64层螺旋CT冠状动脉血管成像诊断复杂性冠状动脉狭窄

目的：评价64层螺旋CT冠状动脉血管成像诊断复杂性冠状动脉狭窄的价值以及对制定治疗策略的影响。方法：选取69例接受冠状动脉CTA检查，提示有至少1支冠状动脉显著狭窄（≥50％）的患者。将冠状动脉狭窄分为复杂性病变和简单病变。前者包括分叉病变、完全闭塞病变、开口病变、弥漫长病变。后者为除复杂性病变所含类型以外的病变。分又病变根据Lefevre分型进一步分为5型。所有患者均于2周内行CAG。将CTA的结果与CAG对照。结果：CTA共检出大于50％狭窄286处，其中简单病变为157处，复杂性病变为129处。其中分叉病变57处、闭塞病变22处、开口病变9处、弥漫长病变41处。57处分叉病变，按照Lefevre分型，有Ⅰ型18处、Ⅱ型21处、Ⅲ型5处、Ⅳ型6处、Ⅳa型5处和Ⅳb型2处。与CAG相比，CTA诊断简单病变的敏感度为92．16％，特异度为98．51％，阳性预测值为89．81％，阴性预测值为98．50％。CTA诊断分又病变的敏感度为100％，特异度为99．12％，阳性预测值为85．96％，阴性预测值为100％。CTA诊断闭塞病变、开口病变和弥漫长病变的敏感度、特异度、阳性预测值及阴性预测值均为100％。结论：64层螺旋CT冠状动脉CTA可准确诊断各类复杂性冠状动脉狭窄，指导进一步治疗方案的选择具有重要的临床价值。

Diagnostic Value of 64-slice Cardiac CTA in Patients with Complicated Coronary Artery Stenosis

Objective：To evaluate the diagnostic value of 64-slice cardiac CTA in the evaluation of complicated coronary artery stenosis and its further impact on clinical decision making. Methods： 69 patients with CTA confirmed significant coronary artery stenosis （≥50% ） were included. Stenosis was classified into simple lesion and complicated lesion. The com plicated lesions were defined as bifurcation lesion,occlusion lesion, ostial lesion and diffuse long lesion. The rest of the lesions were defined as simple lesions. Bifurcation lesions were further classified into 5 subtypes according to Lefevre classification. All patients underwent coronary angiography via catheterization within 2 weeks after CTA scan. The results of 2 modalities were compared. Results：CTA revealed 286 significant stenosis in 69 patients,among which 157 were simple lesions and 129 were complicated lesions. The complicated lesions included 57 bifurcation lesions, 22 occlusion lesions, 9 ostial lesions and 41 diffuse long lesions. Among all 57 bifurcation lesions,there were 18 ｜esions of type 1,21 lesions of type 2,5 lesions of type B, 6 lesions of type 4,5 lesions of type 4a and 2 lesion of type 4b. Compared with CAG results, the sensitivity, specificity, positive predicting value and negative predicting value of CTA for diagnosis of simple lesions were 92.16 %,98. 51% ,89.81% and 98.50 % respectively. The sensitivity, specificity, positive predicting value and negative predicting value of CTA for diagnosis of bifurcation lesions were 100% ,99.12%,85.96% and 100% respectively. CTA was found to have 100 % diagnostic accuracy compared with CAG for diagnosis of occlusion lesions, ostial lesions and diffuse long lesions. Conclusion..64-slice spiral CT coronary angiography can accurately evaluate complicated coronary artery stenosis and further guide PCI procedures. It plays a significant role in diagnosis of coronary artery disease.