MSCT冠状动脉造影的临床应用

Clinlical Application of Coronary Angiography by MSCT

目的 :评价多层螺旋CT(MSCT)冠状动脉造影效果及其诊断冠状动脉狭窄的价值。材料和方法 :65例临床疑诊冠心病患者作MSCT扫描 ,所有数据获得在一次屏气中完成。利用心电门控技术 ,将所得原始图像进行重建 ,分别对左主干 (LMA)、左前降支 (LAD)、回旋支 (LCA)和右冠状动脉 (RCA)及其分支的重建图像进行影像学评价 ;其中 45例同时作常规冠状动脉造影 (CAG) ,以造影结果为金指标 ,将两种方法所得结果进行对比 ,了解MSCT冠状动脉造影诊断冠脉狭窄的敏感性和特异性。结果 :MSCT冠脉钙化积分诊断冠心病的敏感性 79.6% ,特异性 84.9% ;65例共 2 60支血管经MSCT成像 ,2 2 8支 (87.7% )可用于影像学评价 ;各节段冠状动脉重建图像 ,左主干和前降支近中段显示率最高 ;CAG发现狭窄 49支 ,MSCT发现狭窄 44支。MSCT对冠状动脉狭窄诊断的敏感性 83 .7% ,特异性 97.7%。结论 :在控制心率的情况下 ,MSCT冠状动脉造影可作为诊断冠状动脉狭窄的一种无创筛选检查方法。

Purpose:To evaluate image quality of angiography by MSCT and the diagnostic accuracy in determining coronary artery stenosis . Materials and methods:65 patients who were suspected with the stenosis of the coronary arteries were examined with MSCT. The CT data were aquired within a single breathhold, and isocardiophasic slices were reconstructed by means of retrospective electrocardiographic gating in left main(LMA), left anterior descending(LAD), left circumflex(LCA), right coronary artery(RCA) and side branches respectively. 45 out of 65 cases were performed by coronary angiography which was regarded as a gold standard to study sensitivity and specificity after comparing the results of two experiments. Results:Sensitivity and specificity of diagnosing stenosis of coronary calcium score to identify obstructed branches was 79.2%, 84.9% respectively. 260 arteries of 65 cases with MSCT examinations, there were 228 arteries (87.7%) which could be analysed for diagnosis. The demonstration of LAM and the proximal-middle segments of LAD was best in reconstruction images. 49 arteries were diagnosed as the stenosis of coronary arteries in conventional angiography. Meanwhile 44 arteries,by means of MSCT investigation, were found to be stenosis. The total sensitivity of MSCT was 83.7%, specificity was 97.7%. Conclusion: With the heart rate controlled, coronary angiography by MSCT could be used as a non-invasive screening method diagnosing stenosis of coronary artery.