64层CT冠状动脉成像技术和冠状动脉造影对冠状动脉疾病诊断的对照研究

目的比较64层计算机断层摄影扫描冠状动脉成像技术(64-slice computed tomography coronaryangiography,64-SCTCA)和冠状动脉造影(coronary artery angiography,CAG)在冠状动脉粥样硬化性心脏病(冠心病)诊断中的价值。方法回顾性分析126例疑似冠心病的患者64-SCTCA和CAG检查资料,并对两组资料进行对比分析。结果 64-SCTCA和CAG检查结果中可用于评价的病变血管段支数比较,差异无统计学意义(P0.05)。CAG共发现≥50%狭窄节段242个,64-SCTCA共发现≥50%狭窄节段199个,两种检查方法对病变狭窄的显示情况比较,差异无统计学意义(P0.05)。全部126例冠心病患者中有91%通过64-SCTCA发现(110/121)。64-SCTCA诊断冠状动脉病变血管的敏感性、特异性、阳性预测值、阴性预测值分别为81.6%、98.8%、79.5%、99%。结论 64-SCTCA可作为冠心病无创、便捷、可靠的检查方法。     

冠状动脉CT造影评估冠状动脉钙化进展及临床意义

冠状动脉粥样硬化是冠心病的病理学基础,而冠状动脉钙化是粥样硬化病变的重要标志。检测和评估冠状动脉钙化不仅对预测心血管事件有重要意义,还有助于了解疾病进展,从而更好地指导临床诊治。冠状动脉CT造影(CCTA)是对冠状动脉钙化斑块进行精确量化评估的无创检查手段,其对于定量冠状动脉钙化以及预后评估具有重要的临床价值。本文对冠状动脉钙化CCTA检测方法及其临床应用等进行综述。     

Coronary angiography by computed tomography: coronary imaging evolves

Rapid technological advances have facilitated high-resolution noninvasive coronary angiography using multislice computed tomography. Appropriateness guidelines recently have been published in the Journal of the American College of Cardiology and endorsed by several imaging specialty societies. Clinical studies are now available supporting the use of this method in selected diagnostic situations, particularly when the exclusion of coronary artery disease is of paramount clinical concern.     

64层螺旋CT与冠状动脉造影诊断冠状动脉狭窄的对比研究

目的评价64层螺旋CT冠状动脉成像(64-slice spiral computed tomographic coronary angiography,64-SCTCA)对冠状动脉各节段狭窄病变的诊断价值。方法85例疑诊为冠状动脉性心脏病(冠心病)患者,先后行64-SCTCA和冠状动脉造影(coronary angiography,CAG)检查,评价64-SCTCA诊断冠状动脉各节段狭窄病变的敏感性、特异性、阳性预测值、阴性预测值和准确性。结果①在CAG可清晰显影的744个节段中,64-SCTCA造影可清晰显示和评价的占639段(85.89%),另外105段(14.11%)显影不清。左主干和前降支可评价节段的比例显著高于左回旋支和右冠状动脉(P0.001),同一支血管中近段可评价的比例显著高于远段(P0.001);②64-SCTCA诊断冠心病的敏感度、特异度、准确度、阳性和阴性预测值分别为96.23%、90.63%、94.44%、93.55%、94.12%。按可评价节段计算,64-SCTCA诊断冠状动脉各节段有意义狭窄病变总的敏感性、特异性、准确性、阳性和阴性预测值分别为89.06%、95.89%、84.44%、95.33%、94.32%;③按可评价节段计算,64-SCTCA对诊断左主干、左前降支、左回旋支和右冠状动脉各节段病变的价值相似,但检测冠状动脉近中段病变的价值高于远段(χ2=4.66,P=0.03)。结论64-SCTCA对冠状动脉狭窄病变有较好的诊断价值,其检测左主干和左前降支病变的价值高于左回旋支和右冠状动脉,对冠状动脉近段病变的诊断价值高于远段,适合于冠心病的筛查。     

Multislice computed tomography angiography in the diagnosis of coronary artery disease

Multislice CT angiography represents one of the most exciting technological revolutions in cardiac imaging and it has been increasingly used in the diagnosis of coronary artery disease. Rapid improvements in multislice CT scanners over the last decade have allowed this technique to become a potentially effective alternative to invasive coronary angiography in patients with suspected coronary artery disease. High diagnostic value has been achieved with multislice CT angiography with use of 64- and more slice CT scanners. In addition, multislice CT angiography shows accurate detection and analysis of coronary calcium, characterization of coronary plaques, as well as prediction of the disease progression and major cardiac events. Thus, patients can benefit from multislice CT angiography that provides a rapid and accurate diagnosis while avoiding unnecessary invasive coronary angiography procedures. The aim of this article is present an overview of the clinical applications of multislice CT angiography in coronary artery disease with a focus on the diagnostic accuracy of coronary artery disease; prognostic value of coronary artery disease with regard to the prediction of major cardiac events; detection and quantification of coronary calcium and characterization of coronary plaques. Limitations of multislice CT angiography in coronary artery disease are also briefly discussed, and future directions are highlighted.     

