老年性冠状动脉粥样硬化斑块的MSCT检测及质量分析

目的探讨多层螺旋CT(MSCT)对冠状动脉粥样硬化软、硬斑块的检出及诊断的价值。方法应用SIEMENSSensation16层螺旋CT对86例60岁以上疑有或拟诊断为冠心病的患者行冠状动脉检查,采用回顾性心电门控技术对采集的数据进行图像后处理。结果多平面重建(MPR)、最大密度投影(MIP)、容积积分技术(VRT)、仿真内镜(CTVE)处理方法评价斑块及狭窄敏感性、准确性各有优势;成像质量受设备,检查方法,重建,多方面因素的影响。结论MSCT评价冠状动脉粥样硬化斑块的检查方法简单易行,病人易耐受;Cascoring评价结果与金标准接近。     

北京社区自然人群冠状动脉钙化的多排螺旋CT初步研究

目的利用64排螺旋CT(64multi-detector computed tomography,64-MDCT)初步评价北京社区人群的冠状动脉钙化(coronary artery calcium,CAC)情况。方法对北京地区社区人群进行抽样研究,利用64-MDCT(GE,LightSpeed VCT)对1480例研究对象进行冠状动脉钙化扫描,应用Agatston积分法分别计算其冠状动脉钙化积分(coronary artery calcium score,CACS),观察CAC分布特征,以性别及年龄分组比较组间的CAC差别。结果总样本CAC阳性率为29.9%;男性组的CAC阳性率为37.6%,明显高于女性组的23.1%(P0.01)。同一性别各年龄组的CACS均呈正偏态分布,CAC阳性率和CACS均随年龄增加而显著增高(P0.01);40～、50～岁组的CAC阳性率以及40～、50～、60～岁组的CACS存在性别间的显著性差异。1480例研究对象有206例(13.9%)为单支钙化,237例(16.0%)为多支钙化;总样本共5920支冠状动脉中以前降支(26.8%)及右冠状动脉(13.5%)钙化阳性率为高(P0.01)。结论 64-MDCT能够方便、快速地量化检测社区人群的CAC的发病情况,评价人群中的CAC分布特征及规律,从而初步判定人群中的冠状动脉粥样硬化病变的流行病学特征。     

冠状动脉0钙化积分人群非钙化性斑块的发生率及其危险因素分析简

目的 利用计算机断层扫描（computerized tomography,CT）冠状动脉成像,研究冠状动脉0钙化积分人群非钙化性斑块的发生率及管腔狭窄程度,并分析其相关危险因素.方法 对968例冠状动脉0钙化积分患者的影像学资料和临床资料进行回顾性分析,所有患者均行64层螺旋CT冠状动脉钙化积分扫描及CT冠状动脉成像检查;采用单因素分析和Logistic回归分析冠状动脉非钙化性斑块形成的相关危险因素.结果 968例患者中,203例（21.0％）检出非钙化性斑块,斑块导致轻度狭窄124例（61.1％）、中度狭窄53例（26.1％）、重度狭窄26例（12.8％）.Logistic回归分析显示原发性高血压（高血压）（OR=3.994,P=0.010）、男性（OR=2.663,P=0.000）、吸烟史（OR=1.376,P=0.001）、甘油三酯增高（OR=3.536,P=0.000）、高密度脂蛋白胆固醇降低（OR=0.653,P=0.008）为冠状动脉非钙化性斑块形成的危险因素.糖尿病史、血清甘油三酯和高密度脂蛋白胆固醇浓度与斑块导致的管腔狭窄程度有关.结论 冠状动脉0钙化积分人群中有相当比例的人存在非钙化性斑块,高血压、高脂血症为非钙化性斑块形成的两大独立危险因素.     

