冠状动脉双源CT成像及造影在冠脉粥样硬化性狭窄诊断中的对比

目的探讨冠状动脉双源CT成像及造影在冠脉粥样硬化性狭窄诊断中的对比应用效果。方法选取我院收治的冠脉粥样硬化性狭窄患者120例,随机分成观察组和对照组,每组60例,观察组采用冠状动脉双源CT增强扫描,对照组采用冠状动脉造影,比较分析两组的检查情况。结果观察组诊断正确率为93.33%,对照组诊断正确率为86.67%,观察组明显高于对照组,两组患者在诊断正确率方面相比,差异具有统计学意义(P0.05)。结论冠状动脉双源CT成像诊断检出率高,是冠心病检查的首选方式。     

双源CT冠状动脉成像的护理

目的：探讨冠心病患者行双源CT冠状动脉筛查过程中的护理问题。方法：对1 145例行双源CT冠状动脉成像检查患者的相关资料进行回顾性分析。结果：1 145例患者无1例推注造影剂过程中出现渗漏。检查后进行图象处理后,达到优良诊断标准的为1 078例,优良率达到94.15%。结论：细致、科学有效地做好护理工作是协助医师顺利完成双源CT冠状动脉筛查的重要保障。     

Flash双源CT冠状动脉成像与DSA的对比分析

目的探讨双源CT冠状动脉成像(dual source computed tomography coronary angiography,DSCTA)与冠状动脉数字减影(digital subtraction arteriography,DSA)诊断冠状动脉疾病的效果。方法对44例临床怀疑冠心病而行CT冠状动脉检查的患者采用Flash双源CT冠状动脉成像检查,并以DSA为金标准进行对比分析。结果本组患者均顺利完成DSCTA,均可见完整清晰的显影血管,共计检查了524段动脉节段,MSCTA检查发现无狭窄420段,轻度狭窄20段,中度狭窄28段,重度狭窄56段。经冠状动脉造影检查确诊冠心病阳性28例,阴性16例;双源CT冠脉成像诊断44例患者中真阳性27例,3例假阳性,13例真阴性,1例假阴性。经分析,DSCTA诊断符合率为90.91%,敏感性为96.43%、特异性为81.25%。与金标准DSA的检查结果进行对比分析发现,DSCTA诊断冠状动脉狭窄的一致性较好,kappa值为0.87。结论双源CT冠状动脉成像技术可作为冠心病患者筛查手段或低危冠心病患者的复查检查手段,具有可靠、简便、准确、快捷的优点。     

320排CT冠状动脉成像在心律不齐患者中的应用价值分析

目的 探讨320排640层CT冠状动脉成像在心律不齐患者诊断中的应用价值。方法 选取我院诊治的697例心律不齐冠状动脉病变患者的临床资料,按入院顺序随机分为观察组345例、对照组352例,对照组采用冠状动脉CT血管造影检查,观察组行320排640层CT冠状动脉成像检查,两组均以冠状动脉血管造影检查结果为标准,评估320排640层CT冠状动脉成像、冠状动脉CT血管造影对心律不齐患者冠状动脉病变程度的诊断效能,并比较两组图像质量、CT值、噪声、CT辐射剂量。结果 观察组诊断冠状动脉狭窄程度的总体符合率为98.26%(339/345),显著高于对照组诊断的符合率为94.89%(334/352),差异有统计学意义(χ²=5.967,P<0.05),观察组图像质量明显高于对照组,差异有统计学意义(P<0.05),观察组CT值较对照组明显高,而噪声及CT辐射剂量明显低于对照组(P<0.05)。结论 320排640层CT冠状动脉成像在心律不齐患者冠状动脉病变程度评估中有较高诊断效能,同时其有成像质量高、噪声小及辐射少的优势,可作为心律不齐患者冠状动脉病变评估的...     

