低辐射量CT冠状动脉造影联合斑块钙化积分对评估冠状动脉狭窄的临床价值

目的 分析低辐射量CT冠状动脉造影(coronary angiography,CTCA)联合斑块钙化积分对评估冠状动脉狭窄的临床价值.方法 采取前瞻性研究,选取行低辐射量CT℃A检查的75例患者作为研究对象,其中男患占65.33％ (49/75),女患占34.67％ (26/75),均采取低辐射量CTCA扫描,在低辐射量CTCA图像中评估斑块钙化积分,并以侵入性冠状动脉造影结果为参考标准,综合评估冠状动脉狭窄情况,分为冠状动脉明显狭窄组和冠状动脉无明显狭窄组,对比两组患者的斑块钙化积分,分析低辐射量CTCA、斑块钙化积分及两者联合对冠状动脉狭窄的诊断准确率.结果 冠状动脉明显狭窄组的斑块钙化积分503.2±557.4,高于冠状动脉无明显狭窄组的42.6±79.6,差异显著(P =0.002,＜0.01);低辐射量CTCA评估冠状动脉狭窄的灵敏度、特异度、诊断符合率分别为96.2％、78.26％、90.67％,斑块钙化积分评估冠状动脉狭窄的灵敏度、特异度、诊断符合率分别为85.19％、100.0％、89.47％,两者联合评估冠状动脉狭窄的灵敏度、特异度、诊断符合率分别为96.15％、100.0％、97.33％.结论 在冠状动脉狭窄的评估方法选择上,低辐射量CTCA、斑块钙化积分分别具有很高的敏感度、特异度,两者联合可进一步提高对冠状动脉狭窄的评估准确率,不额外增加辐射剂量、延长扫描时间,值得临床借鉴应用.     

基于CCTA的ΔCT-FFR对重度钙化冠状动脉功能学评估的临床价值分析

目的 探讨基于冠状动脉计算机断层扫描血管成像(CCTA)的血流储备分数(CT-FFR)和冠状动脉病变最严重狭窄处的近端与远端CT-FFR测量差值(ΔCT-FFR)对重度钙化冠状动脉功能学评估诊断效能的临床价值。方法 收集2018年1月-2019年6月解放军总医院心血管内科收治住院的107例冠心病(CAD)患者的149支血管进行回顾性分析。所有患者住院期间依次进行CCTA、CT-FFR、侵入性冠状动脉造影(ICA)和有创血流储备分数(FFR)检查。以单支冠状动脉钙化积分(CACS)≥100判断为血管水平的重度钙化,根据CACS水平将冠状动脉分为CACS≥100组(n=56)和CACS<100组(n=93)。以FFR≤0.8作为诊断冠状动脉血流动力学异常的“金标准”,ΔCT-FFR定义为冠状动脉病变最严重狭窄处近端与远端CTFFR的测量差值。采用Pearson相关和Bland-Altman图评估血管水平CT-FFR与FFR值的相关性和一致性。通过ΔCT-FFR校正CT-FFR的检测结果,使用Delong检验比较不同诊断方法间受试者工作特征曲线(ROC)的曲线下面积(AUC),在血管水...     

冠状动脉斑块钙化致PTCA失败一例

病例资料 患,女60岁,因发作性胸闷4年,加重2个月入院,查体：血压145/90mmHg,心率64次/分,心律齐,心前区未闻及杂音。心电图示：V1-V6,T波倒置。临床诊断：冠心病,不稳定性心绞痛。     

冠状动脉管腔内对比度衰减梯度对钙化斑块诊断价值的研究

目的：以侵入性冠状动脉造影（ICA）为金标准,评价冠状动脉CT血管成像（CCTA）时管腔内对比度衰减梯度（TAG）诊断钙化斑块所致冠状动脉狭窄的价值。方法：回顾性分析78例冠状动脉有钙化斑块的患者,共112支血管,所有患者均做了CCTA （采用320排容积CT）和ICA检查。以血管为单位,计算TAG;并以CCTA目测法评价钙化斑块处管腔的狭窄程度。以ICA结果将狭窄程度分为轻度组（<50%）、中度组（50%～69%）和重度组（≥70%）。比较TAG在3组间的差异;计算并对比分析TAG、CCTA和TAG+CCTA诊断钙化斑块处狭窄程度的灵敏度、特异度、阳性预测值、阴性预测值和ROC曲线下面积。结果：轻度组85支,中度组40支,重度组14支。3组的TAG分别为-14.400±7.024、-27.307±6.222和-37.325±11.187,3组间有显著性差异（P<0.001）。判断中度及以上狭窄时,TAG的灵敏度和特异度为94.44%和81.03%,TAG、CCTA和TAG+CCTA的ROC曲线下面积分别为0.930、0.579和0.934,其中TAG与CCTA (P<...     