16排螺旋CT对冠状动脉斑块的诊断价值

目的探讨16排螺旋CT（16-mulddetector spiral computed tomography,16-MDCT）检测和区分冠状动脉斑块的准确性。方法对2005年8月至2006年3月68例拟诊为冠心病的患者先行16-MDCT检查,4天内再行定量冠状动脉造影（QCA）和血管内超声（IVUS）检查,冠状动脉血管腔直径狭窄（DS）≥50％定义为有意义的狭窄,分别测量斑块的CT密度,单位为CT值（Hounsfield units,HU）,根据冠状动脉斑块的CT值区分斑块性质并作出分类：（1）软斑块：CT值为≤50HU;（2）纤维斑块（中等斑块）：CT值为50—119HU;（3）钙化斑块≥120HU。结果在112段16-MDCT和QCA均诊断为冠状动脉狭窄≥50％的病变中,其敏感性为91．8％（112／122）,特异性为97．8％（556／568）,共96段有意义的狭窄病变纳入研究,分别位于左前降支57段,左回旋支17段,右冠状动脉14段,左主干8段。IVUS发现软斑块21个（21．9％）、纤维斑块36个（37．5％）、钙化斑块38个（39．5％）,混合性斑块（纤维钙化斑块）1个（1．1％）,16-MDCT发现软斑块20个,平均CT值（11±36）HU（-27～42HU）、纤维斑块37个,平均CT值（83±20）Hu（58—105HU）、钙化斑块39个,平均CT值（292±80）HU（167—530HU）,差异有统计学意义（P〈0．05）。结论无创性16排螺旋CT冠状动脉成像技术不仅可诊断冠状动脉狭窄病变,同时对区分钙化斑块及非钙化斑块有较高的诊断价值。     

冠状动脉CT血管造影综合评估易损斑块的进展

急性冠状动脉综合征（ACS）是以冠状动脉粥样硬化斑块破裂或侵袭,继发完全或不完全闭塞性血栓形成为病理基础的一组临床综合征。与稳定斑块相比,容易破裂的斑块具有明显的影像学特征：大斑块体积,低衰减斑块,餐巾指环标志,正性重构和点状钙化,这为在导致临床事件之前运用非侵入性成像识别易损斑块提供了独特的机会。随着影像技术的发展,冠状动脉CT 血管造影（CCTA）无创性评价冠状动脉易损斑块的作用已成为国内外研究热点。笔者就CCTA在评估冠状动脉斑块易损性方面的临床应用现状与进展等方面作一综述。     

双源CT血管成像评价冠状动脉钙化性斑块血管腔狭窄程度准确性的研究

目的 探讨双源CT冠状动脉成像(DSCTA)评价钙化斑块引起血管腔狭窄的准确性.方法 62例患者DSCTA显示冠状动脉一处或多处钙化斑块,并行冠状动脉造影(CAG)检查.钙化斑块大小分为小、中和大.使用各种后处理技术,以确定钙化斑块引起血管阻塞(狭窄管腔直径≥50%),无血管阻塞(狭窄管腔直径＜50%),并与CAG比较.结果 DSCTA显示小钙化斑块122处,中钙化斑块44处,大钙化斑块86处.122处小钙化斑块,5%CAG显示有梗阻.44处中钙化斑块,14%梗阻,86处大钙化斑块,42%有梗阻.DSCTA与CAG一致95%(116/122)小钙化斑块、91%(40/44)中钙化斑块、67%(58/86)大钙化斑块.DSCTA低估2例小钙化斑块血管腔狭窄,高估4例小钙化斑块、4例中钙化斑块、28例大钙化斑块血管腔狭窄.86处大钙化斑块引起的血管腔梗阻,DSCTA敏感性100%,特异性44%,阳性预测值56%,阴性预测值100%,准确性67%.结论 DSCTA准确显示90%以上小和中等大小钙化斑块血管阻塞病变,正确诊断约2/3大钙化斑块血管阻塞病变.判断错误通常是高估狭窄程度.     