Coronary artery aneurysms as seen on multidetector computed Tomography angiography

Coronary artery aneurysms (CAA) are present in 1.4–5.3% of the population (Nichols, Lagana, Parwani. Arch Pathol Lab Med 2008; 132:823–828). While angiography remains the gold standard for evaluating CAAs, multidetector computed tomography angiography (MDCTA) is an emerging way of assessing CAAs (Pahlavan and Niroomand. Clin Cardiol 2006;29:439–443). With the increasing clinical utilization of MDCTA, CAAs are often initially diagnosed using this method. Since MDCTA is used largely in lower risk and asymptomatic patients, understanding the etiology and treatment is paramount for clinicians reading these studies. © 2011 Wiley Periodicals, Inc.     

Electron beam computed tomography: screening for coronary artery disease.

The need to detect coronary atherosclerosis early in its course has been well recognized by clinicians and epidemiologists for decades. The ability to identify populations with a greater prevalence of coronary disease prior to manifestation of illness would greatly reduce cardiac morbidity and mortality. Electron beam computed tomography (EBCT) uniquely combines the characteristics of speed and excellent density resolution that have led to a rebirth of interest in detecting coronary calcium as a means of screening asymptomatic populations for coronary atherosclerosis. Electron beam computed tomography is noninvasive and widely applicable. It can both detect and quantitate the presence of coronary atherosclerosis. A positive test has diagnostic and prognostic significance, predicting future cardiac events and the extent of atherosclerosis, including the probability of obstructive coronary artery disease (CAD). Multiple studies demonstrate a 6- to 35-fold increased risk of developing a cardiac event with elevated calcium scores. A negative test is highly predictive for excluding obstructive CAD. The cost ranges from $300 to $400, similar to that of an exercise treadmill test. Moreover, scanning for coronary calcium does not require injection of contrast medium, requiring no patient preparation or exercise; therefore, a CT technician can perform the study without supervision. The entire procedure takes < 10 min to perform. These features make EBCT a potential screening test for occult CAD in symptomatic and asymptomatic persons.     

Coronary computed tomography angiography in coronary artery disease

AIM: To investigate the research directions of coronary computed tomography (CT) angiography in the diagnosis of coronary artery disease (CAD) based on a systematic review of the literature.METHODS: A search of articles on coronary CT angiography in the diagnosis of CAD was performed during a 6-year-period between 2005 and 2010 from f ive main radiology journals namely, Radiology, American Journal of Roentgenology, European Radiology, European Journal of Radiology and British Journal of Radiology. Analysis of the references was focused on the research directions of coronary CT angiography with regard to the type of studies in terms of diagnostic value, application of dose-reduction strategies and resultant effective radiation doses with use of these techniques.RESULTS: One hundred and forty two studies were identified which met the selection criteria and were included in the analysis. 64-slice CT (single source anddual-source CT) dominated 78% of the coronary CT angiography studies. Prior to 2007, research was focused on the diagnostic value of coronary CT angiography, but since 2008 more attention has been paid to radiation dose reduction. Radiation dose was reported in 64 studies, representing 45% of total studies published in the f ive radiology journals. Various dose-saving strategies have been implemented and prospective electrocardiography-triggering and high pitch techniques were found to be the most effective approaches for radiation dose reduction, with the corresponding mean effective dose being 3.5 ± 1.9 mSv and 1.7 ± 0.6 mSv, respectively.CONCLUSION: This review shows that the current research in coronary CT angiography has shifted from the previous focus on diagnostic accuracy in CAD to more emphasis on radiation dose reduction.     

