64层螺旋CT冠状动脉血管造影的临床应用

目的:分析冠状动脉CT表现,探讨64层螺旋CT冠状动脉成像的综合应用价值。方法:对398例行64层螺旋CT冠状动脉成像的结果进行综合分析,针对每个病例逐一进行冠状动脉13个节段的影像分析,以评价64层螺旋CT冠状动脉成像的应用价值。结果:本组398例中,共有5 038个节段显影,能达到诊断要求的4 399个节段,649段因运动或钙化、完全闭塞未进行血管评价;309例存在不同程度的冠状动脉狭窄,LAD(Left Anterior Descendy Artery)有病变276例,LCX(Left Circumflex Artery)有病变163例,RCA(Right Coronary Artery)有病变154例;208例冠状动脉有钙化,钙化积分<400有158例,400~1 000之间有42例,>1 000有8例;32例同时行冠状动脉造影,其结果与冠状动脉造影结果比较,对病变诊断的敏感度为95.70%,特异度为90.91%,阳性预测值为82.40%,阴性预测值为97.94%;支架术后63例,共142段血管段上有支架;搭桥术后7例,共17支桥血管。结论:64层螺旋CT冠状动脉成像作为一种无创的检查手段,在诊断中有较高的敏感性和特异性,可应用于冠状动脉病变的筛查和冠状动脉支架术后的随访。

Clinical application of 64-slice spiral CT angiography for coronary artery

Objective:Analysis the CT appearance of coronary artery and to explore the clinical application of 64-slice spiral CT angiography of coronary artery.Methods:CT coronary angiography was performed in 398 patients.Analysis of 13 segments of coronary in each case was done.To appreciation the clinical application of 64-slice spiral CT angiography of coronary artery.Results:A total of 5 038 segments of 398 patients were clearly displayed by CT and 4399 segments were considered to have the diagnostic image quality.Because of motion,severe calcification and completely occlusion,649 segments could not be sufficiently evaluated.309 patients were found stenosis,there were 276 in left anterior descendy artery(LAD),163 in left circumflex artery(LCX) and 154 in right coronary artery(RCA).208 patients had calcification and the calcium score Agatston score equivalent(ASE)] of 158 patients were less than 400.42 of the 208 patients had an ASE between 400 to 1000 and 8 patients had an ASE greater than 1000.Compared with internal carotid artery(ICA),the sensitivity,specificity,positive predictive value and negative predictive value of the 64-slice spiral CT angiography of the 32 patients were 95.70%,90.91%,82.40%,97.94%,respectively.142 segments had stenting in all the 63 patients who were performed percutaneous transluminal stenting.Seven patitents of them were operated with coronary artery bypass grafts and there were 17 bypass artery grafts.Conclusion:As a minimally invasive examination,64-slice spiral CT angiography is a valuable method with higher sensitivity and specificity.It can be an excellent screening test for coronary heart disease and a useful tool to assess the coronary stent patency.