关于糖尿病病人冠状动脉斑块体积和肥胖的因素:64层CT冠状动脉血管成像研究

正摘要目的确定在无症状型糖尿病病人中CT冠状动脉血管成像所测冠状动脉斑块与病人临床指标及心血管风险因素之间的关系。材料与方法检查前所有病人均签署机构     

CCTA的血管及斑块特征对缺血性狭窄的预测价值

目的 探析心脏冠状动脉血管成像(Cardiac coronary angiography, CCTA)的血管及斑块特征对缺血性狭窄的预测价值。方法 选择2021年1月-2022年1月行CCTA检查的110例疑似冠心病患者。根据血流储备分数(FFR)分为缺血组(≤0.80)53例和非缺血组(>0.80)57例。所有患者均行CCTA检查,对比两组患者CCTA血管及斑块特征,采用logistic回归模型分析缺血性狭窄中CCTA特征预测独立因素。绘制受试者工作特征曲线(ROC)评估CCTA血管及斑块特征预测缺血性狭窄的价值。结果 缺血组与非缺血组患者在狭窄程度、病变受累血管、斑块长度、弥漫病变支数、重构指数特征对比,差异具有统计学意义(P<0.05);其余血管及斑块特征指标[包括病变部位支数、斑块体积、负荷、钙化斑块体积(CPV)、纤维斑块体积(FPV)及低密度斑块体积)]两组对比差异无统计学意义(P>0.05)。logistic回归模型结果显示,狭窄程度(OR=0.689)、弥漫病变(OR=0.325)、病变受累血管特征(OR=0.511)均为缺血性狭窄独立影响因素(P&l...     

利用CT评估伴和不伴糖尿病病人的冠状动脉疾病和冠状动脉钙化斑块负荷

目的使用CT冠状动脉血管成像(CTCA)比较伴和不伴2型糖尿病病人的冠状动脉粥样硬化负荷。方法与材料无冠状动脉疾病(CAD)史的147例糖尿病病人[平均年龄(65±10)岁;男89例]和979例非糖尿病病人[平均年龄(61±13)岁;男567例]行CTCA检查。测定了每例病人的冠状动脉     

不同胸痛类型冠状动脉粥样硬化性心脏病：基于冠状动脉CTA的对比分析

【摘要】目的：利用CTA技术探讨不同胸痛性质患者冠状动脉钙化积分及冠状动脉粥样硬化斑块及冠心病出现概率的差异性。方法：将3001例门诊疑诊冠心病并行冠状动脉CT血管成像（CCTA）检查的胸痛患者纳入分析,搜集患者的一般信息及传统冠心病相关危险因素。其中,415例（13.8%）有典型心绞痛（A组）,840例（28.0%）有不典型心绞痛者（B组）,1746例（58.2%）有非心绞痛性胸痛（C组）。分析和比较3组患者在冠脉钙化积分（CACS）、冠状动脉粥样硬化斑块情况及冠心病等方面的差异。结果：A组中CACS中位数为0分（上、下四分位数为0、49分）,B组中为0分（上、下四分位数为0、33分）,C组中为0分（上、下四分位数为0、23分）,三组间CACS的差异具有统计学意义（H=9.896,P=0.007）。A、B、C组中冠状动脉粥样硬化斑块的出现率依次为49.6%（206/415）、43.7%（367/840）和39.9%（697/1746）,三组间差异具有统计学意义（χ2=13.873,P=0.001）。A、B、C组中冠心病的出现率依次为22.9%（95/415）、18.6%（156/840）和15.5%（270/1746）,三组间差异具有统计学意义（χ2=14.085,P=0.001）。二元logistic回归分析结果显示典型心绞痛为冠状动脉粥样硬化斑块（OR=1.530,95%CI：1.207~1.940,P<0.001）及冠心病（OR=1.762,95%CI：1.328~2.338,P<0.001）的独立危险因素。结论：典型心绞痛为冠状动脉CTA显示的冠状动脉粥样硬化斑块及冠心病的独立危险因素。     

Iterative model reconstruction reduces calcified plaque volume in coronary CT angiography

