多层螺旋CT冠状动脉成像在冠心病中的临床应用

The clinical application of multi-slice spiral CT coronary angiography in patients with coronary heart disease

目的 评价多层螺旋CT冠状动脉造影 (MSCTA)在冠心病中的应用价值。方法 对4 0例冠心病患者 (35例拟诊冠心病 ,5例冠状动脉支架或搭桥术后患者 )进行了心电门控螺旋CT(MSCT)增强扫描 ,所得数据传到工作站进行三维重建 ,并与冠状动脉造影结果相对照。结果 4 0例患者中对 16 0支冠状动脉 (简称冠脉 )进行了MSCT三维重建 ,35例拟诊者中 4例MSCTA和DSA排除了冠脉疾病 ;31例 12 4支冠脉中 ,MSCTA对于显示近中段≥ 5 0 %的狭窄有一定的准确性 (敏感性 81 8% ,特异性 90 1% ) ,不能显示轻度狭窄病变、远端或细小分支病变 ;可以发现并判断粥样硬化斑块的类型 ,显示斑块的形态及引起狭窄的程度。钙化斑块特别是钙化范围广者可引起管腔轻度狭窄 (冠状动脉腔径狭窄 <5 0 % ) ,非钙化斑块则引起较明显的狭窄 (冠状动脉腔径狭窄≥ 5 0 % )。 4例冠状动脉支架和 1例冠状动脉搭桥术后均可清晰显示支架和血管桥的位置及远端血流情况。结论MSCTA是有效可靠的冠心病诊断方法 ,对病变血管管腔狭窄、粥样硬化斑块的评价有一定的应用价值。它作为一种非创伤性检查方法 ,可替代DSA用于易碎软斑块的早期检查。

Objective To assess the value of multi-slice spiral computed tomography (MSCT) coronary angiography in patients with coronary heart disease.Methods Forty patients of coronary heart disease with sinus rhythm were studied by contrast-enhanced, electrocardiographically-gated MSCT, and CT findings were compared with those of conventional angiography. Results Compared with conventional angiography, MSCT angiography correctly determined the absence of coronary artery disease in 4 patients. Of the total 124 coronary arteries (left main, left anterior descending, left circumflex, and right coronary artery) in 31 cases, the proximal and severe lesions of coronary artery (≥50% stenosis) could be detected (sensitivity=81.8%, specificity=90.1%), as well as the stenosis extent resulted from the coronary plaques. Plaque morphology could be clearly differentiated and classified by MSCT. Calcified plaque, especially the extensively calcified, caused mild lumen diameter stenosis (<50% stenosis). However, non-calcified plaque caused significant stenosis (≥50% stenosis). In the segments with coronary stents and bypass graft, the position and distal blood flow were well showed.Conclusion MSCT coronary angiography is a reliable diagnostic method for coronary heart disease. It is valuable in demonstrating coronary lumen stenosis and coronary atherosclerotic plaque. MSCT coronary angiography can replace conventional angiography for detecting rupture-prone soft coronary plaque as a noninvasive method.