多层螺旋CT冠状动脉成像的临床应用和进展

临床应用证明多层螺旋CT(MSCT)在心脏成像方面是切实有效的。综述了MSCT冠状动脉造影的检查技术和临床应用进展。MSCT冠状动脉造影可以部分取代导管法冠状动脉造影并作为冠心病诊断和治疗效果随访观察的重要手段。     

多层螺旋CT冠状动脉成像的临床应用和进展

临床应用证明多层螺旋CT(MSCT)在心脏成像方面是切实有效的.综述了MSCT冠状动脉造影的检查技术和临床应用进展.MSCT冠状动脉造影可以部分取代导管法冠状动脉造影并作为冠心病诊断和治疗效果随访观察的重要手段.     

心脏CT检查时对比剂注射方案的优化

多层螺旋CT（MSCT）的间世拓展了CT在心脏检查中的应用范围,新一代MSCT尤其是64层以上的螺旋CT,因其良好的时间分辨力、空间分辨力及密度分辨力,得到了临床医生的广泛认可。冠状动脉CT血管成像（CCTA）对冠状动脉疾病的诊断,其阴性预测值可达到98％～99％,与传统冠状动脉造影相比,MSCT对冠心病的筛查、斑块及组成成分的观察、斑块危险度的预测、     

多层螺旋CT在冠脉成像中的应用

多层螺旋CT冠状动脉造影（multi-slice spiral CT coronary angiography MSCTCA）是近年来出现的一项影像新技术，本文综述了近年来多层螺旋CT冠状动脉造影的检查方法和临床应用研究进展。MSCT冠状动脉造影可以作为冠状动脉患者筛选、冠心病诊断及治疗效果随访观察的重要手段。     

64层螺旋CT冠状动脉成像临床应用

目的：探讨64层螺旋CT（MSCT）冠状动脉成像方法显示冠状动脉狭窄的能力及可靠性。方法：对26例临床怀疑冠心病的患者行心脏冠状动脉CT成像（CTA）并与常规冠状动脉造影（CAG）结果进行比较分析。结果：以冠状动脉血管造影（CAG）为金标准,冠状动脉CTA影像判断血流动力学相关性冠状动脉狭窄（≥50%）的敏感度0.933、特异度0.974、准确度0.968、阳性预测值0.857、阴性预测值0.989。结论：64层螺旋CT冠状动脉成像是一种无创、简便、优良的冠状动脉成像方法,可作为冠状动脉粥样硬化的筛选手段及冠状动脉术后复查的首选方法。     

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.     

64层螺旋CTA对冠状动脉病变的诊断价值

目的探讨64层螺旋CT在冠状动脉病变中的临床应用价值,为临床进一步数字减影血管造影(DSA)检查或其他治疗提供依据。方法对80例临床拟诊为冠心病的患者进行64层螺旋CT动脉血管造影(SCTA)检查,对所有扫描图像采用西门子工作站提供的各种分析软件进行后重建,观察冠状动脉管腔情况并进行分析判定。结果 64层螺旋CT可对冠状动脉的起源变异、狭窄程度、桥血管通畅程度及支架术后进行评估。结论 64层SCTA是一种安全、快速、无创的诊断冠心病的方法,也可作为筛查公众中冠状动脉病变的重要手段。     

64层螺旋CT冠状动脉血管成像与冠脉造影结果对照研究

目的:评价多层螺旋CT(MSCT)冠状动脉血管成像方法显示管腔≥50%狭窄的准确性,分析改善成像质量的方法.方法:对72例临床诊断或可疑冠心病的患者在心电门控下采用64层螺旋CT进行冠状动脉血管成像.其中56例在2周内行导管法冠状动脉造影.结果:本组56例与冠状动脉造影结果相对照,冠状动脉血管成像诊断≥50%血管狭窄的敏感性为91.5%,特异性为97.5%,阳性预测值为82.3%,阴性预测值为98.9%.结论:64层螺旋CT冠状动脉血管成像具有较高的敏感性和特异性,同时具有无创和简便的特点,可以作为临床对高危人群筛查的首选方法.     

64层螺旋CT冠状动脉成像诊断冠状动脉狭窄的初步探讨

目的：探讨64层螺旋CT（MSCT）冠状动脉成像对冠状动脉狭窄的诊断价值。方法：53例冠心病患者同期均行64层螺旋CT冠状动脉成像和常规冠状动脉造影（CCA）,以CCA的诊断结果作为金标准,采用美国心脏协会冠状动脉改良分段法,分析745个冠状动脉节段MSCT图像质量及对冠状动脉狭窄的显示情况,得出有意义病变（冠状动脉狭窄率≥500%）MSCT诊断的正确性,并分析钙化对其影响。结果：587个冠状动脉节段图像可以满足诊断要求,158个节段因运动伪影（27个节段）或管壁严重钙化（131个节段）无法进行血管评价。MSCT诊断冠状动脉狭窄的敏感度为93．4％、特异度为97．9％、阳性预测值为93．9％、阴性预测值为97．7％。钙化积分≥1000的患者,MSCT诊断冠状动脉狭窄的特异度、敏感度、阳性预测值、阴性预测值分别为74％、82％、68％、96％。结论：64层螺旋CT冠状动脉成像是一种快速、安全、无创的检查方法,与常规冠状动脉造影检查结果有较好的一致性,可以作为临床怀疑冠心病患者的首选检查方法。     

