血管内超声与64排螺旋CT分析冠状动脉斑块的对比研究

目的对冠状动脉病变患者进行血管内超声(IVUS)和64排螺旋CT(64MDCT)检查,评价两种检查手段在冠状动脉病变诊断中的应用价值。方法 24例临床怀疑或诊断为冠心病的患者接受冠状动脉64MDCT检查,并应用其工作站相关后处理技术对冠状动脉粥样斑块进行评估分析。一周内实施冠状动脉内IVUS检查,对冠状动脉病变进行定性和定量分析。结果分析病变血管52支,其中左主干24支,前降支21支,左回旋5支,右冠状动脉2支。IVUS显示有斑块病变的血管段为60段,64MDCT显示有斑块病变的血管样本57段,其中3段病变64MDCT诊断正常而IVUS显示为斑块早期病变。64MDCT对出现任何粥样硬化斑块节段诊断的敏感性为96%,特异性为94.7%。IVUS与64MDCT的管腔面积,外弹力膜面积、斑块面积的相关系数r分别为0.79、0.83、0.81。结论 IVUS能准确判断冠状动脉斑块的大小和性质。64MDCT作为非侵入性方法亦能显示管壁斑块的构成,判断病变的类型及程度,具有一定的敏感性和准确率。

Assessment of Coronary Atherosclerotic Plaques Using Intravascular Ultrasound:Comparison with 64-Slice Computed Tomography

Objective The purpose of this study was to compare the accuracy of 64-slice CT （64- MDCT） with that of intravascular ultrasound （IVUS） for the identification and quantitative analysis to coronary atherosclerotic plaques. Materials and Methods A total of 24 patients with suspected coronary atherosclerotic disease （CAD） were studied using contrast-enhanced 64-MDCT and IVUS within 1 week. The morphology, classification, and quantitative analysis of atherosclerotie plaques were compared between 64-MDCT and IVUS. Results Fifty two arteries satisfied with the diagnosis of atherosclerosis, 24 LM （left main coronary artery） ,21 LAD（ left anterior descending coronary artery） ,5 LCX（left circumflex coronary artery） and 2 RCA （right coronary artery） were included. Sixty segments with coronary atherosclerotic plaques were imaged and analyzed by IVUS and 57 segments by 64-MDCT. It was 3 segments were diagnosed differently by IVUS and 64-MDCT,which were early atherosclerotic plaques by IVUS while normal by 64-MDCT. It was indicated that the sensitivity and specificity of 64-MDCT to value coronary artery atherosclerotic plaque were 96% and 94.7%. The correlation coefficients between IVUS and 64-MDCT for determining vascular CSA, lumen CSA, and plaque burden were 0.85,0.82 and 0.77 ,respectively （P 〈 0.01 ）. Conclusions IVUS can identify the size and character of atherosclerotic plaques and also analyze quantitatively. 64-MDCT is a noninvasive way to estimate the plaques and also has well sensibility and specificity.