40层螺旋CT冠状动脉成像在冠心病诊断和随访中的价值

目的:分析897例临床确诊或疑似冠心病患者的40层螺旋CT冠状动脉成像结果,以探讨40层螺旋CT冠状动脉成像在冠心病诊断和随访中的价值.方法:262例临床确诊和579例疑似冠心病患者予以40层螺旋CT冠状动脉成像检查,经最大密度投影、容积重建和曲面多平面重建等后处理,其中207 例患者曾行选择性冠状动脉造影检查,将40层螺旋CT冠脉成像检查结果对照冠状动脉造影检查结果计算其敏感性、特异性、准确性、阳性预测值和阴性预测值.有135例患者1年后再次做40层螺旋CT冠状动脉成像检查.结果:94%患者冠状动脉成像图像可用于分析.有斑块伴中重度狭窄病例512例,包括单支病变 216例,2支病变169例,3支病变127例.男女性可疑冠心病患者40层螺旋CT 冠状动脉成像结果显示:无斑块或有斑块伴轻度狭窄的比例女性患者为56.98%(200/351),男性患者为45.18%(103/228),χ~2 =7.72,P<0.01,随着年龄的增长,冠状动脉多支病变逐渐增多.207例多层螺旋CT 冠状动脉成像与冠状动脉造影结果对比显示,冠状动脉分支血管有意义狭窄( ≥50%)的敏感性为84.5%(223/264);特异性为97.3%(1117/1148);阳性预测值为87.8%(223/254);阴性预测值为96.5%(1117/1158);准确性为94.9%(1340/1412).135例患者1年后重复40层螺旋CT冠状动脉成像显示有斑块消失6处、有斑块缩小5处、有新斑块出现9处、有斑块扩大10处.结论:40 层螺旋C T 作为无创性冠状动脉病变诊断技术可作为冠心病筛查,随访的良好方法,尤其适合临床症状较多的女性患者的鉴别诊断以及合并有高血压、糖尿病、血脂异常的高龄患者的随访.

The clinic value of 40-slice CT coronary artery angiographies in diagnosing and following up coronary artery disease

Objective:To assess the clinic value of 40-slice CT coronary artery angiographies in diagnosing and following up coronary artery disease.Methods:897 patients, who were suspected or suffered from coronary artery disease in clinic,were examined by 40-slice CT coronary angiography with image post-processing, among them, 207 cases underwent X-ray coronary artery angiography, 135 cases were examined repeatedly by 40-slice CT coronary angiography after one year. The image was analyzed with its influencing factor such as age, gender, hypertension, diabetes, and hyperlipidemia. The sensitivity, specificity, positive predicted value, negative predicted value and accuracy were determined by catheter coronary artery angiography as the golden standard. Results:The good image quality rate of multi-slice CT coronary artery angiography was 94% in 897 patients. The total rate of significant stenosis of coronary artery (≥50%) was 60.88%. For the suspected patients with coronary artery disease, the rate of no plaques or plaques with mild stenosis of coronary artery (≤50%)was 56.70%(200/351)in female,and 45.18% in male respectively,χ~2=7.72, P<0.01. Increasing along with the age, the rate of multiple coronary stenosis raised gradually. Compared with the results of conventional coronary angiography in 207 cases, the sensitivity, specificity, positive predicted value, negative predicted value and accuracy were 84.5%, 97.3%, 87.8%, 96.5% and 94.9% respectively for significant stenosis of coronary artery with 40-slice CT coronary angiography. Some of the calcified and non-calcified plaques were disappeared, and others occurred after one year. Conclusion: Multi-slice (40) spiral CT coronary angiography is an effective and non-invasive method to screen for suspected coronary artery disease especially in female person and follow up coronary artery plaques with significant stenosis.