64层螺旋CT与DSA在冠状动脉造影中的应用分析

目的 探讨并对比64层螺旋CT （MSCT）冠状动脉造影与DSA对冠状动脉各节段病变的检测情况.方法 收集2010年12月～2011年12月我院收治的92例患者64层螺旋CT和DSA检查临床资料.观察并比较两种方法对冠状动脉各阶段狭窄病变的检测情况.结果 CT检出冠脉狭窄的敏感度、特异度、阳性预测值和阴性预测值分别为91.1％、94.6％、90.0％和95.3％.经过与DSA对照,MSCT检测出的冠状动脉各段病变数、钙化斑块及非钙化斑块数与DSA相近.结论 64层螺旋CT与DSA在诊断冠状动脉各段病变及狭窄程度上准确度相似,具有一致性.64层CT在冠脉狭窄病变中具有重要的临床价值,值得在临床上广泛应用.     

Multislice CT: 64 slices and beyond

Since the first introduction of 4-slice multislice computed tomography (MSCT) more than 6 years ago, MSCT imaging has achieved widespread acceptance and became a standard of care in routine clinical practice by offering high-speed, non-invasive, thin-slice diagnostic scanning for a wide range of clinical applications in radiology and cardiology. In the past year, the industry has witnessed an explosive increase in the amount of data obtained by MSCT and in the number at acquired slices to 32 and 64. While some experts have argued that a 16-slice system is sufficient from a practical standpoint, a closer examination of 32- and 64-slice systems offers new and superior clinical benefits over and above 16-slice technology, especially in imaging of the coronary arteries and in multiphase and functional studies. With the introduction of 32-slice computed tomography (CT) systems, the routinely acquired slice thicknesses have been reduced to 0.5 mm and 1 mm. At these slice thickness levels, it is possible to acquire isotropic volume data sets in all CT scans. Recently, diagnosis based on isotropic volume data has become the standard in CT imaging as it offers far greater clinical benefits than previous 16-slice CT technology. While many of the clinical benefits of a 64-slice CT system center around imaging the heart, there are several distinct areas in the radiology practice that benefit as well. One key area is in the field of interventional neuroradiology and the ability to separate venous from arterial flow using computed tomography angiography (CTA). The evolution of MSCT has opened up new frontiers in diagnostic imaging that were unimaginable just a few years ago.     

急性胸痛三联症64层螺旋CT“一站式成像”的研究

目的探讨64层螺旋CT一次性联合检查同时显示冠状动脉、肺动脉、主动脉的能力和成像质量。资料与方法 60例急性胸痛患者进行64层MSCT检查,应用回顾性心电门控技术,冠状动脉、肺动脉、主动脉一次性联合成像,采用多种重组方式显示冠状动脉、肺动脉、主动脉,对照50例单纯64层MSCT冠状动脉成像、30例单纯肺动脉成像和20例单纯主动脉成像,进行分析比较,评价成像质量和能否满足临床诊断需要。结果 一站式成像平均扫描时间为(8.0±1.5)s,对比剂用量100 ml,注射流率为4.0～4.5 ml/s。冠状动脉成像质量研究组与对照组比较存在显著性差异(P<0.01),对照组成像质量优于研究组;主动脉成像中升主动脉、主动脉弓、降主动脉和整体胸主动脉的成像质量在两组整体和组间比较无显著性差异(P均>0.05),两组成像质量同样优良;肺动脉中央段、周围段和整体肺动脉的成像质量在两组整体和组间比较存在显著性差异(P均P<0.01),研究组均优于对照组。结论 64层MSCT能够在10 s内完成冠状动脉、肺动脉、主动脉一次性联合检查。主动脉、肺动脉成像质量优良,同单纯主动脉成像比较无显著性差异、较单纯肺动脉成像质量为佳,冠状动脉成...     

Diagnostic value of multislice computed tomography angiography in coronary artery disease: a meta-analysis

PURPOSE: To perform a meta-analysis of the diagnostic value of multislice CT (MSCT) angiography in the detection of coronary artery disease (CAD) when compared to conventional coronary angiography. MATERIALS AND METHODS: A search of PubMed and MEDLINE databases for English literature was performed. Only studies with at least 10 patients comparing MSCT angiography with conventional coronary angiography in the detection of CAD were included. Diagnostic value of MSCT angiography compared to coronary angiography was compared and analyzed at segment-, vessel- and patient-based assessment. RESULTS: 47 studies (67 comparisons) met the criteria and were included in our study. Pooled overall sensitivity, specificity and 95% confidence interval for MSCT angiography in the detection of CAD were 83% (79%, 89%), 93% (91%, 96%) at segment-based analysis; 90% (87%, 94%), 87% (80%, 93%) at vessel-based analysis; and 91% (88%, 95%), 86% (81%, 92%) at patient-based analysis, respectively. Diagnostic accuracy of MSCT angiography in evaluating assessable segments was significantly improved with 64-slice scanners when compared to that with 4- and 16-slice scanners (p<0.05). CONCLUSION: Our meta-analysis showed that MSCT angiography has potential diagnostic accuracy in the detection of CAD. Diagnostic performance of MSCT angiography has been significantly improved with the latest 64-slice CT, with resultant high qualitative and quantitative diagnostic accuracy. 16-slice CT was limited in spatial resolution which makes it difficult to perform quantitative assessment of coronary artery stenoses.     

