双源CT成像评价冠状动脉支架通畅程度的价值

目的探讨双源CT(DSCT)对冠脉支架植入患者支架通畅程度评估的意义。方法选择冠状动脉支架术后拟行冠状动脉造影复查患者50例(植入支架59枚),行冠状动脉CT血管成像(CTA)扫描。2名研究者对CA结果不知道的情况下分别对冠状动脉支架内管腔进行评估。结果与CA结果对比,DSCT诊断支架再狭窄的敏感度、特异度、阳性预测值、阴性预测值(以支架为单位)分别为55.6%(5/9),97.8%(44/45),83.3%(5/6)和91.7%(44/48);DSCT对直径≥3 mm支架的再狭窄检出的敏感度、特异度、阳性预测值及阴性预测值分别为71.4%、100%、100%、94.4%;对直径<3 mm支架的再狭窄检出的敏感度、特异度、阳性预测值及阴性预测值分别为50.0%、90.9%、50.0%、90.9%。结论与CA结果比较,DSCT对冠脉支架评估的特异性、阳性预测值和阴性预测值高,敏感性相对较低。其临床意义在于排除管腔通畅的患者,亦可以作为诊断支架内再狭窄的无创性成像技术。

Evaluation of coronary stent patency with dual source CT

Objective To evaluate the dual source computed tomography（DSCT） on stents implantation in patients with coronary artery diagnostic significance of the situation of stent patency.Methods Fifty patients（fifty-nine stents） planned to review coronary angiography were selected in the study.Two researchers who did not know the results of coronary angiography assessed the coronary stent lumen with DSCT.Results Compared to coronary angiography results,the sensitivity, specificity,positive and negative predictive value of DSCT in coronary artery stent restenosis were 55.6%（5/9）,97.8% （44/45）,83.3%（5/6） and 91.7%（44/48）,respectively.The sensitivity,specificity,positive and negative predictive value of DSCT in diameter≥3 mm stents were 71.4%,100%,100%,94.4%;in diameter 3 mm were 50.0%,90.9%, 50.0%,90.9%,respectively.Conclusion Compared to coronary angiography,the specificity,positive predictive value and negative predictive value of evaluation coronary stent with DSCT is higher,sensitivity is lower.The diagnosis clinical significance of DSCT in coronary artery stent restenosis is to exclude the patency of the lumen in patients,and also can be used as a noninvasive means in diagnosing in-stent restenosis.