冠状动脉多层螺旋CT成像及冠脉造影对冠脉搭桥术后桥血管的评价

目的观察冠状动脉多层螺旋CT成像及冠脉造影对冠脉搭桥手术后桥血管的评价作用。方法33例冠脉搭桥手术患者,术前常规冠脉造影检查,手术行不停跳冠脉搭桥术,手术后1 a行冠状动脉多层螺旋CT成像,并于冠状动脉多层螺旋CT成像复查后1周内行冠脉造影检查。结果33例患者共行冠脉搭桥101支,冠状动脉多层螺旋CT成像能够成功显示99支,显示率为98.02%。冠状动脉多层螺旋CT成像与冠脉造影结果对比,其对冠脉搭桥手术后桥血管狭窄和阻塞评价敏感度达100%。结论应用冠状动脉多层螺旋CT成像对冠脉搭桥术后桥血管评价简便、无创,具有较好的可信性和可行性。     

Assessment of coronary artery disease using coronary computed tomography angiography in patients with aortic valve stenosis referred for surgical aortic valve replacement

Background

In patients referred for aortic valve replacement (AVR) a pre-surgical assessment of coronary artery disease is mandatory to determine the possible need for additional coronary artery bypass grafting. The diagnostic accuracy of coronary computed tomography angiography (coronary CTA) was evaluated in patients with aortic valve stenosis referred for surgical AVR.

Methods

Between March 2008 and March 2010 a total of 181 consecutive patients were included. All patients underwent pre-surgical coronary CTA (64- or 320-detector CT scanner) and invasive coronary angiography (ICA). The analyses were performed blinded to each other.

Results

The mean ± SD age of the included patients was 71 ± 9 years and 59% were male. The prevalence of significant coronary artery stenosis > 70% by ICA was 36%. Average heart rate during coronary CTA was 65 ± 16 bpm. In a patient based analysis 94% of the patients (171/181) were considered fully evaluable. Coronary CTA had a sensitivity of 68%, a specificity of 91%, a positive predictive value of 81%, and a negative predictive value of 83%. Advanced age, obstructive lung disease, NYHA function class III/IV, and high Agatston score were found to be significantly associated with disagreement between ICA and coronary CTA in univariate analysis.

Conclusion

In patients with aortic valve stenosis referred for surgical AVR the diagnostic accuracy of coronary CTA to identify significant coronary artery disease is moderate. Coronary CTA may be used successfully in a subset of patients with low age, no chronic obstructive lung disease, NYHA function class < III and low coronary Agatston score.     

64层螺旋CT血管成像与冠状动脉造影对冠心病诊断价值的对比研究

目的评价64层螺旋CT在冠状动脉造影方面的诊断价值。方法58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,分别对左主干、左前降支、回旋支和右冠状动脉及其分支的重建图像行影像学评价,所有患者均行常规选择性冠状动脉造影检查作为对照。结果58例患者共757(87.0%)节段的冠状动脉(血管直径≥1.5 mm)成像,638节段(84.3%)可用于多层螺旋CT和冠状动脉造影定量分析。冠状动脉造影共发现狭窄101节段,多层螺旋CT发现狭窄104节段,多层螺旋CT对冠状动脉狭窄诊断的敏感性为86.1%,特异性为96.8%。结论64层螺旋CT冠状动脉造影可作为诊断冠状动脉病变的一种无创筛选方法。     

冠状动脉计算机断层扫描血管造影双低扫描对冠状动脉狭窄的诊断性能

目的观察分析冠状动脉(冠脉)计算机断层扫描血管造影(CTA)双低扫描对冠脉狭窄的诊断性能。方法选取2017年7月至2018年7月于宝鸡市妇幼保健院经心电图诊断疑似冠脉狭窄的患者94例,分别进行计算机断层扫描血管造影双低扫描检查和数字减影血管造影(DSA)检查,将接受计算机断层扫描血管造影检查的患者纳入观察组(n=114),数字减影血管造影检查的为对照组(n=108)。记录两组患者的诊断结果,分析两组检查方法的灵敏度、特异度、准确度,以及对冠脉狭窄程度的检测结果。结果计算机断层扫描血管造影双低扫描检查的灵敏度为96.67%,特异度为80.00%,准确度95.74%。在对狭窄程度诊断结果的比较中,计算机断层扫描血管造影双低扫描与DSA的诊断结果比较,差异无统计学意义(P>0.05)。结论冠脉计算机断层扫描血管造影双低扫描能够清晰显示冠脉狭窄的部位、程度,准确性较好,且对患者辐射量小,可以应用于对冠脉狭窄的诊断。     

Noninvasive coronary angiography by contrast-enhanced electron beam computed tomography

Electron beam computed tomography (EBCT) is a cross-sectional imaging method with high temporal and spatial resolution. So far, it has mainly been applied for the detection of coronary artery calcifications which permit the very sensitive detection of coronary atherosclerosis even in the very early stages. However, after intravenous injection of a contrast agent, EBCT also permits the direct visualization of the coronary artery lumen. For these investigations, a volume data set is acquired that consists of 40 axial cross-sections of the heart (3 mm slice thickness). To evaluate the coronary arteries as to the presence of stenoses and occlusions, various forms of postprocessing, including shaded surface display, maximum intensity projection, and multiplanar reconstruction, are applied. The sensitivities and specificities for the detection of coronary artery stenoses and occlusions are about 90%. Best results are obtained for coronary artery bypass grafts, the left main coronary artery, and the left anterior descending coronary artery, while reduced image quality impairs the results for the right coronary artery and the left circumflex coronary artery.     

