64排螺旋CT评价冠状动脉旁路移植术后桥血管的效果

目的：探讨64排螺旋CT在冠状动脉桥血管的临床应用价值。方法：对42例冠状动脉旁路术后病人,共145条桥血管（其中内乳动脉46条,大隐静脉桥99条）,进行64排螺旋CT造影（CTA）。CT扫描时病人的平均心室率为（60±5）次／min。42例中20例桥血管血管吻合口冠状动脉狭窄（≥50％）或闭塞的病人及7例吻合口远端狭窄或闭塞的病人同时进行了冠状动脉造影（CAG）。结果：42例病人CTA均可评价。显示桥血管通畅125条．闭塞20条（其中内乳动脉5条,静脉桥15条）。CTA诊断冠状动脉桥血管狭窄（≥50％）或闭塞的准确性达100％。结论：CTA可以准确评价冠状动脉桥血管以及吻合口再狭窄的程度,桥血管近端吻合口的位置,可提示冠状动脉桥血管术后CAG的径路,是评价冠状动脉桥血管病变．创伤性小的首选方法。     

16排螺旋CT评估冠状动脉病变的临床价值

目的:探讨16排螺旋CT对冠状动脉病变评估的临床价值. 方法:对40例冠心病病人进行16排螺旋CT冠状动脉造影(CTA)并和常规冠状动脉造影(CAG)结果进行比较. 结果:CTA能显示所有主要的冠状动脉分支及节段,以CAG为金标准,CTA发现76支主干支有病变,其中67支病变部位与CAG一致;75支畅通程度一致.118个节段血管有病变,其中96段病变部位与CAG一致;321段畅通程度一致.CTA检查冠状动脉主干支的敏感性为84.8%,特异性为89.3%,阳性预测值(PPVS)为88.2%,阴性预测值(NPVS)为86.2%. 结论:CTA是诊断冠状动脉病变较可靠的无创检查方法.     

320层容积冠状动脉CT血管成像在冠心病诊断中的应用

目的探讨320层容积冠状动脉CT血管成像(CTA)诊断冠心病的准确性。方法 95例患者在行冠状动脉CTA检查后2周内行冠状动脉造影(CAG)检查,以CAG为金标准,判断冠状动脉CTA诊断冠状动脉中度狭窄(狭窄≥50%)及重度狭窄(狭窄≥75%)的敏感性、特异性、阳性预测值、阴性预测值及准确性。结果 CAG显示的1180个冠状动脉节段中,CTA显示中度狭窄的节段共98段;CAG显示80段,CTA诊断中度狭窄的敏感性、特异性、阳性预测值、阴性预测值分别为87.50%、97.45%、71.43%、99.01%,准确性为96.78%;CTA显示重度狭窄的节段共206段;CAG显示207段,CTA诊断重度狭窄的敏感性、特异性、阳性预测值、阴性预测值分别为93.33%、98.66%、93.78%、98.56%,准确性为97.71%。结论320排容积CTA诊断冠心病受心率影响小,诊断准确性高,可以作为冠心病的筛选检查。     

16排螺旋CT评估冠状动脉病变的临床价值

目的:探讨16排螺旋CT对冠状动脉病变评估的临床价值。方法:对 40例冠心病病人进行16排螺旋CT冠状动脉造影(CTA)并和常规冠状动脉造影 (CAG)结果进行比较。结果:CTA能显示所有主要的冠状动脉分支及节段,以 CAG为金标准,CTA发现76支主干支有病变,其中67支病变部位与CAG一致;75 支畅通程度一致。118个节段血管有病变,其中96段病变部位与CAG一致;321段畅通程度一致。CTA检查冠状动脉主干支的敏感性为84．8％,特异性为89．3％,阳性预测值(PPVS)为88．2％,阴性预测值(NPVS)为86．2％。结论:CTA是诊断冠状动脉病变较可靠的无创检查方法。     

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...     

