠状动脉狭窄的诊断准确率接近CAG,区分高危斑块优于CAG,作为冠心病的一种无创筛查手段具有很高的临床应用价值。     

Coronary artery calcium scoring vs. coronary CT angiography for the assessment of occupationally significant coronary artery disease

BackgroundExisting pathways for investigating coronary artery disease (CAD) in individuals undertaking high-hazard employment are currently guided by coronary artery calcium scoring (CACS) or coronary CT angiography (CTA). The optimal pathway has not been established.AimTo compare the diagnostic outcome and occupational recommendations from two differing investigative pathways for the investigation of CAD in a cohort of high-hazard employees.MethodsWe collected CACS and coronary CTA data from three clinics across two Hospitals on 200 consecutive individuals employed in high-hazard occupations to confirm/exclude occupationally significant CAD. High-hazard occupations were grouped into civil/military pilots and aircraft controllers (n ?= ?106); non-pilot aircrew (NPA) (n ?= ?26); and ground-based (military) personnel (GBP) (n ?= ?52). Demographics, referral indications and recommended occupational outcomes between pathways were compared between groups.ResultsThe CACS pathway led to more than double the number of individuals being returned to partial or full employment, compared with the coronary CTA pathway (OR 2.10, [95%CI 1.54–2.85], P ?< ?0.001). This effect was seen in all sub-groups.Of the 177 subjects that would have been returned to full employment using CACS, 21 (11.9%) would have been occupationally restricted on the basis of significant non-calcified plaque disease using coronary CTA (11.4% pilots/controllers; 19.2% non-pilot aircrew, and 7.7% ground-based personnel).ConclusionUsing CACS to determine the presence of occupational CAD risks returning individuals to roles with occupationally significant CAD that may lead to an unacceptably high likelihood of an incapacitating/distracting acute coronary event. Coronary CTA appears to be a more reliable, non-invasive imaging modality for confirming or excluding occupationally significant CAD in high-hazard employees.     

双能量CT冠状动脉成像结合CT心肌灌注诊断冠心病准确性的初步研究

目的 探讨心脏双能量CT冠状动脉造影(DE-CTA)结合CT心肌灌注(DE-CTP)对冠心病诊断的准确性.方法 对31例临床可疑或已知冠心病的患者行心脏双能量CT和负荷-静息SPECT检查,所有患者在1个月内接受导管造影检查.重建冠状动脉DE-CTA和DE-CTP图像用于冠状动脉狭窄程度和心肌灌注缺损的评判,并以冠状动脉造影为参考标准,建立DECT对冠状动脉狭窄诊断价值的基线值,进而计算DE-CTA加DE-CTP对冠心病诊断的敏感性、特异性、阳性预测值、阴性预测值和准确性.结果 28例患者获得满意的图像质量,以冠状动脉造影为参考标准:(1)DE-CTA显示112支冠状动脉,其中41支冠状动脉狭窄≥50%,诊断冠状动脉狭窄的敏感性、特异性、阳性预测值、阴性预测值分别为81%(38/47)、95%(62/65)、93%(38/41)、87%(62/71),准确性为89%(100/112);(2)DE-CTP显示46支狭窄冠状动脉供血区域心肌灌注缺损,诊断狭窄≥50%冠状动脉的敏感性、特异性、阳性预测值、阴性预测值分别为76%(36/47)、85%(55/65)、78%(36/46)、83%(55/66),准确性为81%(91/112);(4)DE-CTA加DE-CTP诊断52支冠状动脉狭窄≥50%,诊断冠状动脉狭窄的敏感性、特异性、阳性预测值、阴性预测值分别为96%(45/47)、89%(58/65)、86%(45/52)、97%(58/60),准确性为92%(103/112).结论 DE-CT一次扫描即能获得冠状动脉解剖学和血流灌注信息,可以对冠心病做出综合性诊断.DE-CTP能够为CTA提供有益的补充.

