OCT和IVUS在冠状动脉病变诊断中的对比研究

目的:评价光干涉性断层显像(OCT)在冠状动脉(冠脉)病变中的诊断价值。方法:对7例冠心病患者,在常规冠脉造影后,对病变血管先后行血管内超声(IVUS)和OCT检查,分别测量参考血管和病变血管最狭窄处外弹力膜面积(EMA)、最狭窄处血管管腔面积(LA)、斑块面积(PA)、斑块纤维帽厚度(CD),计算偏心指数(EI)和重构指数(RI),观察斑块类型及斑块夹层和血栓,并比较两者测量指标及对斑块性状判断的差异。结果:7例患者均成功完成了IVUS和OCT检查,术中术后无明显并发症发生。与OCT相比,IVUS高估斑块面积,低估管腔截面积,两者同一部位测得的PA和LA分别是(5.464±0.805)mm2和(4.916±0.952)mm2以及(3.646±0.857)mm2和(4.240±0.976)mm2,差异有统计学意义(均P<0.05);IVUS高估纤维帽厚度,两者同一部位测得的CD分别是(0.206±0.090)mm和(0.146±0.081)mm,差异亦有统计学意义(P<0.05)。OCT发现斑块夹层和血栓有更敏感的趋势。结论:OCT有很高的图像分辨率,在对斑块性状判断上优于IVUS,操作安全可靠。

The Contrast Study on OCT and IVUS in the Diagnosis of Coronary Heart Diseases

Objective: To evaluate the diagnosis value of optical coherence tomography(OCT) used in coronary heart diseases(CHD) compared with intravenous ultrasound(IVUS). Methods: After coronary angiography(CAG), 7 CHD cases accepted IVUS and OCT examinations respectively. The elastic membrane area(EMA) of referenced vessels and the culprit lesions, the lumen area(LA) of culprit lesions, the plaque area(PA), the fibrosis cap diameter(CD) of plaque, the eccentric index(EI),the remodeling index(EI) of vessels were measured. At the same time, the classification of plaques and the dissection in plaques were also observed by IVUS and OCT respectively. Results: Seven cases were all carried out examinations successfully, and there were no complications during the procedure. Compared with OCT, IVUS overestimated the PA, underestimated the LA (P = 0.019,0.014), and overestimated the CD (P=0.013). The ability of finding dissection and thrombus in plaque by OCT was higher than by IVUS. The patients had transient angina pectoris during the examination by OCT, and the corresponding ECG leads appeared ischemia. Conclusion: OCT had a higher resolution than IVUS, and it was better than IVUS when judging the properties of plaque. The procedure was safe. However, more cases should be observed in the future.