ObjectiveTo assess the impact of iterative model reconstruction (IMR) on calcified plaque quantification as compared to filtered back projection reconstruction (FBP) and hybrid iterative reconstruction (HIR) in coronary computed tomography angiography (CTA).MethodsRaw image data of 52 patients who underwent 256-slice CTA were reconstructed with IMR, HIR and FBP. We evaluated qualitative, quantitative image quality parameters and quantified calcified and partially calcified plaque volumes using automated software.ResultsOverall qualitative image quality significantly improved with HIR as compared to FBP, and further improved with IMR (p < 0.01 all). Contrast-to-noise ratios were improved with IMR, compared to HIR and FBP (51.0 [43.5–59.9], 20.3 [16.2–25.9] and 14.0 [11.2–17.7], respectively, all p < 0.01) Overall plaque volumes were lowest with IMR and highest with FBP (121.7 [79.3–168.4], 138.7 [90.6–191.7], 147.0 [100.7–183.6]). Similarly, calcified volumes (>130 HU) were decreased with IMR as compared to HIR and FBP (105.9 [62.1–144.6], 110.2 [63.8–166.6], 115.9 [81.7–164.2], respectively, p < 0.05 all). High-attenuation non-calcified volumes (90–129 HU) yielded similar values with FBP and HIR (p = 0.81), however it was lower with IMR (p < 0.05 both). Intermediate- (30–89 HU) and low-attenuation (<30 HU) non-calcified volumes showed no significant difference (p = 0.22 and p = 0.67, respectively).ConclusionsIMR improves image quality of coronary CTA and decreases calcified plaque volumes.     

Coronary 64-slice CT angiography predicts outcome in patients with known or suspected coronary artery disease

The aim of this study was to assess the prognostic value of 64-slice CT angiography (CTA) in patients with known or suspected coronary artery disease (CAD). Sixty-four-slice coronary CTA was performed in 220 patients [mean age 63 ± 11 years, 77 (35%) female] with known or suspected CAD. CTA images were analyzed with regard to the presence and number of coronary lesions. Patients were followed-up for the occurrence of the following clinical endpoints: death, nonfatal myocardial infarction, unstable angina, and coronary revascularization. During a mean follow-up of 14 ± 4 months, 59 patients (27%) reached at least one of the predefined clinical endpoints. Patients with abnormal coronary arteries on CTA (i.e., presence of coronary plaques) had a 1st-year event rate of 34%, whereas in patients with normal coronary arteries no events occurred (event rate, 0%, p < 0.001). Similarly, obstructive lesions (≥50% luminal narrowing) on CTA were associated with a high first-year event rate (59%) compared to patients without stenoses (3%, p < 0.001). The presence of obstructive lesions was a significant independent predictor of an adverse cardiac outcome. Sixty-four-slice CTA predicts cardiac events in patients with known or suspected CAD. Conversely, patients with normal coronary arteries on CTA have an excellent mid-term prognosis.     

Role of 320-slice multislice computed tomography coronary angiography in the assessment of coronary artery stenosis

Objective

To evaluate the effectiveness of the multislice CT coronary angiography, as a non-invasive imaging tool in assessment of coronary artery stenosis.

Patients and methods

The study included 50 patients who were referred for MSCT coronary angiography followed by catheter coronary angiography. Patients with previous coronary bypass grafts and those with coronary stents were excluded. History of contrast allergy, renal impairment and severe chest conditions were exclusion criteria. The coronary angiographic CT studies were performed using a 320 CT scanner. The catheter coronary angiographic studies were performed via femoral arterial puncture. The results of CT angiography were compared with the gold standard catheter angiography.

Results

The positive predictive value and negative predictive value of MSCT coronary angiography in detection of coronary artery stenosis were 94% and 100%, respectively.

Conclusion

In conclusion, MSCT coronary angiography is a very helpful and rapid non-invasive coronary imaging modality that was able to detect and grade coronary artery stenosis better than other noninvasive examinations used to detect CAD, such as exercise stress testing. Due to its very high negative predictive value, it may eliminate the need for invasive coronary procedures in the presence of normal coronary imaging.     

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。     

双源CT诊断冠脉狭窄的价值—与冠状动脉造影对照分析

目的:探讨双源CT冠脉成像评价冠脉中度及中度以上狭窄的准确性及可行性。方法:入选60例临床高度怀疑或已确诊冠脉疾病的患者,行双源CT扫描,扫描过程中患者心率平稳,未出现心率不齐及心律失常。患者于1周内行经皮选择性冠状动脉造影,并以冠状动脉造影作为标准,从冠脉节段及冠脉分支角度分别评价双源CT诊断冠脉中度及中度以上狭窄的准确性、敏感性、特异性、阳性预测率及阴性预测率。结果:以冠脉节段为基础分析,双源CT诊断冠脉明显狭窄的敏感性、特异性、阳性预测率、阴性预测率、准确性分别为81.14%、97.57%、85.34%、96.74%、95.13%;以冠脉分支为基础分析,双源CT诊断冠脉明显狭窄的敏感性、特异性、阳性预测率、阴性预测率、准确性分别为84.21%、93.79%、89.88%、90.06%、90.0%。双源CT与选择性冠脉造影对发现冠脉狭窄节段及检查冠脉分支病变的能力进行卡方检验,χ2分别0.625、1.041;P0.05,双源CT与选择性冠脉造影比较在发现冠脉明显狭窄差异上无统计学意义。结论:双源CT在诊断冠脉明显狭窄时有很高的准确性,可作为无创性评价冠脉狭窄及疾病的手段。     

