16层CT冠状动脉成像与选择性冠状动脉造影的对比研究

目的:探讨16层CT对冠状动脉粥样硬化病变的显示情况及临床价值。方法:39例患者进行16层CT冠状动脉造影检查(疑似冠心病者31例,PTCA术后8例)及选择性冠状动脉造影。分析16层CT对冠状动脉各节段的显示情况。以管腔直径减小>50%为标准,判定冠状动脉狭窄。分析16层CT诊断冠状动脉狭窄的敏感性、特异性及符合率,及对病变性质的显示情况。结果:16层CT对冠状动脉的总体显示率为94.8%(333/351)。评价冠状动脉病变的总体敏感性为82.2%,特异性为94.7%,符合率为86.0%。16层CT显示钙化及非钙化斑块混合存在致血管狭窄21处,高估3处;中间密度斑块致狭窄8处,高估3处;软斑块3处,无显著狭窄。16层CT能清晰显示支架位置、形态及远端血流,1例再狭窄,1例闭塞,余通畅,其结果与选择性冠状动脉造影一致。另外,16层CT显示冠状动脉起源变异2例,前降支冠状动脉瘤1例,室壁瘤1例,房间隔缺损1例。结论:16层CT冠状动脉成像是一种颇具潜力的无创性检查方法,能够较为准确、全面的评价冠状动脉病变。

The reliability of 16-slice spiral CT coronary artery angiography: correlated with selective coronary angiography

Objective: To evaluate the reliability of 16-slice spiral CT angiography(MDCTA)in displaying atherosclerotic plaques of coronary artery and its clinical application. Materials and Methods: Thirty-nine patients underwent both 16-slice spiral CT coronary arteriography and selective coronary angiography(31 patients suspected to have CAD and 8 post-PTCA patients). In all cases, visibility of coronary artery segments was recorded. Vessel diameter reduction >50% was defined as significant stenosis. The MDCTA results were compared with DSA, the sensitivity, specificity and accuracy were calculated. Results: Coronary artery segments could be visualized by 16-slice spiral CTA in 94.8%(333/351). The sensitivity, specificity and accuracy of 16-slice CT coronary angiography were 82.2%, 94.7% and 86.0% respectively. The 16-slice CT showed stenosis caused by mixed calcified and uncalcified plaques in 21 lesions, in which 3 lesions were overestimated compare to DSA; stenosis caused by mid-density plaque in 8 lesions, in which 3 lesions were overestimated. Soft plaque in 3 lesions did not cause stenosis. The 16-slice CT can clearly show the location, shape of stents and distal blood perfusion in the post-PTCA cases. Patency of 11 stents, 1 occlusion and 1 serious restenosis were diagnosed accurately. In addition, 16-slice CT found 2 cases with variant of coronary artery opening, 1 case of LAD aneurysm, 1 case of left ventricular protuberance and 1 case of atrial septal defect. Conclusion: 16-slice spiral CT scanner provides a very promising approach to non-invasive coronary artery examination, combined with heart rate control, reliable noninvasive detection of obstructive coronary artery disease can be achieved successfully.