Spiral multislice computed tomography coronary angiography: a current status report

Multislice computed tomography coronary angiography (MSCT-CA) has emerged as a powerful noninvasive diagnostic modality to visualize the coronary arteries and to detect significant coronary stenoses. The latest generation 64-slice computed tomography (CT) scanners is a robust technique which allows high-resolution, isotropic, nearly motion-free coronary imaging. Coronary stenoses are detected with high sensitivity and a normal scan accurately rules out the presence of a coronary stenosis. With the introduction of further novel concepts in CT-technology one may expect that MSCT-CA will become a clinically used diagnostic tool.     

Double right coronary artery detected on coronary computed tomography angiography: A case report

Double right coronary artery is a relatively rare coronary anomaly. In this case report we aim to increase awareness of the importance of recognizing such anomaly and a brief literature review of similar cases and possible high risk features. Computed Tomography is well recognized modality to detect coronary anomaly and in our case we demonstrated this as well.     

老年人多层螺旋CT冠状动脉成像诊断冠状动脉狭窄的研究

目的评价64层螺旋CT冠状动脉成像在诊断老年患者冠状动脉狭窄中的临床应用价值。方法回顾性分析39例患者行64层螺旋CT冠状动脉造影的老年患者(>65岁)的影像资料,在15段分段法的基础上,评价每段冠状动脉CT造影的图像质量;以传统X线冠状动脉造影为“金标准”,评价CT血管造影诊断冠状动脉狭窄及其程度的价值。结果多层螺旋CT冠状动脉造影(MSCTA)评价冠状动脉狭窄的敏感度、特异度、阳性预测值和阴性预测值分别为98.9%(90/91)、98.2%(426/434)、91.8%(90/98)和99.8%(426/427)。冠状动脉MSCTA与传统X线冠状动脉造影(CAG)对血管狭窄程度评价具有很好的一致性。结论多层螺旋CT冠状动脉成像在诊断老年人冠心病中具有重要的临床应用价值。     

糖尿病患者CT冠状动脉造影的诊断价值

目的通过对比观察糖尿病与非糖尿病患者CT冠状动脉造影（CTCA）的特征,探讨CTCA在糖尿病合并冠心病患者中的诊断价值。方法对380例糖尿病患者及481例非糖尿病患者进行CTCA检查,其中111例患者（糖尿病41例,非糖尿病70例）行选择性冠状动脉造影检查,观察CTCA与选择性冠状动脉造影的相关性,并比较糖尿病与非糖尿病患者冠状动脉病变的特征。结果糖尿病与非糖尿病患者中CTCA检查与选择性冠状动脉造影均相关良好,糖尿病患者血管狭窄发病率较非糖尿病患者显著增高（45．8％ vs 24．5％;P〈0．05）,多支病变发病率明显增高（P〈0．05）。结论糖尿病患者冠状动脉病变特征复杂,CTCA在糖尿病患者冠心病的筛查中具有重要意义。     

电子束CT冠状动脉血管成像技术对老年男性冠心病患者的诊断价值

目的 :评价电子束 CT冠状动脉血管成像技术 （EBT）在老年男性冠心病患者的诊断价值。方法 :对 4 8例临床有冠心病症状、可疑冠心病症状或无症状的老年男性 ,进行 EBT及冠脉造影 （CAG）检查 ,以 CAG结果作为“金标准”评价 EBT与冠脉狭窄之间的相关性。结果 :1冠状动脉狭窄组的 EBT阳性率明显高于非狭窄组 （P<0 .0 1） ;两种方法的检测结果并无统计学差异 （P>0 .0 5 ）。 2 EBT诊断冠脉狭窄的灵敏度、特异度、误诊率、漏诊率、准确度、阳性预告值、阴性预告值、阳性似然比及阴性似然比分别为 86 %、6 7%、33%、14 %、83%、95 %、4 0 %、2 .6及 0 .2 1。3EBT阳性与冠脉存在狭窄血管支数之间呈正相关。 4 EBT对于冠脉近段血管狭窄诊断的敏感性、特异性、准确性均较高 ,而对远段血管的诊断则与 CAG相差较大。结论 :1EBT是预测老年冠心病的有价值的检查手段。 2EBT对于冠脉近段病变具体位置的确定有价值。