16层螺旋CT冠状动脉血管成像和传统冠状动脉血管造影的对比研究

目的评估16层螺旋CT血管成像（CTA）判断冠状动脉血液动力学相关性狭窄（≥50％）的价值。方法对同时接受16层CT冠状动脉成像和传统冠状动脉血管造影检查的26例患者进行回顾性分析。扫描时采用16排探测器，机架转速为2周／s，使用后心电门控进行横断面影像重建，结合三维重建影像评估冠状动脉狭窄程度。结果以冠状动脉血管造影为金标准，冠状动脉CTA影像判断血液动力学相关性冠状动脉狭窄（≥150％）的敏感度为90．0％，特异度为95．5％，准确度为94．7％，阳性预测值为77．6％，阴性预测值为98．2％。结论16层CTA判断冠状动脉血液动力学相关性狭窄（≥150％）有较高的临床诊断价值，对临床冠心病的诊断有较大指导意义。     

Prevalence and morphology of coronary artery ectasia with dual-source CT coronary angiography

To assess the prevalence and morphological characteristics of coronary artery ectasia (CAE) with CT coronary angiography (CTCA) in comparison to conventional catheterangiography (CCA). Dual-source CTCA examinations from 677 consecutive patients (223 women; median age 57 years) were retrospectively evaluated by two blinded observers for the presence of CAE defined as a diameter enlargement ≥1.5 times the diameter of adjacent normal coronary segments. Vessel diameters and contrast attenuation within and proximal to ectatic segments were measured. CCA was used to compare measurements obtained from CTCA with the coronary flow velocity by using the thrombolysis in myocardial infarction (TIMI) frame count. CTCA identified CAE in 20 of 677 (3%) patients. CCA was performed in ten of these patients. CAE diameter measurements with CTCA (10.0 ± 5.4 mm) correlated significantly (r = 0.92, p < 0.001) with the CCA measurements (8.8 ± 4.9 mm), but had higher diameters (levels of agreement: −1.0 to 3.4 mm). Contrast attenuation was significantly lower in the ectatic (343 ± 63 HU) than in the proximal (394 ± 60 HU) segments (p < 0.01). The attenuation difference significantly correlated with the CAE ratio (r = 0.67, p < 0.01) and the TIMI frame count (r = 0.58, p < 0.05). The prevalence of CAE in a population examined by CTCA is around 3%. Contrast attenuation measurements with CTCA correlate well with the flow alterations assessed with CCA.     

Image quality and artifacts in coronary CT angiography with dual-source CT: Initial clinical experience

Introduction

We aimed to characterize artifacts observed in a routine clinical coronary CT angiography (CCTA) performed by a dual-source CT (DSCT) scanner (Definition; Siemens Medical Solutions).

Methods

Studies of 167 consecutive patients referred for CCTA, performed after β-blockade (if not contraindicated), were prospectively analyzed for artifacts with a predefined visual approach. American Heart Association coronary segments (n = 2589) were assessed in 40%-80% R-R interval phases by 2 experts for stenosis, plaque presence or composition, and presence or type of artifacts. Each segment was considered evaluable when image quality was diagnostic in at least one cardiac phase. Artifacts included motion (cardiac, respiratory, patient), phase misregistration because of varying heart beats, calcified plaque blooming or beam hardening, metal beam hardening, large patient size, and contrast timing error.

Results

Maximum HR (HR) during CCTA ranged from 45 to 120 beats/min (66.4 ± 14.8 beats/min). Artifacts of some type were observed in 69 (41.3%) of 167 studies. Calcified plaque was the most common source of artifacts (14.4%), followed by misregistration (13.8%). Only 25 (1%) of 2589 coronary segments, in 6 (4%) of 167 patients were unevaluable, primarily because of calcified plaque blooming (coronary calcium score [CCS], 1112 ± 1255]. Artifacts were associated with CCS (P = 0.002), change in HR (P = 0.01), age (P = 0.03), and body mass index (P = 0.048). The optimal phase for evaluation of all coronary arteries was 70% (mid-diastole), with a shift toward the systolic phases for HR > 70 beats/min.

Conclusion

CCTA artifacts with DSCT were related primarily to calcified plaque and cardiac phase misregistration. When correctly recognized, the artifacts did not have a serious effect on the final interpretation.     

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。