双源CTA在高心率冠心病患者冠状动脉狭窄诊断中的应用观察

目的观察双源CT冠状动脉血管成像（双源CTA）诊断较高心率者（≥75次/m in）冠状动脉狭窄的效果。方法 51例冠心病患者,心率均≥75次/min,均接受双源CTA和传统冠状动脉血管造影（CAG）检查。结果双源CTA、CAG均检出冠状动脉狭窄者94段,均未检出者359段,仅CAG检出者34段,仅双源CTA检出者20段。以CAG结果为金标准,双源CTA诊断高心率冠心病患者冠状动脉狭窄的敏感度为73.44%,特异度为94.72%,符合率为89.34%,阳性预测值为82.46%,阴性预测值91.35%。结论 双源CTA诊断偏高心率冠心病患者（心率≥75次/m in）冠状动脉狭窄（≥50%）效果较好。     

三维CT血管造影与冠状动脉造影图像实时融合技术在冠状动脉慢性闭塞病变介入治疗中的应用:1例报道

本文回顾了我科应用三维冠脉CT血管造影(CTA)与冠状动脉造影(CAG)图像实时融合技术指导右冠状动脉慢性闭塞病变介入治疗的患者1例。该患者因"不稳定型心绞痛"入院,CAG示:前降支中段狭窄95%、前降支远端70%、回旋支近中段50%~90%,右冠近段弥漫狭窄最重85%,右冠中段闭塞。患者冠脉CTA明确右冠脉慢性闭塞病变特征,并预测慢性闭塞病变开通难易程度。同时,我们采用三维CTA与CAG图像融合技术,实时指导慢性闭塞开通,并且帮助明确球囊及支架的位置。同时运用微导管、对侧造影验证三维CTA与CAG图像融合指导的效果。     

64排螺旋CT在老年冠心病合并糖尿病患者冠脉病变诊断中的应用

目的探讨64排螺旋CT检查老年冠心病并糖尿病患者冠脉病变程度及冠脉内病变性质的应用价值。方法对52例临床诊断为冠心病并糖尿病的老年患者行冠状动脉64排螺旋CT冠脉造影（CTA）及常规选择性冠状动脉造影（CAG）检查。对CTA增强扫描轴位图像行多平面重建、容积再现、最大密度投影、曲面重建、仿真血管内镜等后处理,评估冠脉管腔狭窄程度及斑块性质。成像、造影以CAG为金标准,分析CTA的诊断价值。结果CAG发现狭窄段174个,CTA正确检出155个（89．1％）。其诊断冠状动脉狭窄的敏感性为89．1％,特异性为92．8％,准确率91．9％,阳性预测值81．2％,阴性预测值96．1％。结论CTA对冠状动脉狭窄有较高的诊断价值。     

256层螺旋CT对冠状动脉狭窄的评估

目的：应用256层螺旋CT对冠状动脉狭窄进行评估。方法：回顾性分析126例拟诊冠心病患者行256层螺旋CT （CTA）和冠状动脉造影（CAG）检查的资料。以 CAG结果为诊断冠心病的“金标准”,分析 CTA检测冠心病的准确度、灵敏度、特异度、阴性预测值与阳性预测值,并分析二者诊断冠状动脉狭窄的一致性。结果：以CAG结果为诊断冠心病的“金标准”, CTA 检测393段冠脉节段冠状动脉狭窄的准确度为89.3％,灵敏度为91.4％,特异度为84.9％,阴性预测值为82.3％,阳性预测值为92.8％,Kappa值＝0.755,P＜0.01。结论：256层螺旋CT可较好地显示冠状动脉狭窄,作为简单易行的无创性检查,对血管狭窄诊断的敏感性高。可作为亚健康人群的早期筛查和冠心病的复查可靠方法。     

不同手术策略对冠状动脉搭桥术后桥血管病变的影响

目的：分析冠状动脉搭桥术（coronary artery bypass grafting,CABG）后桥血管病变特点并探讨不同手术策略对桥血管病变的影响。方法：收集我院CABG术后因再发心肌缺血于2014年10月至2016年10月再次入院行冠状动脉造影（coronary angiography,CAG）共126例患者的临床资料,其中桥血管病变（桥血管造影显示狭窄≥75%或出现“线样征”）80例,自体冠状动脉病变加重（未搭桥冠状动脉狭窄从＜75%加重到≥75%）46例,对80例桥血管病变患者的259支桥血管及其吻合口进行评估,单支桥140支,序贯桥119支,平均3.2支/人,其中左乳内动脉桥72支,左桡动脉桥8支,右桡动脉桥3支,大隐静脉桥176支。结果：（1）桥血管病变患者80例,构成比63.5%,自体冠状动脉病变加重患者46例,构成比36.5%;（2）靶血管直径≥1.5mm与直径＜1.5mm的桥血管病变率分别为22.9%,42.9%,差异有统计学意义（P＜0.05）;（3）单支桥、序贯桥病变率分别为25.0%,28.6%,差异无统计学意义（P＞0.05）。结论：桥血管病变是CABG术后患者再发心肌缺血的主要原因,术中尽可能选择直径1.5mm以上的靶血管吻合,采用序贯吻合技术不增加桥血管病变率。     

