双源CT冠状动脉成像的临床研究

目的评价双源螺旋CT冠状动脉成像（DSCTA）的临床价值。方法对1278例临床可疑冠心病患者（男830例,年龄（57.7±9.3）岁,女448例,年龄（50.3±10.5）岁）的临床资料进行回顾性分析,其中,24例合并主动脉瓣损害（钙化或增厚）,35例合并二尖瓣损害,4例合并肺栓塞,5例合并主动脉壁内血肿,1例合并主动脉夹层,房颤63例,房性早搏27例,室性早搏13例,均经DSCT心电门控增强扫描,60例同期行冠状动脉造影。结果 485例心率小于75次/min,503例心率在75～85次/min之间,290例心率大于85次/min,最高心率127次/min。平均心率小于75次/min的患者,最佳重建时相在40%～80%R-R间期内。平均心率大于等于75次/min的患者,最佳重建时相在20%～80%R-R间期范围内。1278例扫描图像中,1例由于主动脉瓣重度关闭不全,血管显影淡,不能满足诊断。6例心律不齐患者图像质量差,不能满足诊断。60例与选择性冠状动脉造影对照,灵敏度89.23%,特异度91.75%,阳性预测值92.06%,阴性预测值88.83%。结论 DSCTA基本不受心率限制,可清楚显示由于钙化或纤维斑块引起的冠状动脉狭窄程度,可作为冠心病筛查首选,特别是对合并有心律不齐或合并心脏瓣膜病患者。

Clinical advantage of dual-source CT in coronary artery angiography

Objective To assess the clinical advantage of dual-source computed tomography（DSCT） in coronary arteriograph（CAG） . Methods 1278 patients（830 men aged 57.7±9.3 years and 448 women aged 50.3±10.5 years） with clinically suspected coronary heart diseases（CHD） in which the complicatians were found to be aortic valve lesions（n=24） ,mitral valve lesions（n=35） ,pulmonary embolism（n=4） ,intramular hematomas of the aortae（n=5） ,aortic dissection（n=1） ,atrial fibrillation（n=63） ,atrial premature beat（n=27） and ventricular premature beat（n=13） were collected and studied. All patient initially underwent enhanced DSCT scanning with ECG-gated. Simultaneously,60 patients underwent additional CAG studies. Results In 485 patients with the heart rates less than 75 bpm,the best reconstruction phase was from 40% to 80% of the R-R interval. In 503 patients with the heart rates between 75 bpm and 85 bpm and 290 patients with the heart rates more than 85 bpm,the best reconstruction phase was from 20% to 80% of the R-R interval. Among 1278 patients,only one case with severe aortic valve insufficience and 6 cases with arrhythmia were unable to diagnose for poor imaging quality. Among 60 patients comparing to CAG,sensitivity was 89.23%,specificity was 91.75%,positive predictive value was 92.06%,and negative predictive value was 88.83%. Conclusion DSCT angiography can clearly show the degrees of coronary artery stenosis caused by calcification or fiber plaques without heart rate control,which can be taken as a first choice for screening the coronary heart diseas,especially incorporating arrhythmia or heart valve disease.