64层螺旋CT冠状动脉成像检测不稳定斑块的危险因素分析

目的 探讨64层螺旋CT冠状动脉成像(64SCTA)检测冠状动脉粥样斑块的价值,分析形成不稳定斑块的危险因素.方法 选择112例住院冠心病患者行64SCTA和导管法冠状动脉造影,均检测血清内皮素-1、基质金属蛋白酶-9(MMP-9)、白介素-6(IL-6)、肿瘤坏死因子-α和超敏C反应蛋白(hs-CRP).以冠状动脉造影为标准评价64SCTA检测冠状动脉斑块的作用;根据检测正确的粥样斑块CT值将患者分为软斑块组(51例)和非软斑块组(61例),比较两组各检测指标的差异,分析软斑块形成的危险因素. 结果 64SCTA检测冠状动脉斑块的灵敏度为87.4%,特异度为87.1%,阳性预测值82.2%,阴性预测值91.0%.软斑块组与非软斑块组比较,MMP-9、IL-6、hs-CRP、冠状动脉病变数及诊断、性别和糖尿病的构成比差异有统计学意义.Logistic回归分析显示,MMP-9>5.231 ng/L(P=0.0215,OR=2.33,95%CI 1.13～4.79)、hs-CRP>3.583 mg/L(P=0.0008,OR=4.32,95%CI 1.84～10.15)和不稳定心绞痛(P=0.0339,0R=4.33,95%CI 1.12～16.77)为软斑块形成的危险因素.结论 64SCTA检测冠状动脉斑块价值较高,是目前无创方法检测冠状动脉斑块最为可靠的手段之一.MMP-9、hs-CRP和不稳定心绞痛为不稳定斑块的独立危险因素.     

CT心脑血管一体化成像斑块负荷的危险因素分析

目的： 分析CT心脑血管一体化成像不同类型斑块发生的危险因素分析,进一步为临床提供预警价值。 方法： 分析第一部分前瞻性收集临床同时进行冠状动脉和头颈部动脉CT动脉成像连续性300例患者,根据斑块类型分为钙化斑块、非钙化斑块、混合斑块和无斑块。构建多因素Logistic模型对斑块发生的危险因素进行分析。P≤0.05差异有统计学意义。 结果： 冠状动脉总斑块和头颈部动脉的总斑块发生率构成比有相关性（χ2=14.22,P=0.001）。血糖(OR=3.20;95%CI：1.57～6.51;P = 0.001)是冠状动脉非钙化斑块发生的独立危险因素,不是头颈部动脉非钙化斑块发生的独立危险因素。血糖(OR=2.27;95%CI：1.08～4.76;P= 0.030)、年龄(OR=1.04;95%CI：1.01～1.08;P= 0.007)和甘油三酯(OR=1.19;95%CI：1.02～1.38;P=0.021)是冠状动脉钙化斑块独立危险因素;年龄(OR = 1.10;95%CI：1.05～1.15;P=0.001)是头颈部动脉钙化斑块的独立的危险因素。 结论： 冠状动脉总斑块和头颈部动脉的总斑块的发生有相关性,不同部位的各类型斑块的危险因素不同。血糖是冠状动脉非钙化斑块发生的独立危险因素,不是头颈部动脉非钙化斑块发生的独立危险因素。     

应用16层螺旋CT评价辛伐他汀对冠状动脉斑块的影响

目的 评价辛伐他汀对冠状动脉粥样斑块的影响.方法 对43例经16层螺旋CT及回顾性心电门控技术检测出的冠脉粥样斑块患者,给予辛伐他汀20 mg/d口服,12个月后复查斑块情况.结果 43例患者有119支冠状动脉存在132个粥样斑块,治疗后各种斑块大小有不同程度的缩小,其中脂质斑块(27个)缩小幅度26.4%(P＜0.05),纤维斑块(34个)缩小幅度14.1%(P＜0.05),混合斑块(13个)缩小幅度12.7%(P＜0.05),而钙化斑块(58个)缩小幅度不明显(3.7%,P＞0.05).结论 辛伐他汀可逆转或稳定冠脉粥样斑块,从而降低急性冠状动脉事件的发生;16层螺旋CT可定量评价粥样斑块的变化,为临床治疗提供客观依据.     

