主动脉缩窄及主动脉弓离断的电子束CT诊断

目的：探讨电子束CT诊断先天性主动脉缩窄和主动脉弓离断的价值。材料和方法：共10例病人，年龄6—18岁，均经手术证实。对所有患儿行EBCT增强扫描，并对图像行三维重建。结果：10例病人术前均得到正确诊断，其中8例为主动脉缩窄，2例为主动脉弓离断。EBCT均显示了全部8例主动脉缩窄及其缩窄的程度、形态，并显示缩窄处与左锁骨下动脉的关系。其中6例（75％）为局限性狭窄，2例（25％）形成中-重度长管状狭窄。合并畸形有：3例合并动脉导管未闭，1例合并室间隔缺损，1例合并肺动脉狭窄，1例合并二尖瓣狭窄，2例同时合并动脉导管未闭和室间隔缺损。2例主动脉弓离断病例，均合并有动脉导管未闭、室间隔缺损和肺动脉狭窄。EBCT均显示升主动脉与降主动脉呈分离状。结论：EBCT作为一种无创性检查方法，对先天性主动脉病变的诊断有重要价值，并能同时显示合并的胸部大血管异常。     

脑血管电子束CT(EBCT)成像技术的初步探讨

探讨合理的脑血管电子束的检查模式，材料与方法，选择７例ＥＢＣＴＡ检查结果正常都胡机分组、对照，进行前瞻性研究，采用ＩｍａｔｒｏｎＣ－１５０ＣＢＣＴ扫描仪，连续容积和步进式两种扫血管部位ＣＴ值要高于相同条件下的ＳＶＳ扫描；同一扫     

Coronary artery calcification is related to coronary atherosclerosis in chronic renal disease patients: a study comparing EBCT-generated coronary artery calcium scores and coronary angiography.

BACKGROUND: Coronary artery calcification (CAC) measured by electron beam computed tomography (EBCT) correlates with plaque burden, vessel stenosis and is predictive of future cardiac events in the general population. Extensive CAC has been described recently in dialysis cohorts. For the first time we studied the relationship between CAC and coronary angiographic findings in patients with chronic renal failure, on dialysis and after renal transplantation. METHODS: We studied 46 patients who all had an EBCT-derived Agatston coronary calcium score and a diagnostic coronary angiogram within a 12-month period. The mean age was 55.7+/-13.2 (SD) years (range 29-80). The mean duration of dialysis was 54.4 months (range 1-372). RESULTS: The mean CAC was 2370+/-352.8. The mean CAC in patients with an abnormal coronary angiogram (n = 35) was 2869.6+/-417.9, while that in patients with a normal coronary angiogram (n = 11) was 559.4+/-255.1 (P = 0.001 for the inter-mean comparison). Total CAC correlated with the number of diseased vessels (P = 0.0001) and with severity of atherosclerosis in all the vessels (P = 0.0001). The individual coronary artery calcification score correlated well with the severity of atherosclerotic coronary disease (P<0.0001 for all) in the left anterior descending, right coronary and circumflex arteries. Running a multivariate regression analysis for atherosclerosis burden, we found that the only predictor was CAC (r = 0.34, P = 0.0001). CONCLUSION: CAC is common and more severe in patients with chronic kidney disease. Although in chronic kidney disease patients CAC can occur in the absence of occlusive coronary atherosclerosis, our data suggest that, as in the general population, CAC in chronic kidney disease patients is associated with obstructive atherosclerosis and may therefore be associated with a worse outcome.     

Coronary dual source multi detector computed tomography in patients suspected of coronary artery disease: Prevalence of incidental extra-cardiac findings

Objectives

(1) To establish the prevalence of incidental extra-cardiac findings (ECFs) in coronary multi detector computed tomography (CCT) performed in a large, homogeneous cohort of patients suspected of coronary artery disease (CAD). (2) To examine whether any association can be established between ECFs and pretest risk as determined by conventional risk factors for CAD, the Diamond-Forrester risk model or coronary artery calcium scores. (3) To assess cost related to extra-cardiac examinations.

Design

Retrospective study of consecutive patients who had CCT performed. A large field of view was recreated from the non-enhanced CT scan and evaluated by a radiologist for incidental ECFs.

Subjects

Patients with chest pain referred to CTA by a cardiologist.

Results

In 1383 patients a total of 481 ECFs were indentified, 378 minor (meaning no follow-up was needed) and 103 major ECFs (ECF followed up clinically and/or with additional imaging), in a total of 393 (28%) patients. 85 (6%) patients had one major ECF and 9 (0.7%) patients had two major ECFs. In 19 (4 cases of malignancy) patients the major ECF had therapeutic consequences. Significant positive associations were found between age and smoking, respectively and the presence of ECFs. The cost estimate of saving one life from malignant disease based on ECF examinations is 40,190€.

