16层CT显示冠状动脉狭窄与导管法造影的对照研究

Detection of Coronary Artery Stenosis Using 16-Slice Spiral CT:Comparison with Catheterization Coronary Angiography

目的:评价16层CT在显示冠状动脉狭窄中的价值和限度。方法:55例临床诊断或可疑冠心病的患者做16层CT冠状动脉成像检查(回顾性心电门控、0.5s螺旋扫描、单或双扇区重建算法和静脉注射对比剂),其检查结果与导管法冠状动脉造影对照。结果:在55例患者冠状动脉的568节段(血管直径≥2mm)中,CT图像能够满足管腔评价者为492节段(占86.6%),其中16层CT显示中度或中度以上狭窄(≥50%)的敏感度和特异度分别为87.5%和97.2%,阳性和阴性预测值分别为82.4%和98.1%;16层CT显示高度狭窄(≥75%)的敏感度和特异度分别为91.6%和98.7%,阳性和阴性预测值分别为 84. 6%和 99. 3%。结论:如果冠状动脉 CT 图像能够满足管腔评价, 16 层 CT 显示冠状动脉狭窄(≥50%)的准确性很高。在冠状动脉中、高度狭窄的初步诊断以及介入治疗的筛选方面,16 层 CT可以部分取代传统的导管法冠状动脉造影。

Objective:To evaluate the accuracy of 16-slice spiral CT in detecting coronary artery stenosis.Methods:A total of 55 consecutive patients with known or suspected coronary artery disease were studied by 16-slice spiral CT (retrospectively ECG-gating;0.5s rotation;one-sector or two-sector reconstruction algorithm;intravenous contrast agent).The results were compared with catheterization coronary angiography.Results:In the 568 coronary artery segments of 55 patients,492 were judged to be evaluable by CT (86.6%),56 of 64 coronary artery segments with significant stenosis (≥50% reduction of vessel diameter) were correctly detected by CT,416 of 428 coronary artery segments with normal or mild stenoses (<50% reduction of vessel diameter) were correctly detected by CT.These values corresponded to a sensitivity of 87.5%,specificity of 97.2%,positive predictive value of 82.4%,and negative predictive value of 98.1% for the detection of significant coronary artery segments stenoses by CT.In the 492 evaluable coronary artery segments,33 of 36 coronary artery segments with high-grade stenosis (≥75% reduction of vessel diameter) were correctly detected by CT,450 of 456 coronary artery segments with normal or stenoses (<75% reduction of vessel diameter) were correctly detected by CT.These values correspond to a sensitivity of 91.6%,specificity of 98.7%,positive predictive value of 84.6%,and negative predictive value of 99.3% for the detection of high-grade coronary artery segments stenoses by CT.Conclusion:16-slice spiral CT with retrospectively ECG-gating permits the visualization of significant coronary artery stenoses with high accuracy if image quality is sufficient.