光学相干断层成像在评价冠状动脉斑块方面的应用

光学相干断层成像(OCT)使用干涉仪记录不同深度生物组织的反射光,通过计算机构建能够让人简单识别的图像,因具备较高安全性和分辨率,已成为血管内检测技术的主力之一。冠状动脉中,不同的斑块组成具有不同的光学特性,在OCT图像上有不同的表现。冠状动脉斑块破裂并在此基础上形成血栓通常是引起心原性猝死或急性冠状动脉综合征(ACS)的重要原因。通过OCT评价斑块的特点可以充分全面了解其稳定性,从而预测临床心血管事件,指导诊断与治疗。     

Long-term prognostic implication of coronary plaque characterization as detected by 64-multidetector computed tomography in Egyptian population

Objectives

We aimed to determine the role of multi-detector computed tomography (MDCT) in prognosis of patients with known or suspected coronary artery disease (CAD) by applying plaque characterization and whether obstructive versus non-obstructive plaque volume is a predictor of future cardiac events.

Aortic atherosclerotic lesions in the thoracic aorta detected by multiplane transesophageal echocardiography as a predictor of coronary artery disease in elderly patients

BACKGROUND: The presence of atherosclerotic lesions in the thoracic aorta by transesophageal echocardiography (TEE) appears to be a marker for the presence of significant coronary artery disease (CAD) in the general population. HYPOTHESIS: We investigated whether atherosclerotic lesions in the thoracic aorta, by multiplane TEE, could be a marker for CAD in elderly patients. METHODS: In all, 127 patients (67 men, 60 women, aged 68 +/- 13 years), underwent a TEE study with imaging of the thoracic aorta and cardiac catheterization with coronary angiography. The presence of a distinct, linear, or focal, highly echogenic mass protruding into the vessel lumen was the criterion for the diagnosis of atherosclerotic plaque. RESULTS: Atherosclerotic lesions were found in 30 of 36 patients (83.3%) with and in 20 of 91 (22%) without CAD. Of the 41 patients > or = 70 years, atherosclerotic lesions were detected in 14 of 17 (82.3%) with and in 13 of 24 patients (54%) without CAD. The sensitivity, specificity, and positive and negative predictive values in this group were 82.3, 46, 52, and 78.6%, respectively. Multivariate logistic regression analysis revealed that in patients aged > or = 70 years only advanced atherosclerotic lesions were independent predictors of significant CAD. However, the high negative predictive value of the method indicates that the absence of aortic plaque is a strong predictor of the absence of CAD. CONCLUSIONS: The presence of atherosclerotic lesions in the thoracic aorta is a strong predictor of CAD only in patients < 70 years old. However, the negative predictive value of the method is high for all patients regardless of age.     

Topography of atherosclerotic coronary artery disease

This article reviews several issues relevant to current interest in coronary angioplasty, acute reperfusion, and the use of new interventional devices (stents, probes, atherectomy devices, etc.): diffuse versus focal nature of plaque, the number of vessels severely diseased, quantitation of luminal stenosis and length of stenosis, and the distribution of plaque in the four major coronary arteries in various clinical ischemic subsets.     

The relation between coronary artery calcification in asymptomatic subjects and both traditional risk factors and living in the city centre: a DanRisk substudy

Abstract. Lambrechtsen J, Gerke O, Egstrup K, Sand NP, Nørgaard BL, Petersen H, Mickley H, Diederichsen ACP (Svendborg Hospital, Svendborg; Odense University Hospital, Odense; SVS, Esbjerg; Institute of Regional Health Services Research, University of Southern Denmark; Vejle Hospital, Vejle; and Odense University Hospital, Odense, Denmark). The relation between coronary artery calcification in asymptomatic subjects and both traditional risk factors and living in the city centre: a DanRisk substudy. J Intern Med 2012; 271 : 444–450. Objective. To evaluate the association between the risk factor for living in the city centre as a surrogate for air pollution and the presence of coronary artery calcification (CAC) in a population of asymptomatic Danish subjects. Design and subjects. A random sample of 1825 men and women of either 50 or 60 years of age were invited to take part in a screening project designed to assess risk factors for cardiovascular disease (CVD). Noncontrast cardiac computed tomography was performed on all subjects, and their Agatston scores were calculated to evaluate the presence of subclinical coronary atherosclerosis. The relationship between CAC and several demographic and clinical parameters was evaluated using multivariate logistic regression. Results. A total of 1225 individuals participated in the study, of whom 250 (20%) were living in the centres of major Danish cities. Gender and age showed the greatest association with the presence of CAC: the odds ratio (OR) for men compared with women was 3.2 [95% confidence interval (CI) 2.5–4.2; P < 0.0001], and the OR for subjects aged 60 versus those aged 50 years was 2.2 (95% CI 1.7–2.8; P < 0.0001). Other variables independently associated with the presence of CAC were diabetes and smoking with ORs of 2.0 (95% CI 1.1–3.5; P = 0.03) and 1.9 (95% CI 1.4–2.5, P < 0.0001), respectively. The adjusted OR for subjects living in city centres compared to those living outside was 1.8 (95% CI 1.3–2.4; P = 0.0003). Conclusion. Both conventional risk factors for CVD and living in a city centre are independently associated with the presence of CAC in asymptomatic middle‐aged subjects.     