双源CT冠状动脉成像在飞行人员冠心病诊断中的价值

目的 探讨双源CT冠状动脉成像在飞行人员冠心病诊断中的临床应用价值.方法对10名临床怀疑冠心病的飞行人员患者行双源CT冠状动脉成像（computed tomography coronary angiography,CTCA）检查和常规X线冠状动脉血管造影（conventional coronary angiography,CCA）检查,以CCA为金标准比较分析CTCA诊断冠状动脉狭窄的敏感性、特异性及准确性.结果 10例飞行人员患者均成功完成了双源CTCA与CCA 检查,双源CTCA图像优良率为96.3%.CTCA发现不同程度冠状动脉狭窄和斑块形成7例,其中2例同时存在前降支心肌桥;冠状动脉-肺动脉瘘1例;冠状动脉正常2例.7例患者的CTCA图像上15个冠状动脉节段有不同程度狭窄,以CCA为金标准,双源CTCA诊断冠状动脉有狭窄的敏感性、特异性及准确率分别为100.0%、98.2%、98.4%;诊断冠状动脉中度及中度以上狭窄的敏感性、特异性及准确率分别为80.0%、99.2%、98.4%.双源CTCA与CCA显示冠状动脉节段病变的能力无统计学差异（χ2=0.50,P=0.4795）.结论 双源CTCA作为一种无创检查方法,能够准确地评估飞行人员冠状动脉狭窄程度和冠状动脉管壁斑块情况,并能显示冠状动脉先天变异等,对于安全可靠地诊断飞行人员冠心病具有较高的应用价值.     

双源CT冠状动脉成像在心律失常患者中的初步应用

目的 探讨双源CT冠状动脉成像在心律失常患者中诊断冠状动脉明显狭窄的可行性及准确性.方法 连续选取60例临床高度怀疑或已确诊冠心病的患者,且行双源CT扫描过程中,出现心率变异过大(心率>14次/min)或心律失常,其中30例入院患者在2~3周内行选择性冠状动脉造影检查.以选择性冠状动脉造影为标准,从冠状动脉节段及冠状动脉分支2个角度分别评价双源CT在诊断冠状动脉明显狭窄中的敏感性、特异性、准确性、阳性预测值及阴性预测值.结果 60例出现心电信号异常患者中,心率55~269次/min,平均心率(92.8±31.9)次/min.编辑前图像质量总评分为2.26±1.03,编辑后图像质量总评分为3.50±0.61.其中30例行选择性冠状动脉造影的患者中,以冠状动脉节段为基础双源CT诊断冠状动脉明显狭窄的敏感性、特异性、阳性预测率、阴性预测率、准确性为64.0%、97.14%、76.19%、94.97%、93.0%.以冠状动脉分支为基础双源CT诊断冠状动脉明显狭窄的敏感性、特异性、阳性预测率、阴性预测率、准确性为73.81%、89.61%、79.48%、86.25%、84.03%.经χ2 检验,χ2 值分别为1.75、0.21,P值均＞0.05,双源CT与选择性冠状动脉造影比较,不管从冠状动脉节段角度还是从冠状动脉分支角度分析,两者在诊断冠状动脉明显狭窄时没有统计学意义.结论 双源CT冠状动脉成像在心律失常患者的应用是可行的,经心电编辑后图像质量明显改善,对于冠状动脉明显狭窄的诊断有较高的准确性.     

家庭协同护理模式对首次行冠脉CTA检查的老年患者负性情绪及检查结局的影响

【摘要】 目的 探讨家庭协同护理模式对首次行冠状动脉CT血管成像（CCTA）检查的老年患者负性情绪及检查结局的影响。 方法 采用便利抽样的方法,选取郑州市某三级甲等综合医院首次行CCTA检查的老年患者238例,2018年8至9月行CCTA检查的老年患者125例作为对照组,2018年10至11月行检查的老年患者113例作为干预组,对照组采用常规的护理和健康教育,干预组在常规护理的基础上采用家庭协同护理模式的健康教育,比较两组患者干预前和干预后焦虑、抑郁负性情绪、CCTA检查知识及一次性检查成功率的差异。结果 两组患者干预后焦虑、抑郁均低于健康教育前,干预组低于对照组,差异具有统计学意义（P＜0.05）;干预组检查知识、一次性检查成功率均高于对照组,差异具有统计学意义（P＜0.05）。结论 运用家庭协同护理模式进行健康教育,能显著降低老年冠状动脉CT血管成像检查患者的负性情绪,增强老年冠状动脉CT血管成像的检查知识,提高一次性检查成功率。     

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.     

