多层螺旋CT无创性冠状动脉造影对冠状动脉疾病的诊断价值

目的:探讨16层螺旋CT冠状动脉造影对冠状动脉病变的临床诊断价值。方法:57例疑似冠状动脉病变的患者行16排螺旋CT检查和冠状动脉造影,不包括5例为冠状动脉支架置入术后(支架12个)。将冠状动脉分为13个节段,分析所有管腔大于2mm的节段,评价图像是否能满足管腔评价。管腔狭窄大于50%认为有意义,以常规冠状动脉造影作为金标准,比较16层螺旋CT在诊断有意义的冠状动脉狭窄方面的敏感性、特异性、阳性预测值、阴性预测值。结果:在所有638个节段中,588个节段(占92.16%)能够满足冠状动脉管腔评价。对于16层螺旋CT能够显示有意义冠状动脉狭窄,与ICA相对照,若以动脉节段计数,MSCT显示中度以上狭窄的敏感性、特异性、阳性预测值、阴性预测值和准确度分别为93.61%、91.11%、89.79%、98.12%和94.63%。以动脉主干计数,MSCT显示中度以上狭窄的敏感性、特异性、阳性预测值、阴性预测值和准确度分别为92.82、、91.31%、80.43%、97.37%和82.08%。以患者计数,MSCT显示中度以上狭窄的敏感性、特异性、阳性预测值、阴性预测值和准确度分别为94.73%、90.00%、93.01%、92.99%和82.75%。结论:16层螺旋CT结合回顾性心电门控技术冠状动脉成像无创、简单易行。既能显示管腔情况又能显示冠脉管壁,弥补了ICA的不足;经严格控制影响因素,具有较高的敏感性和特异性,较高的阴性预测值可避免不必要的有创性检查。对支架术后的随访也有较高的应用价值,对血管变异的显示直观确切。可作为一种有效的筛查和随访手段应用于临床。

The diagnostic value of MSCT noninvasive coronary angiography to coronary artery disease

Objective:The aim of this study was to evaluate the potential clinical value of 16-slice computed tomography coronary angiography in the diagnosis of coronary artery disease(CAD).Methods:57 patients with known or suspected CAD(not including 5 patients with implantation of 12 stents) underwent 16-slice spiral CT and invasive coronary angiography(ICA).Coronary artery were divided into 13 segments.All vessels with a diameter 2 mm were analyzed and a lumen restriction of >50% was considered a significant stenosis.Invasive coronary angiography was taken as gold standard for calculations of diagnostic accuracy.Sensitivity,specificity,and diagnostic accuracy of 16-MSCT in the detection or exclusion of CAD were evaluated on both per patient and per segment basis.Results:All scans showed diagnostic image quality.Of 638 segments,588(92.16%) could be evaluated.Specificity,sensitivity,and positive and negative predictive values,accuracy for the presence of significant stenoses were:by segment(n=588),93.61%,91.11%,89.79%,98.12% and 94.63%,respectively;by artery(n=228),92.85%,91.31%,80.43%,97.37% and 82.08%,respectively;by patients(n=57),94.73%,90.00%,93.01%,92.99% and 82.75%,respectively.Conclusion:16-slice CT with retrospectively ECG-gating is a convenient,reliable noninvasive diagnostic method for coronary artery disease.It can display the coronary artery wall and lumen to come up with the insufficiency of ICA.As to evaluation of coronary stenosis,the sensitivity and specificity is high if image quality is sufficient.The higher negative predictive value can avoid unnecessary invasive ICA.It has great potential value in the follow-up of implantation of stents.It can be used as a screening method in the diagnosis of coronary artery disease.