Abstract：

Objective To evaluate the combination of dual-energy CT angiography (DE-CTA) and dual-energy CT peffusion (DE-CTP) in the diagnosis of coronary artery disease. Methods Thirty-one patients with angina pectoris were examined using dual-source dual energy CT and conventional coronary angiography. For DE-CTA, we used a contrast-enhanced ECG-gated coronary scan protocol with energy levels of two tube detector arrays at 140 and 100 kVp. Two kinds of acquired images were fused for the CT angiogram and further calculated to construct a perfusion map (Siemens DE Heart PBV). The compared the following results: DE-CTA vs. CA, DE-CTP vs. CA to assess the sensitivity and specificity, and further compared DE-CTA plus DE-CTP with CA. Results DECT obtained diagnostic image quality in 28 patients.DE-CTA detected 41/112 arterial stenosis. Using CA as a reference, the sensitivity of DE-CTA was 81%(38/47), specificity was 95% (62/65), positive predictive value was 92% (38/41), negative predictive value was 87% (62/71), and accuracy was 89% (100/112). DE-CTP detected 46 perfusion defects in artery territories. Using CA as a reference, the sensitivity of DE-CTP was 76% ( 36/47), specificity was 85% (55/65), positive predictive value was 78% (36/46), negative predictive value was 83% (55/66),and accuracy was 81% (91/112). DE-CTA plus DE-CTP diagnosed 52 arteries stenosis. Using CA as a reference, combination of DE-CTA and DE-CTP gave sensitivity of 95% ( 45/47 ), specificity of 89%(58/65) , NPV of 97% (58/60), and accuracy of 92% (103/112). Conclusions DECT can provide perfusion blood volume information as well as vessel pathology in one scan. DECT can provide comprehensive diagnosis and improve diagnosis of CAD.     

钙化对FFR CT诊断冠状动脉疾病准确性影响的研究

目的研究钙化对冠状动脉CT血管成像(CCTA)测定的血流储备分数(FFR_(CT))诊断冠状动脉疾病准确性的影响。方法回顾性分析行CCTA检查和有创FFR检查的38例病人共50支血管的资料。用Agatston积分法测量50支血管的钙化积分值,以钙化积分值100为阈值,分为A1组(≤100)和A2组(100)。利用c FFR软件进行FFR_(CT)值测定,FFR及FFR_(CT)0.8定义为病变特异性心肌缺血。采用组内相关系数(ICC)计算总体及A1、A2组FFR_(CT)与FFR的一致性。以有创FFR作为参考标准,以血管为分析单位,分别计算总体及A1、A2两组FFR_(CT)的诊断准确度、敏感度、特异度、阳性预测值及阴性预测值,并采用Fisher确切概率法比较2组间的差异。结果总体FFR_(CT)和FFR的ICC系数为0.771(95%CI:0.597~0.870),A1组FFR_(CT)和FFR的ICC为0.819(95%CI:0.633~0.910),A2组FFR_(CT)和FFR的ICC为0.649(95%CI:0.032~0.873)。总体FFR_(CT)诊断敏感度、特异度、准确度、阳性预测值及阴性预测值分别为90.9%、97.4%、96.0%、90.9%、97.4%;A1组和A2组FFR_(CT)诊断敏感度、特异度、准确度、阳性预测值及阴性预测值分别为85.7%、100%、96.9%、100%、96.0%和100%、92.3%、94.1%、80.0%、100%;A1和A2组间诊断效能各指标的差异均无统计学意义(均P0.05)。结论 FFR_(CT)与FFR在冠状动脉狭窄血流评估方面有较好的一致性,研究未显示钙化影响FFR_(CT)的诊断效能。     

Incremental value of the CT coronary calcium score for the prediction of coronary artery disease

Objectives:

To validate published prediction models for the presence of obstructive coronary artery disease (CAD) in patients with new onset stable typical or atypical angina pectoris and to assess the incremental value of the CT coronary calcium score (CTCS).

Methods:

We searched the literature for clinical prediction rules for the diagnosis of obstructive CAD, defined as ≥50% stenosis in at least one vessel on conventional coronary angiography. Significant variables were re-analysed in our dataset of 254 patients with logistic regression. CTCS was subsequently included in the models. The area under the receiver operating characteristic curve (AUC) was calculated to assess diagnostic performance.

Results:

Re-analysing the variables used by Diamond & Forrester yielded an AUC of 0.798, which increased to 0.890 by adding CTCS. For Pryor, Morise 1994, Morise 1997 and Shaw the AUC increased from 0.838 to 0.901, 0.831 to 0.899, 0.840 to 0.898 and 0.833 to 0.899. CTCS significantly improved model performance in each model.

