16层螺旋CT冠状动脉成像的临床应用

目的:探讨16层螺旋CT冠状动脉(简称冠脉)成像在冠心病诊断中的临床价值。方法:选取50例临床诊断或可疑冠心病患者行16层螺旋CT冠状动脉造影检查(MSCTCA),先行冠脉钙化积分平扫,然后行冠脉增强扫描,选取一组质量最佳的薄层图像行冠脉三维重建,分析MSCTCA对冠状动脉狭窄性病变的显示能力,并对冠脉支架显示及通畅性进行评价。结果:冠脉钙化积分与其狭窄程度呈正相关,中度以上狭窄的冠脉钙化积分值明显高于轻度狭窄,其间有统计学显著性差异(P<0.001)。MSCTCA对诊断有临床意义的冠脉中度以上狭窄的敏感度、特异度、诊断准确率、阳性预测值、阴性预测值分别约89.6%、93.9%、92.6%、86.7%、95.4%。MSCTCA对冠脉支架显示良好,检出5例9根支架,其中2根支架不通畅,出现支架内再狭窄。结论:16层螺旋CT冠脉成像安全、无创,对评价冠状动脉狭窄、支架开放及通畅性等方面有着较高的临床应用价值,可作为冠心病筛查的有效手段以及介入和手术治疗后的随访手段。

Clinical application of 16-slice spiral CT coronary angiography

Objective:To evaluate the clinical value of 16-slice spiral CT coronary angiography(MSCTCA) in diagnosis of coronary heart diseases(CHD).Methods: Fifty patients,which were clinically diagnosed or suspected CHD,were studied by 16-slice MSCTCA.The coronary artery (CA) calcification scores was first performed,then enhanced CA scanning done.The one group of the best quality of thin-thickness constructed images was selected to perform 3-dimensional CA process.The ability to display CA stenosis by MSCTCA was analysed,and the displaying of CA stent and its patency was evaluated.Results: CA calcification scores was positive related to CA stenosis degree.The CA calcification score value of above moderate-degree stenosis was obviously higher than mild-degree stenosis.There were statistically significant differences among them(P<0.001).The sensitivity,specificity,accuracy,positive predicted value and negative predicted value of MSCTCA in detection of clinically significant stenosis(≥50%) were about 89.6%,93.9%,92.6%,86.7%,95.4% respectively.The CA stent was displayed well in MSCTCA;9 stents in 5 patients were detected,and 2 stents of them were not lucid(inside-stent stenosis again).Conclusion: 16-slice spiral CT coronary angiography is a safe,noninvasive tool,and is valuable in clinical application for evaluating CA stenosis and stent patency.It can be used as efficient means of CHD screening,as well as follow-up of CHD intervention and surgical operation treatment after.