16层螺旋CT血管造影在诊断与评价冠状动脉疾病中的应用价值

目的探讨16层螺旋CT冠状动脉血管造影对冠状动脉疾病诊断与评价的临床价值。方法58例冠状动脉病变(44例冠心病,3例冠状动脉肌桥血管,9例冠心病冠状动脉支架置入术后,2例冠心病患者冠状动脉搭桥术后)行16层螺旋CT冠状动脉血管造影及血管三维成像,血管三维成像方法包括:容积再现技术(VR),最大密度投影(MIP)及曲面重建(CPR)。结果58例冠状动脉病变三维成像图像质量中,优20例,良29例,差9例,优良率达84.5%。44例冠心病患者中,35例图像优良,其中31例VR,MIP及CPR显示不同部位冠状动脉狭窄或阻塞且与DSA相吻合,诊断正确率为88.6%;4例为假阳性;9例图像质量较差不能用于诊断。3例冠状动脉肌桥血管,VR及MIP图像均显示为右侧冠状动脉一大分支血管进入右心脏壁内走行。9例冠心病冠状动脉支架置入术,VR,MIP及CPR图像均能较好显示冠状动脉支架的置入部位、长度、形态,均未见移位、变形及狭窄。2例冠心病冠状动脉搭桥术后,VR图像显示搭桥血管起源及数量;搭桥血管无狭窄、阻塞及扩张。结论16层螺旋CT血管造影是诊断与评价冠状动脉病变无创伤性有效方法之一。

Clinical value of 16- slice spiral CT angiography in diagnosing and evaluating coronary artery disease

Objective To discuss the clinical value of coronary arteriography of 16-slice spiral CT in diagnosing and evaluating coronary artery disease.Methods 58 patients with coronary artery disease,including 44 cases coronary heart disease,3 cases of coronary artery myocardial bridge,9 cases of in-stents of coronary artery,and 2 cases by-pass grafts of coronary artery,were examined by 16-slice spiral CT angiography.Three-dimensional imaging of coronary artery,including VR,MIP and CPR,was performed.Results The quality of three-dimensional images of coronary artery of 58 patients was evaluated,which was devided into three grade:excellent in 20,well in 29 and poor in 9.The rate of choiceness was 84.5%.Among the images of 44 patients with coronary artery stenosis or obstruction,the imaging was well in 35.Coronary arterialstenosis or obstruction was demonstrated by VR,MIP and CPR,which was in accord with DSA in 31.The rate of diagnostic accuracy was 88.6%,and false positive oceurrecl in 4.The imaging could not be used in diagnosing coronary artery diseases for poor image quality in 9.The coronary artery myocardial bridge could be showed by VR and MIP in 3,in which a big branch of right coronary artery entered the right myocardial wall.The position,length and shape of stents of coronary artery could be clearly shown by VR,MIP and CPR in 9 patients with coronary heart disease after in-stent,without shift,deformity and narrowing.The by-pass grafting arteries could be clearly shown by VR in 2 patients with coronary heart disease after by-pass graft surgery,without stenosis,obstruction or dilation.Conclusion 16-slice CT angiography can be used as a noninvasive and effective method in diagnosing and evaluating coronary artery disease.