Initial experience with 64-slice cardiac CT: non-invasive visualization of coronary artery bypass grafts.

AIMS: The aim of this study was to evaluate the diagnostic accuracy in the assessment of coronary artery bypass grafts using 64-slice computed tomography (CT) technology. METHODS AND RESULTS: CT coronary angiography was performed for 96 bypasses in 31 patients with suspected coronary artery disease using a Siemens Sensation 64-slice CT-scanner and compared with invasive coronary angiography (ICA). Patients with an irregular or fast heart rate despite beta-blocker administration were not excluded from the study. All bypass grafts and 94% of the distal bypass anastomoses could be visualized by CT, non-evaluable distal arterial anastomoses were either due to clip material or calcification artefacts. Forty-two bypass graft occlusions and three significant stenoses were detected by CT and confirmed by ICA. Two venous grafts were missed and one arterial graft was not evaluable with ICA, but both were clearly depicted by multi-slice CT. One false negative and two false positive CT-findings resulted in a sensitivity of 97.8%, a specificity of 89.3%, a positive predictive value of 90%, and a negative predictive value of 97.7%. CONCLUSION: State-of-the-art 64-slice CT coronary angiography demonstrates high diagnostic accuracy in the assessment of arterial and venous bypass graft stenoses.     

Noninvasive visualization of coronary artery bypass grafts using 16-detector row computed tomography

OBJECTIVES: The aim of this study was to evaluate the diagnostic accuracy of a 16-detector row computed tomography (CT) scanner for the assessment of coronary artery bypass grafts. BACKGROUND: A new generation of multislice spiral CT scanners, equipped with more and thinner detector rows, allows for reliable noninvasive detection of obstructive coronary artery disease. METHODS: The study included 51 consecutive patients. Three patients had to be excluded from the study due to arrhythmias or fast heart rates despite beta-blockade. A total of 48 patients with 131 coronary artery bypass grafts (internal mammary artery, n = 40; venous grafts, n = 91) were examined by computed tomography angiography (CTA) and by invasive coronary angiography (ICA) using a 16-detector row CT scanner. For cardiac protocols, only the 12 inner detector rings are applied. All CT examinations were performed with retrospective electrocardiogram gating at a mean heart rate of 64 +/- 5 beats/min; 120 ml of Xenetix 300 (Guerbert GmbH, Sulzbach, Germany) were continuously injected. The bypass graft patency and the presence of stenoses as well as the proximal and distal anastomoses were evaluated by two experienced readers. RESULTS: All bypass grafts and 74% of the distal bypass anastomoses could be visualized by CTA; 21 bypass graft occlusions and 1 significant stenosis were detected by CTA and confirmed by ICA. Five false positive and one false negative finding resulted in a sensitivity of 96%, a specificity of 95%, a positive predictive value of 81%, and a negative predictive value of 99%. CONCLUSIONS: Sixteen-detector row CT scanner technology allows for the reliable visualization of coronary bypass grafts. Dysfunctional bypass grafts can be detected with high diagnostic accuracy. This technology can be used as a noninvasive test for patients with suspected graft dysfunction.     