Conclusion

Incidental extra-cardiac findings are common, sometimes revealing serious, even malignant disease. Diagnostic follow-up of major ECFs seems to be cost-effective in a Danish clinical setting. We recommend investigating a large field of view for incidental ECFs following CCT.     

Measurement of coronary calcium scores by electron beam computed tomography or exercise testing as initial diagnostic tool in low-risk patients with suspected coronary artery disease

We determined the efficiency of a screening protocol based on coronary calcium scores (CCS) compared with exercise testing in patients with suspected coronary artery disease (CAD), a normal ECG and troponin levels. Three-hundred-and-four patients were enrolled in a screening protocol including CCS by electron beam computed tomography (Agatston score), and exercise testing. Decision-making was based on CCS. When CCS≥400, coronary angiography (CAG) was recommended. When CCS<10, patients were discharged. Exercise tests were graded as positive, negative or nondiagnostic. The combined endpoint was defined as coronary event or obstructive CAD at CAG. During 12±4 months, CCS≥400, 10–399 and <10 were found in 42, 103 and 159 patients and the combined endpoint occurred in 24 (57%), 14 (14%) and 0 patients (0%), respectively. In 22 patients (7%), myocardial perfusion scintigraphy was performed instead of exercise testing due to the inability to perform an exercise test. A positive, nondiagnostic and negative exercise test result was found in 37, 76 and 191 patients, and the combined endpoint occurred in 11 (30%), 15 (20%) and 12 patients (6%), respectively. Receiver-operator characteristics analysis showed that the area under the curve of 0.89 (95% CI: 0.85–0.93) for CCS was superior to 0.69 (95% CI: 0.61–0.78) for exercise testing (P<0.0001). In conclusion, measurement of CCS is an appropriate initial screening test in a well-defined low-risk population with suspected CAD.     

Coronary artery disease in Chinese adults with type 2 diabetes mellitus estimated by electron beam computed tomography and electron beam computed tomography angiography

Objective To assess the prevalence and risk of coronary artery disease(CAD) in Chinese adults with type 2 diabetes mellitus(T2DM) using electron beam computed tomography(EBCT) and EBCT angiography(EBCTA) . Methods:Ninety-four cases were enrolled in this study including diabetes(n=28) ,impaired glucose tolerance(IGT,n=30) ,coronary heart disease(CHD,n=11) ,and control(n=25) . Cardiac EBCT plain scanning and EBCTA were performed on all of these subjects to evaluate coronary artery calcifica-tion(CAC) scores,and number of segments of stenosed coronary arteries. Both CAC and/or coronary artery stenosis were defined as patients with coronary artery lesions(CAL) . Results CAC scores were not different with the control,diabetes,IGT,or CHD(P>0.05) groups. Compared to control(0.520±1.295) ,more stenosed coronary arteries segments(P<0.05) were detected in diabetes(2.964± 1.915) ,IGT(2.200±2.024) ,and CHD(2.273±1.679) . Number of stenosed artery segments were correlated with age(r=0.215,P=0.019) ,postprandial glucose(r=0.224,P=0.015) ,total cholesterol(r=0.323,P=0.000) ,and duration of diabetes(r=0.208,P=0.004) . The incidences of CAL in diabetes(96.43%) ,IGT(93.33%) ,and CHD(90.91%) was substantially higher than that in normal control(56.00%,P<0.01) . The odds ratio of CAL associated with having diabetes was estimated to be 7.514(95% CI:1.885-63.778) . Conclusions Coronary artery lesions are prevalent in Chinese adults with type 2 diabetes,implying a high CAD risk. EBCTA holds potential in depicting the details of CAL and can be used to track the progression of CAD in diabetes patients.     

电子束CT三维重建在髁突骨折中的应用评价

目的：探讨电子束CT（EBCT）三维重建在髁突骨折中的应用价值。方法：髁突外伤患者11例，均给予临床检查、摄X线片、EBCT平扫及三维重建检查，评估髁突骨折的类型及骨折移位程度、选择适合的治疗方案。结果：EBCT具有扫描速度快、图像清晰的特点，其三维影像可以任意旋转和切割，从不同角度观察病变情况，正确地显示髁突骨折及其类型。结论：EBCT平扫及三维重建能客观地提供髁突骨折的所有特征，将两种以上重建方法结合，可以更清晰地显示和反映骨折线走向、碎骨片的移位，提高了髁突骨所的诊断和显示率，降低了误诊率，为制订治疗方案提供准确信息。