64层与16层螺旋CT冠状动脉成像比较

Comparison of Coronary Angiography between 64-slice and 16-slice Spiral CT △

目的比较64层与16层螺旋CT冠状动脉成像的图像质量和分支显示率,评价64层螺旋CT诊断冠状动脉狭窄的准确性。方法对100例临床可疑冠心病患者(A组)行64层螺旋CT心电门控增强扫描,其中48例患者有常规冠状动脉造影做对照。对另外100例临床可疑冠心病患者(B组)行16层螺旋CT心电门控增强扫描。比较两组图像的质量评分和冠状动脉分支显示率。结果A组图像质量评分为(1.20±0.47)分,明显低于B组的(1.37±0.63)分(P<0.05)。两组冠状动脉近中段显示率差异无显著性(P>0.05),而远段和部分小分支显示率差异有显著性(P<0.05)。64层螺旋CT冠状动脉成像诊断冠状动脉≥50%狭窄的敏感性为94.9%(56/59),特异性为93.2%(124/133)。结论64层螺旋CT冠状动脉成像的图像质量和分支显示率较16层螺旋CT进一步提高,能够可靠诊断冠状动脉≥50%狭窄。

Objective To compare the image quality and visibility of arteries of 64-slice spiral coronary CT angiography （CTA） with those of 16-slice spiral coronary CTA, and to evaluate the diagnostic accuracy of 64-slice spiral CT for the assessment of coronary artery stenosis. Methods Totally 100 patients （ Group A） with suspected coronary artery diseases （CAD） were examined by 64-slice spiral CT, 48 of whom also underwent conventional coronary angiography （CAG）. Another 100 patients （Group B） with suspected CAD were studied by 16-slice spiral CT. Patients with a heart rate above 70 bpm received oral [β-blockers before the scan. Data were retrospectively analyzed and reviewed by two observers. Image quality was assessed by using a 3-point grading scale from excellent （ 1 ） to non-assessable （3） and the rate of displayed coronary branches was calculated. The left main artery （LM）, left anterior descending artery （LAD）, circumflex artery （CX）, and right coronary artery （RCA） were screened for the presence of over 50% stenosis. Results The mean heart rates of two groups showed no significant difference [ （61 ± 8） bpm vs. （ 61 ± 7） bpm, P 〉0. 051. The mean scan time of Group A was significantly shorter than that of Group B [ （ 11.9 ± 0. 9） s vs. （ 22. 2 ± 1.1 ） s, P 〈 0. 01 ]. In the evaluation of image quality, better results were obtained in Group A than in Group B （ 1.20 ± 0. 47 vs. 1.37 ± 0. 63, P 〈 0. 05 ）. The visibility of proximal arteries was similar between two groups, while the visibility of some distal arteries and small branches was found higher in Group A than in Group B （ LAD distal 92% vs. 48%, CX distal98% vs. 89%, the first obtuse marginal （OM1） 93% vs. 84%, cone branch （CB） 86% vs. 71%, P 〈 0. 05 ）. Compared with CAG, the sensitivity, specificity, positive predictive value （ PPV）, and negative predictive value （NPV） of 64-slice spiral coronary CTA to identify over 50% stenosis were 94. 9% （56/59）, 93.2% （124/133）, 86.2% （56/65）, and97.6% （124/127）, respectively. Conclusions With higher temporal and spatial resolution, 64-slice spiral CT provides improved image quality and visibility of small branches as compared with 16-slice spiral CT. 64-slice spiral coronary CTA allows reliable non-invasive diagnosis of obvious coronary artery stenosis.