320排动态容积CT冠状动脉成像对胸痛患者的诊断价值

目的探讨320排动态容积CT冠状动脉成像对胸痛患者冠状动脉狭窄病变及斑块性质的诊断价值。方法对38例因胸痛住院患者先行冠状动脉CT血管造影（CCTA）检查,其中符合冠心病诊断的30例患者于2周内再行冠脉造影（CAG）检查,分析CCTA对冠脉狭窄病变的诊断价值;将冠心病患者分为稳定性心绞痛（SAP）组和急性冠脉综合征（ACS）组,根据不同CT值,将冠状动脉斑块分为软斑块、混合斑块、钙化斑块3类,观察3类斑块在两组患者中的不同构成。结果以CAG为金标准,CCTA对冠脉狭窄诊断的敏感性为91.84%,特异性97.83%,阳性预测值93.75%,阴性预测值97.12%,正确率96.26%,两种检查方法在诊断冠状动脉狭窄病变上差异无统计学意义;两种检查方法对冠脉狭窄程度的判断具有较好一致性（Kappa值=0.829）;ACS患者以软斑块为主（55.9%）,而SAP患者以钙化斑块为主（65%）,差异有统计学意义。结论 CCTA能准确诊断有意义的冠状动脉狭窄病变,且对冠状动脉斑块性质的判断有一定意义,CT值较低的软斑块与ACS有联系。

Diagnostic Value of 320-slice Dynamic Volume MD CT Coronary Angiography in Patients with Chest Pain

Objective To assess the diagnostic value of the coronary artery stenosis and the identification of coronary atherosclerotic plaques with 320-slice dynamic volume MDCT angiography in patients with chest pain.Methods Thirty eight patients with chest pain were enrolled.Thirty patients were diagnosed as coronary heart disease(CHD) by coronary computed tomographic angiography(CCTA),they received coronary angiography(CAG)within two weeks.CAG was the reference standard for the evaluation with CCTA in coronary artery stenosis.All coronary plaques were classified as soft,mixed and calcifying plaque based on CT densities.The ratio of every type plaques were compared in the patients with stable angina(SAP)and acute coronary syndrome(ACS).Resluts The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of CCTA in identifying coronary stenosis were 91.84%,97.83,93.75%,97.12%,96.26%.Results The results of CCTA and CAG had well consistency(Kappa=0.829).The soft plaques predominated in the patients with ACS(55.9%),whereas the calcifying plaques predominated in the patients with SAP(65%).Conclusion CCTA can detect significant coronary stenosis accurately,and may contribute to distinguish with the different coronary atherosclerotic plaques.The presence of soft plaque component was correlated with ACS.