64-slice computed tomography assessment of coronary artery stents: a phantom study

Purpose: To compare the use of a new 64-slice computed tomography (CT) scanner with 16-slice CT in the visualization of coronary artery stent lumen.

Material and Methods: Eight different coronary artery stents, each with a diameter of 3 mm, were placed in a static chest phantom. The phantom was positioned in the CT gantry at an angle of 0° and 45° towards the z-axis and examined with both a 64-slice and a 16-slice CT scanner. Effective slice thickness was 0.6 mm with 64-slice CT and 1 mm with 16-slice CT. A reconstruction increment of 0.3 mm was applied in both scanners. Image quality was assessed visually using a 5-point grading scale. Stent diameters were measured and compared using paired Wilcoxon tests.

Results: Artificial lumen reduction was significantly less with 64-slice than with 16-slice CT. Average visible stent lumen was 53.4% using 64-slice CT and 47.5% with 16-slice MSCT. Most severe artifacts were seen in stents with radiopaque markers. Using 64-slice CT, image noise increased by approximately 30% due to thinner slice thickness.

Conclusion: Improved spatial resolution of 64-slice CT resulted in superior assessment of coronary artery stent lumen compared to 16-slice CT. However, a relevant part of the stent lumen is still not assessable with multi-slice CT.     

多层螺旋CT对先天性冠状动脉瘘的诊断价值

目的：总结并探讨先天性冠状动脉瘘的CT表现及其诊断价值。方法：27例经手术（20例）和临床确诊为冠状动脉瘘的患者,均行超声及MSCT检查,1例行冠状动脉血管造影（CAG）,分析每例患者的临床资料及MSCT表现,并与术后结果进行对照。结果：27例共栓出右冠状动脉瘘14例,左冠状动脉瘘10例,左右冠状动脉瘘3例．本组中超声检出21例,CT检出26例,1例经CAG检查确诊。MSCT可以清楚显示冠状动脉瘘的起源、管腔形态,瘘口的大小、数量以及汇入心腔的准确解剖位置。CT诊断7例患者合并其它心内外畸形,1例合并肺动脉栓塞。结论：MSCT对先天性冠状动脉瘘有较高的诊断价值,尤其对诊断并发动脉瘤和心内外畸形的冠状动脉瘘更有价值,是无创性诊断本病的可靠方法。     

Current status of coronary multislice CT angiography

Multislice computed tomography (MSCT) is an emerging technique which has an enormous potential to improve the current practice of coronary artery imaging. This article reviews the current status of coronary MSCT angiography (MSCTA) with emphasis on the imaging techniques and clinical utilities of 16-slice CTA. Results and experiences gained from coronary MSCTA in the past few years have taught us that accurate diagnosis of coronary artery disease relies on good technical studies and can be achieved by optimizing image parameters including image timing and image reconstruction ECG-trigger delay. Current clinical applications of coronary MSCTA include: quantitative assessment of coronary artery stenosis, characterization of coronary atherosclerotic plaques, and follow-up of coronary artery stent and bypass graft. Furthermore, MSCT has brought an increasing awareness to the amount of radiation used in CT. This has prompted CT researchers and manufacturers to improve various techniques and develop new strategies to reduce radiation dose. It is anticipated that MSCT will become a sensitive and accurate tool for detecting coronary artery disease and monitoring outcomes after treatment for coronary artery disease.     

主动脉壁内血肿的64层螺旋CT诊断

目的：探讨64层螺旋CT诊断主动脉壁内血肿（AIH）的价值。方法：对25例主诉急性胸背痛患者进行64层螺旋CT检查（连续容积扫描）,均经临床及影像学检查诊断为主动脉壁内血肿。结果：25例AIH患者按Stanford分型,A型2例,B型23例。MSCT征象：25例均见主动脉壁呈新月形或环形增厚,厚度≥5mm,无内膜破裂形成的双腔主动脉征象。平扫呈高密度11例,高密度为主的混杂密度8例,等密度6例。21例见钙化内移征象,5例可见穿透性溃疡征,动脉粥样硬化性改变18例,内膜渗透3例,血肿分层征象2例。并发心包积液4例,胸腔积液16例,主动脉夹层3例,主动脉瘤2例。结论：MSCT能为主动脉壁内血肿的诊断和治疗提供重要信息,且便于治疗后随访观察,可以作为AIH的首选诊断及随访检查方法。