多层螺旋CT诊断冠状动脉疾病的发展趋势

多层螺旋CT（multidetector spiral computed tomography，MDCT）在CAD诊断领域的主要适应证有：测定冠状动脉钙化积分（coronary artery calcium score，CACS）、CT冠状动脉造影、评价心肌功能及冠心病（coronary artery disease，CAD）在治疗后的随访。据报道，CACS用于诊断CAD的敏感性范围在68．0％～100％，特异性范围在21．0％～100％。高CACS是一个敏感性很高但特异性相对较低的指标，与常规冠状动脉造影（coronary angiography，CAG）相比，16排MDCT的冠状动脉造影在诊断冠状动脉狭窄（350％）时具有中高度敏感性和高度阴性预测值（negative predictive value，NPV）。与之相比，64排MDCT的敏感性和NPV更高，但特异性与阳性预测值（positive predictive value，PPV）却无明显提高。将冠状动脉形态学与心肌灌注功能研究相结合，是今后CAD的研究方向。

Multidetector spiral CT in the diagnosis of coronary artery disease: prospective

The clinical indications of multidetector spiral CT (MDCT) to coronary artery disease (CAD) include (coronary artery calcium score, CACS), CT coronary angiography, myocardial function investigation, and the follow-up after CAD treatment. The sensitivity and specificity of CACS for the detection of significant CAD have been reported as 68.0%~100% and 21.0%~100%, respectively. CACS has a high sensitivity but a relatively low specificity to CAD. 16-MDCT shows a moderate to high sensitivity and high negative predictive value (NPV) for the detection or exclusion of the vessels with significant lesions, but has a low positive predictive value (PPV) compared with CAG. 64-MDCT has a higher sensitivity and NPV than 16-MDCT, but specificity and PPV are not much improved. MDCT has been also used to identify coronary artery plaque. Combination of functional with anatomical studies will be a new approach of MDCT imaging for an integrated research of CAD diagnosis and evaluation.