老年人64层螺旋CT冠状动脉成像的临床技术特点及应用

目的探讨老年人64层螺旋CT冠状动脉成像的技术特点及临床应用价值。方法对257例老年冠状动脉疾病患者行64层螺旋CT冠状动脉造影检查,针对老年患者的特点选用适合的检查技术,并评价所获得的图像质量;将患者按照年龄分组,分为65～74岁、75～84岁、≥85岁三组,分别统计各组CT冠状动脉成像的成功率并总结成像技术特点。结果 257例老年患者的2150段冠脉血管中,2041段冠状动脉血管(94.93%)图像质量可以满足影像学诊断。经统计学方法处理,表明在不同年龄组的老年患者中,冠状动脉成像显示成功率无显著性差异。结论 64层螺旋CT对老年人冠状动脉成像有很好的显示成功率,可作为老年人冠状动脉病变的一种有效筛选方法;在对老年人行CT冠状动脉成像检查时,根据老年人的特点适当的运用成像技术会获得良好的效果。     

自动追踪冻结联合智能边缘修复技术在宝石能谱CT冠状动脉成像诊断心肌桥中的应用价值

目的 探究自动追踪冻结(SSF)联合智能边缘修复(IBR)技术在宝石能谱CT冠状动脉成像诊断心肌桥(MB)中的应用价值.方法 选取本院2017年1月～2019年12月期间178例疑似冠心病患者行宝石能谱CT冠状动脉检查图像及临床资料进行分析,其中诊断MB患者57例.根据SSF和IBR技术重建图像,并由经验丰富的CT诊断...     

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。     

MSCT冠状动脉造影的临床应用

目的: 评价多层螺旋CT(MSCT)冠状动脉造影效果及其诊断冠状动脉狭窄的价值.材料和方法:65例临床疑诊冠心病患者作MSCT扫描,所有数据获得在一次屏气中完成.利用心电门控技术,将所得原始图像进行重建,分别对左主干(LMA)、左前降支(LAD)、回旋支(LCA)和右冠状动脉(RCA)及其分支的重建图像进行影像学评价;其中45例同时作常规冠状动脉造影(CAG),以造影结果为金指标,将两种方法所得结果进行对比,了解MSCT冠状动脉造影诊断冠脉狭窄的敏感性和特异性.结果:MSCT冠脉钙化积分诊断冠心病的敏感性79.6%,特异性84.9%;65例共260支血管经MSCT成像,228支(87.7%)可用于影像学评价;各节段冠状动脉重建图像,左主干和前降支近中段显示率最高;CAG发现狭窄49支, MSCT发现狭窄44支.MSCT对冠状动脉狭窄诊断的敏感性83.7%,特异性97.7%.结论: 在控制心率的情况下,MSCT冠状动脉造影可作为诊断冠状动脉狭窄的一种无创筛选检查方法.     

High-resolution selective three-dimensional magnetic resonance coronary angiography with navigator-echo technique: segment-by-segment evaluation of coronary artery stenosis

PURPOSE: To investigate the feasibility of high-resolution selective three-dimensional (3D) magnetic resonance coronary angiography (MRCA) in the evaluation of coronary artery stenoses. MATERIALS AND METHODS: In 12 patients with coronary artery stenoses, MRCA of the coronary artery groups, including the coronary segments with stenoses of 50% or greater based on conventional x-ray coronary angiography (CAG), was performed with double-oblique imaging planes by orienting the 3D slab along the major axis of each right coronary artery-left circumflex artery (RCA-LCX) group and each left main trunk-left anterior descending artery (LMT-LAD) group. Ten RCA-LCX and five LMT-LAD MR angiograms were obtained, and the results were compared with those of conventional x-ray angiography. RESULTS: Among 70 coronary artery segments expected to be covered, a total of 49 (70%) segments were fully demonstrated in diagnostic quality. The identification of segmental location of stenoses showed as high an accuracy as 96%. The retrospective analysis for stenosis of 50% or greater yielded the sensitivity, specificity, and accuracy of 80%, 85%, and 84%, respectively. CONCLUSION: Selective 3D MRCA has the potential for segment-by-segment evaluation of major portions of the right and left coronary arteries with high accuracy.     