Conclusions:

Validation demonstrated good diagnostic performance across all models. CTCS improves the prediction of the presence of obstructive CAD, independent of clinical predictors, and should be considered in its diagnostic work-up.     

Diagnostic accuracy of 16-slice CT coronary angiography in the evaluation of coronary artery disease

Multislice CT coronary angiography (CT-CA) has emerged as a potential imaging method for coronary artery disease. This study aimed to ascertain the accuracy of 16-slice CT in the diagnosis of significant coronary stenosis (>or=50% reduction of lumen diameter). This mixed retrospective/prospective observational study compared 95 paired 16-slice CT-CA and fluoroscopic coronary angiography (FCA) sets. A cardiologist and a radiologist blinded to the FCA findings evaluated CT-CA images independently by visual estimation. Disagreement between these reporters was arbitrated by a third CT reporter (a cardiologist). A separate cardiologist blinded to CT-CA findings assessed FCA by visual estimation. Of 1,161 coronary segments assessable on FCA, 1,103 segments (95%) were assessable on CT-CA. The CT-CA correctly diagnosed 147/180 segments with significant stenoses (sensitivity = 82%) and correctly identified 874/923 coronary segments without significant stenoses (specificity = 95%). The positive and negative predictive values of CT-CA in the diagnosis of coronary segment with significant stenosis were 75 and 96%, respectively. On patient-based analysis, CT-CA correctly identified all 68 studies with at least one vessel with significant stenosis (sensitivity = 100%; specificity = 83%). The positive and negative predictive values of CT-CA in identifying patients with significant coronary stenosis were 94 and 100%, respectively. The 16-slice CT-CA showed moderately good sensitivity but very high specificity and negative predictive value in the diagnosis of significant coronary stenosis. The CT-CA would appear to be a useful 'rule-out' test for patients with low-risk profile for ischaemic heart disease.     

重视冠状动脉多层CT成像的低剂量检查

近年来,随着MSCT技术的飞速发展,尤其是64层MSCT和双源CT(DSCT)的问世,MSCT在心脏冠状动脉成像方面应用越来越广泛,在诊断冠状动脉粥样硬化以及评价支架术后再狭窄和搭桥血管等方面发挥着越来越重要的作用,冠状动脉CTA已成为冠心病检查的一项重要的无创性成像手段.     

重视冠状动脉多层CT成像的低剂量检查

近年来,随着MSCT技术的飞速发展,尤其是64层MSCT和双源CT(DSCT)的问世,MSCT在心脏冠状动脉成像方面应用越来越广泛,在诊断冠状动脉粥样硬化以及评价支架术后再狭窄和搭桥血管等方面发挥着越来越重要的作用,冠状动脉CTA已成为冠心病检查的一项重要的无创性成像手段.     

重视冠状动脉多层CT成像的低剂量检查

近年来,随着MSCT技术的飞速发展,尤其是64层MSCT和双源CT(DSCT)的问世,MSCT在心脏冠状动脉成像方面应用越来越广泛,在诊断冠状动脉粥样硬化以及评价支架术后再狭窄和搭桥血管等方面发挥着越来越重要的作用,冠状动脉CTA已成为冠心病检查的一项重要的无创性成像手段.     

重视冠状动脉多层CT成像的低剂量检查

近年来,随着MSCT技术的飞速发展,尤其是64层MSCT和双源CT(DSCT)的问世,MSCT在心脏冠状动脉成像方面应用越来越广泛,在诊断冠状动脉粥样硬化以及评价支架术后再狭窄和搭桥血管等方面发挥着越来越重要的作用,冠状动脉CTA已成为冠心病检查的一项重要的无创性成像手段.     

重视冠状动脉多层CT成像的低剂量检查

近年来,随着MSCT技术的飞速发展,尤其是64层MSCT和双源CT(DSCT)的问世,MSCT在心脏冠状动脉成像方面应用越来越广泛,在诊断冠状动脉粥样硬化以及评价支架术后再狭窄和搭桥血管等方面发挥着越来越重要的作用,冠状动脉CTA已成为冠心病检查的一项重要的无创性成像手段.