16排CT在评价胸痛患者冠状动脉病变中的应用价值

目的：探讨16排计算机断层扫描技术(CT)在评价胸痛疑似冠心病患者冠状动脉病变中的应用价值。方法：52例胸痛疑似冠心病患者人选,分别用16排CT造影方法(CTA)和常规冠状动脉造影方法(CAG)评价冠状动脉病变情况,并以CAG为标准计算CTA诊断冠状动脉病变的敏感度、特异度、阳性预测值(PPV)和阴性预测值(NPV)。结果：CTA能评价所有627个冠状动脉节段中的546个(87%)。在该546个冠状动脉节段中,CTA诊断冠状动脉病变的敏感度、特异度、PPV和NPV分别是94%、95%、82%和99%;CTA对冠状动脉左主干及其近中段病变的敏感度、特异度、PPV和NPV均高于冠状动脉远段和分支血管。结论：CTA能较准确地评价胸痛疑似冠心病患者冠状动脉(尤其是近、中段)的病变情况。     

16排CT在评价冠状动脉先天性异常中的应用价值

目的:探讨16排计算机断层扫描技术(MSCT)在评价冠状动脉先天性异常中的应用价值。方法:共入选216例进行16排CT造影(CTA)检查的患者,CTA检查通过回顾性心电图门控方法进行。如发现冠状动脉先天性异常,再进行导管介入的冠状动脉造影(CAG)检查证实冠状动脉先天性异常情况。CTA和CAG结果均由两位有经验的医师独立进行评估。结果:在216例CTA检查中,有5例显示冠状动脉先天性异常。在这5例冠状动脉先天性异常中,4例是右冠状动脉(RCA)起源异常,1例是RCA分支圆锥支行走异常。其中,3例RCA开口位于左冠窦,1例RCA开口起源于左前降支(LAD)近端,1例RCA分支圆锥支行走于主动脉和肺动脉之间到达心脏前壁。上述结果经CAG证实。结论:16排CT造影方法能准确地评价冠状动脉先天性异常。     

Comparison of multidetector 64-slice computed tomographic angiography to coronary angiography to assess the patency of coronary artery bypass grafts

This study prospectively evaluated the diagnostic accuracy of 64-slice computed tomographic angiography (CTA) in assessing the patency of coronary artery bypass grafts compared with invasive coronary angiography. In total 147 bypass grafts (100 venous grafts and 47 mammary artery grafts) were evaluated in 50 consecutive patients. Contrast-enhanced 64-slice CTA was performed and compared with invasive angiography. The computed tomographic angiographic scan protocol used 64- x 0.5-mm slice collimation and 0.33-second gantry rotation time during simultaneous electrocardiographic gating. Patients with a heart rate >65 beats/min received beta blockers. Overall 145 of 147 bypass grafts (98.6%) were detected by CTA; 2 nonvisualized grafts were occluded at the time of invasive angiography. Of the grafts visualized, 28 were totally occluded, 103 were patent, and 14 had significant stenoses that were confirmed by invasive angiography. Ninety-five percent (111 of 117) of patent grafts demonstrated good run-off distal to anastomoses but without an ability to accurately evaluate the presence of retrograde flow; 83% (97 of 117) of distal anastomoses were adequately evaluated, whereas the remaining 17% (20 of 117) were not well visualized due to vascular clips and/or calcification artifacts. Two grafts were not demonstrated by invasive angiography but were detected by CTA and found to be widely patent. In conclusion, multidetector 64-slice CTA is a valuable tool for direct visualization of coronary bypass grafts and assessment of their patency. Dysfunctional bypass grafts can be detected with high diagnostic accuracy.     

Long-term patency of bilateral internal thoracic artery Y composite coronary artery bypass grafts—determinants and impact on survival

BackgroundBilateral internal thoracic artery Y-composite grafting with sequential anastomoses is a well-established strategy for multi-arterial coronary artery bypass grafting. This study investigated the factors affecting long-term patency of bilateral internal thoracic artery Y-composite grafts and their influence on survival.MethodsPatients who underwent coronary artery bypass grafting using bilateral internal thoracic artery Y-composite grafts due to triple-vessel disease were included. In total, 415 cases (2003–2020) with at least 1 postoperative coronary computed tomography or angiography examination were enrolled. Through a retrospective review of medical records and computed tomography, risk factors for graft events (string sign or occlusion) were analysed, and the influence of string sign or occlusion in the initial postoperative computed tomography on long-term survival was evaluated.ResultsPatients’ mean age was 66±9 years and 324 were male (78%). The mean number of anastomoses from bilateral internal thoracic artery grafts was 4.0±0.9. The mean follow-up duration was 8.0±4.0 years (interquartile range: 4.8–11.5 years). Beating-heart surgery negatively affected the patency of grafts to the left circumflex and right coronary artery territories (P=0.015 and P=0.030, respectively), but in the left anterior descending territory, the graft patency did not differ (P=0.053). Non-severe (<90%) native-vessel stenosis was a risk factor for poor patency in the left anterior descending, left circumflex, and right coronary artery territories (P<0.001 for all). Twenty-four of the 104 nonvisible or narrowed grafts (23%) on early imaging later became widely patent. Occlusion of the grafts or the string sign within postoperative 1 year did not have a negative impact on long-term survival (P=0.421).ConclusionsThe patency rate was suboptimal in case of non-severe target-vessel stenosis (<90%). The beating-heart technique may negatively influence the patency of anastomoses to the left circumflex and right coronary artery territories. Compromised graft patency observed on initial computed tomography did not lead to worse survival.     