Diagnostic accuracy of 16-row multislice CT angiography in the evaluation of coronary segments

PURPOSE: To evaluate the diagnostic accuracy of 16-row multislice spiral computed tomography coronary angiography (16-MSCT-CA) for the non-invasive assessment of significant coronary artery stenosis. MATERIALS AND METHODS: We enrolled 40 patients (36 male, aged 59+/-11 yrs) with suspected obstructive coronary artery disease and a heart rate <65 bpm during the scan. The 16-MSCT-CA (Sensation 16, Siemens, Forchheim, Germany) was performed with electrocardiographically-gated technique after the intravenous administration of 100 ml of iodinated contrast material followed by a saline bolus chaser. The scan parameters were: collimation 16 x 0.75 mm, rotation time 0.42 s, feed/rot. 3 mm (pitch 0.25), 120 kVp, 500 mAs. All coronary segments = or >2 mm in diameter were evaluated by two independent observers for the presence of significant coronary artery stenosis (= or >50%). Consensus reading was compared to quantitative coronary angiography. RESULTS: The average heart rate was 55+/-6 bpm. Of the 428 segments of = or >2.0 mm diameter 92 were significantly diseased. Without exclusion of any branches (428), the sensitivity, specificity, positive, and negative predictive values to identify = or >50% obstructed segments were 95.7% (88/92), 95.8% (322/336), 86.3% (88/102), and 98.8% (322/326), respectively. No occluded left main, left anterior descending, circumflex or right coronary artery segments remained undetected. CONCLUSIONS: 16-MSCT-CA in a selected low-heart-rate patient population provides high diagnostic accuracy in the evaluation of significant coronary artery stenosis.     

16-MDCT coronary angiography versus invasive coronary angiography in acute chest pain syndrome: a blinded prospective study

OBJECTIVE: The purpose of our study was to prospectively evaluate the usefulness of CT coronary angiography versus invasive coronary angiography for the detection of clinically significant coronary artery disease in patients hospitalized for acute chest pain syndrome. SUBJECTS AND METHODS: Sixty-six consecutive patients (52 men and 14 women; average age, 57 +/- 11 [SD] years) who were hospitalized for acute chest pain syndrome underwent CT coronary angiography and invasive coronary angiography within an average time interval of 4 days. ECG-gated CT coronary angiography was performed with a 16-MDCT scanner (0.42-sec rotation time, 16 x 0.75 mm detector collimation). Beta-blockers were not administered routinely, and thus the average heart rate was 71 +/- 11 beats per minute. CT coronary angiographic images were evaluated concurrently by two radiologists, who were blinded to invasive coronary angiography results, for stenoses having a diameter of 50% or more, using a 15-segment classification, including all segments 2 mm or more in diameter. The consensus interpretation was compared with results of invasive coronary angiography. RESULTS: CT coronary angiography was technically successful in 59 patients (89%). After exclusion of 20 (3.1%) of 649 coronary segments, which were classified as nonevaluable by CT coronary angiography, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT coronary angiography for identifying significant coronary artery disease in the remaining 629 coronary segments were 80% (68/85), 89% (482/544), 52% (68/130), 97% (482/499), and 87% (550/629), respectively. The overall accuracy for the main vessels (left main, left anterior descending, left circumflex, and right coronary arteries) was 93%, 88%, 86%, and 86%, respectively. CONCLUSION: CT coronary angiography using a 16-MDCT scanner enables accurate noninvasive detection of significant coronary artery disease in patients hospitalized for acute chest pain syndrome. Furthermore, relative high sensitivity and specificity of CT coronary angiography can be achieved without pharmacologic manipulation of patient heart rates.     

冠心病患者冠状动脉侧支循环形成的形态学特点分析

目的:分析国人冠状动脉侧支循环的形态学特点。方法:将265例冠心病病人的冠状动脉造影结果进行分析,按Levin的方法进行分类,并与之比较。结果:不同狭窄程度两组间侧支循环开放率差别有高度统计学意义(X2=14.43,P<0.001)。三支血管间侧支循环开放率差别均有统计学意义(X2=3.96,X2=4.28,P<0.05)。东、西方组冠状动脉各支病变的侧支分布的比较差别有高度统计学意义(右冠状动脉X2=9.68,P<0.01;左冠状动脉X2=41.73,P<0.001;左冠状动脉旋支X2=8.54,P<0.01。结论:冠状动脉侧支循环的形成与冠状动脉狭窄程度及病变血管有关。中国人的冠状动脉侧支循环具有独特性。     

