64排CT对冠状动脉旁路移植术后桥血管病变的诊断研究

目的 评价64排螺旋CT血管造影(MSCTA)对冠状动脉旁路移植术(CABG)术后桥血管病变诊断的准确性.方法 2005年7月至2007年4月,共228例患者于CABG术后复查64-MSCTA,其中31例患者(82支桥血管)因有心绞痛或CT结果提示桥血管损害,进一步行冠状动脉造影(CAG).结果 所有桥血管均获得评价.64-MSCTA共发现13支桥血管闭塞,均得到CAG证实.CAG发现15支桥血管严重狭窄,64-MSCTA发现14处,漏诊1处,误诊1处.64-MSCTA诊断冠状动脉桥狭窄的灵敏度、特异度、阳性预测值、阴性预测值和与CAG符合率分别为93.3%、98.1%、93.3%、98.1%和97.1%;诊断桥血管病变的灵敏度、特异度、阳性预测值、阴性预测值和与CAG符合率分别为96.4%、98.1%、96.4%、98.1%和97.6%.结论 64-MSCTA可以准确评价术后桥血管通畅情况.

Diagnostic study on the coronary artery bypass grafts lesions using 64 multi-slice computed tomography angiography

OBJECTIVE: To evaluate the diagnostic accuracy in the assessment of coronary artery bypass grafts using 64 multi-slice computed tomography angiography (64-MSCTA) technology. METHODS: There were 228 patients post coronary artery bypass grafting (CABG) underwent 64-MSCTA from July 2005 to April 2007. Thirty-one patients with 82 bypass grafts performed coronary angiography (CAG) because of angina or grafts lesion showed by 64-MSCTA. RESULTS: All bypass grafts could be visualized by 64-MSCTA. Thirteen bypass graft occlusions and fourteen significant stenosis were detected by 64-MSCTA and confirmed by CAG. One venous grafts distal anastomosis was missed and another one was miss diagnosed as stenosis. One false negative and one false positive CT-finding resulted in a sensitivity of 93.3%, a specificity of 98.1%, a positive predictive value of 93.3%, a negative predictive value of 98.1% and an accuracy of 97.1% for grafts stenosis. As to the grafts lesion, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy for grafts occlusion were 96.4%, 98.1%, 96.4%, 98.1% and 97.6%, respectively. CONCLUSION: 64-MSCTA demonstrates high diagnostic accuracy in the assessment of graft patency and suitable for the follow-up of patients post CABG.