Use of 64-slice CT in symptomatic patients after coronary bypass surgery: evaluation of grafts and coronary arteries.

AIMS: Although previous generations of multislice computed tomography (CT) have demonstrated accurate detection of obstructive bypass graft disease, progression of coronary disease is a more frequent cause for ischaemic symptoms late after bypass graft surgery. We explored the diagnostic performance of 64-slice CT in symptomatic patients after bypass surgery, for the assessment of both grafts and native coronary arteries. METHODS AND RESULTS: The 64-slice CT angiography (Siemens Sensation 64, Germany) was performed in 52 symptomatic patients, 10 +/- 5 years after bypass surgery. Two independent, blinded observers assessed all grafts and coronary arteries for stenosis, using conventional quantitative angiography as a reference. A total of 109 grafts (182 graft segments), 123 distal coronary run-offs, and 116 non-bypassed coronary branches (288 segments) were analysed. Per-segment detection of graft disease yielded a sensitivity of 99% (71/72) and specificity of 96% (106/110). Sensitivity and specificity to detect run-off disease were 89% (8/9) and 93% (106/114), positive predictive value was 50% (8/16). In non-grafted coronary segments, CT detected significant stenosis with a sensitivity and specificity of 97% (62/64) and 86% (192/224). Overestimation occurred more frequently in calcified segments (P = 0.002). CONCLUSION: The 64-slice CT allows angiographic evaluation of grafts and coronary arteries, although overestimation of coronary obstruction occurs, particularly in the presence of calcified disease.     

Non-selective intra-arterial digital subtraction angiography for the assessment of coronary artery bypass grafts

Non-selective intra-arterial digital subtraction angiography (DSA) was performed immediately before selective coronary and bypass angiography in 33 consecutive symptomatic patients 48± 30 months after coronary surgery, for the assessment of 75 coronary bypass grafts. Forty ml of non-ionic, low-iodine content contrast medium (iohexol) were injected into the ascending aorta at 10–20 ml/sec through a 7 or 8 F femoral pigtail catheter.Electrocardiogram-triggered images were acquired on a Siemens Digitron II apparatus in multiple projections in 24 patients and in a single projection in 9 patients. The results of this technique were compared by two independent angiographers with those of selective graft angiography in the same patients. Patency was shown by DSA in 45 of 54 grafts confirmed to be open by selective angiography (sensitivity 83%). Of 21 occluded grafts, stumps were clearly visible at selective angiography in 18 and at DSA in 9 (sensitivity for graft stumns = 50%, p<0.01) Of 54 patent grafts with selective angiogranhy. the distal anastomosis could be visualized by DSA in 28 (52%), but the resolution was comparable to selective angiography in 20 grafts (37%) only. A non-significant difference in the sensitivity of DSA was observed between patent saphenous grafts to the left anterior descending coronary artery versus all other coronary arteries (95 vs 85%, respectively), while only 1 of 5 patent left internal mammary artery grafts to the left anterior descending coronary artery was visualized. In 16 of 50 grafts (32%) visualized in a second projection substantial additional diagnostic information was obtained. In conclusion, non-selective intra-arterial electrocardiogram-triggered DSA can visualize patent saphenous grafts with a high sensitivity and may be a useful screening tool for bypass grafts patency; false negatives, however, and poor visualization of distal anastomoses limit its routine clinical use.