冠状动脉造影及支架置入术在冠心病诊断与治疗的临床应用

目的　评价冠状动脉造影及支架置入术在冠心病诊断与治疗的临床应用价值。方法　对 40例 47支冠状动脉病变内置入 5 6只支架 ,其中置入前降支 2 9只 ,右冠状动脉 1 8只 ,左回旋支 9只。结果　 40例全部置入成功 ,置入后经冠状动脉造影证实狭窄消失 ,即刻效果良好 ,由术前狭窄 ( 88.9± 8.1 ) %减至术后残余狭窄 ( 5 .6± 5 .1 ) %,支架置入成功率 1 0 0 %。术后低血压反应 2例 ,血肿 3例。结论　冠状动脉造影及支架置入术是冠心病诊断与治疗的一种安全可靠、效果良好的介入性诊断治疗方法 ,值得临床广泛应用。     

16层螺旋CT冠状动脉血管成像技术临床应用

目的:探讨16层螺旋CT冠状动脉成像技术临床应用价值。方法:对45例临床诊断或可疑冠心病的住院患者行16层螺旋CT冠状动脉回顾性心电门控平扫及增强扫描。将增强扫描图像传送到Wizard图像工作站进行最大密度投影(MIP)、多平面重组(MPR)、曲面重组(CPR)、容积再现技术(VRT)及平带多平面重组(RMPR)。并将VRT及MIP重组像为参照,用平扫图像对冠状动脉各支段进行钙化积分。结果:左冠状动脉主干(LM)、左前降支近中段(LAD1、LAD2)、第一对角支(D1)、左回旋支(LCX)及右冠状动脉近段(RCA1)显示均45例(100%),左前降支远段(LAD3)23例(51%),第二对角支(D2)30例(67%),第三对角支(D3)24例(53%),第一左缘支(M1)36例(80%),第二缘支(M2)28例(62%),右冠状动脉中段(RCA2)41例(91%),右冠状动脉远段(RCA3)43例(96%)及后降支(PDA)34例(76%)。左冠状动脉主干钙化12例(27%),左前降支近中段钙化有29例(64%),左回旋支钙化例数22例(49%),右冠状动脉近中段钙化有24例(53%)。结论:16层螺旋CT可对冠状动脉进行钙化积分并准确显影,是冠状动脉粥样硬化疾病筛选和诊断的首选方法。     

Intraindividual comparison of contrast-enhanced electron-beam computed tomography and navigator-echo-based magnetic resonance imaging for noninvasive coronary artery angiography

The aim of this study was to compare contrast-enhanced electron-beam computed tomography (EBCT) and navigator-echo-based MRI of the coronary arteries in the same patient population. Both methods were assessed for visualization of the coronary arteries and their diagnostic accuracy in identifying significant coronary artery stenoses compared with conventional coronary angiography. Twenty patients with known coronary artery disease were examined with both contrast-enhanced EBCT and a respiratory-gated MRI sequence. A grading system was used to evaluate the image quality. Sensitivity and specificity for the detection of significant coronary artery stenoses was evaluated compared with conventional coronary angiography. With EBCT, 89% of the main coronary arteries could be completely visualised in the proximal and middle segments; with MRI, 83% were visualised. With EBCT the sensitivities for identifying significant (>/=50%) stenoses in proximal and middle vessel segments were 75% in the main stem, 88% in the left anterior descending coronary artery, 75% in the left circumflex coronary artery, and 90% in the right coronary artery. Respective sensitivities for MRI angiograms were 75, 82, 75 and 80%. With both modalities a sufficient image quality of the main coronary arteries can be obtained in most cases. The diagnostic capability for detecting significant stenoses is comparable for both methods.     

成人先天性冠状动脉畸形的分类及其发生率

目的 探讨成人冠状动脉(冠脉)造影人群先天性冠脉畸形(CCA)的类型及其发生率.方法 2000年10月～2006年10月共1 520例成人患者行冠脉造影检查,对检出有CCA患者的影像资料进行回顾性分析,并根据CCA解剖学特征进行分类.结果 1 520例成人患者共检出各类CCA 58例,发生率3.82%.冠脉起源和分布异常26例,发生率1.71%;其中前降支和回旋支分别开口于左冠窦14例,左主干或回旋支起源于右冠窦各1例,右冠脉分别起源于升主动脉4例、左冠窦3例和无冠窦1例,单支左冠脉2例.冠脉终止异常11例,均为冠脉瘘,发生率0.72%.冠脉结构异常21例,发生率1.38%,其中心肌桥18例,回旋支发育不良2例,窦房结动脉起源于左室后支1例.本组病例未发现有冠脉间异常交通者.结论 冠脉造影是诊断成人CCA的主要方法之一,按解剖学特征进行分类有助于阐明CCA类型及其发生率.