Plaque characterization of atherosclerotic coronary arteries by intravascular ultrasound

Intravascular ultrasound provides cross-sectional images of arteries and enables accurate delineation of lumen dimensions and wall structure. Moreover, ultrasound characterization of atherosclerotic plaque subtypes may have important implications in determining the natural history and the clinical outcome of patients with coronary artery disease. The reliability of intravascular ultrasound to differentiate plaque morphology subtypes was studied in 60 coronary segments excised from 33 coronary arteries obtained from 17 patients at necropsy. Ultrasound was performed with a 25-MHz transducer mounted on the distal end of a rigid probe that was rotated manually inside the lumen artery. Plane film radiography was also performed to establish the presence of calcific deposits. A total of 82 histologic transverse sections corresponding to 82 ultrasound imaging sites were studied from the 60 coronary segments. Of the first 54 images, 36 were fibrous plaques and yielded dense homogenous echo reflections, 6 had discrete areas of lipid that were less echogenic and 12 had calcific deposits that cast echo-free shadows beyond areas of intense echo reflections. The predictive accuracy of evaluating plaque composition in the remaining 28 ultrasound imaging sites was 96%. Thus, anatomical structure of coronary arteries and composition of atherosclerotic lesions can be assessed accurately with intravascular ultrasound and may have potential for better understanding of the atherosclerotic process and provide guidance to interventional procedures.     

Relationship between coronary atherosclerotic stenosis and cerebral atherosclerotic stenosis

To investigate the relationship between severity of cerebrovascular atherosclerosis stenosis and that of coronary atherosclerosis stenosis.Methods Cerebral angiography and coronary angiography were performed in 34 patients who had coronary disease with cerebral ischemia.Patients were divided into 3 subgroups according to the degree ofstenosis on angiography,concomitant diseases,risk factors and biochemical data.Results The follow-up study showed that the incidence of cardiac and cerebrovascular death increased significantly in patients with moderate to severe stenosis of coronary and cerebral arteries;the severity of stenosis in the coronary artery parallels that in the solitary carotid artery,or dual carotid and vertebral arteries.Conclusions Patients with coronary and cerebral artery stenosis,especially those with multi-risk factors,such as hypertension,diabetes and cigarette smoking,should receive intensive treatment to reduce cardiac and cerebrovascular events.(J Geriatr Cardiol 2008;5:227-229)     

The eccentric coronary atherosclerotic plaque: Morphologic observations and clinical relevance

Five hundred consecutive coronary artery segments histologically narrowed 76 to 95% in cross-sectional area by atherosclerotic plaque were classified into concentric and eccentric luminal types. Of the 500 segments, 365 (73%) were eccentric and 185 (27%) were concentric. Of the eccentric lesions, an are of disease-free wall accounted for 2.3 to 32% (mean 16.6%) of the circumference of the internal elastic membrane. The average thickness of the coronary artery media was thinner in diseased segments (mean 88.4 μm) compared to disease-free wall segments in the same vessel (mean 202.9 μm). The presence of disease-free wall segments has clinical importance in at least three areas: (1) the accuracy with which angiography reflects the morphologic features of the diseased vessel, (2) coronary artery spasm, and (3) the mechanism of coronary balloon angioplasty and subsequent “restenosis” of previously dilated vessels.