64层螺旋CT在冠状动脉疾病诊断中的价值

The clinical values of 64-slice computed tomography coronary angiography

目的评价64层螺旋CT冠状动脉成像(64SCTCA)在诊断冠状动脉疾病的临床价值。方法搜集100例患者64SCTCA的完整资料,并以近期实施的选择性X线冠状动脉成像(CCA)结果为金标准进行对比,对64SCTCA显示的冠状动脉主支及主要分支情况进行分级评估。结果所有病例可用于评估的920支冠状动脉中,共显示病变370支,其中348支得到CCA证实；22支64SCTCA诊断狭窄而CCA显示正常,另外有10例CCA确诊存在的病变而在64SCTCA上未能显示,得出64SCTCA诊断冠状动脉病变的敏感性为97．2%,特异性为96．0%,阳性预测值为94．0%,阴性预测值为98．1%。经配对x^2检验,P=0．052,证明两种检查方法在发现冠状动脉病变方面差异无统计学意义。在显示病变程度上,64SCTCA评估与CCA完全一致者311支,准确性86．8%。在64SCTCA结果中,共有59支病变在程度上的评价与CCA结果不符合。结论64SCTCA在显示冠状动脉病变时,具有较高的敏感性和特异性,并且对于病变程度的评估也比较准确,适合用于临床怀疑冠心病的患者CCA前的筛选检查。

Objective To evaluate the clinical values of 64-slice computed tomography coronary angiography（CTCA） in contrast to conventional coronary angiography（CCA）. Methods Assessment of the major and minor branches of coronary arteries by 64-Slice CTCA, showed the information of 100 patients with 64-slice CTCA, comparing with CCA regarded as the golden standard recently implemented. Results Among the 100 patients, 920 coronary arteries were evaluated with 370 lesions found. Of them ,348 lesions were consisted with CCA, 22 lesions were falsely positive and 10 lesions were found by CCA not picked up by 64-slice CTCA. The sensitivity, specificity, positive predict values and negative predict values were 97. 2%, 96%, 94% and 98. 1% respectively for the detection of coronary artery disease（ CAD）, Further statistical analysis using a 2-related χ^2 test showed no obvious difference in the discovery of CAD between 64-slice CTCA and CCA. Comparing both imaging modalities, there was concordance in assessing lesion severity in 311 lesions, and accuracy approaches 86. 8%. Conclusions 64-slice CTCA has excellent sensitivity and specificity in detecting CAD, and also can give fairly accurate assessment of stenosis severity in most patients as compared to CCA. As a alternative method it is a useful non-invasive for detecting coronary arteries disease in symptomatic patients