64层螺旋CT冠状动脉成像初步研究

Coronary artery imaging with 64-slice spiral CT:an initial study

目的探讨64层螺旋CT冠状动脉成像的图像质量和诊断冠状动脉狭窄的准确性。方法对120例临床可疑冠心病患者进行64层螺旋CT回顾性心电门控增强扫描,用多平面重组(MPR)、最大密度投影(MIP)及容积再现技术(VRT)重组图像,其中60例患者有常规X线冠状动脉成像作对照。结果以VRT重组像评价图像质量,92例(77%)为1级,22例(18%)为2级,6例(5%)为3级。MPR、MIP及VRT重组像能显示冠状动脉的所有1级、大部分2、3级以及部分4级分支。64层螺旋CT冠状动脉成像诊断冠状动脉≥150%狭窄的敏感性为93%,特异性为98%。结论64层螺旋CT冠状动脉成像是一种无创、快速的成像方法,对诊断冠状动脉≥50%狭窄有较高的敏感性和特异性。

Objective To evaluate the image quality of coronary CT angiography （CTA） and the diagnostic accuracy for the assessment of coronary artery stenosis with a 64-slice CT scanner. Methods 120 patients with suspected coronary artery disease were studied by ECG-gated 64-slice spiral CT （120 kV, 850 mAs, 0. 33 s-rotation time, 0. 6 mm collimation） ;60 of them also underwent conventional coronary angiography（CCA）. Patients with heart rates above 70 bpm received oral 13-blockade before the scan. Enhanced scan was performed with an intravenous injection of 60 -70 ml contrast agent （370 mg I/ml） and 50 ml saline chaser bolus at 4 ml/s. Images were retrospectively reconstructed under different reformations multiplanar reconstrusc-tion（MPR）, maximum intensity projection（MIP） and volume rendering technology （VRT） and reviewed by two observers. Image quality was assessed using a 3-point grading scale （ excellent, sufficient and non-diagnostic ） and the visibility of coronary branches was evaluated. The left main, left anterior descending, left circumflex and right coronary arteries were screened for the presence of over 50% stenosis. Results Sixty-nine percent of the included patients received β-blockade. The average heart rate was 61±8 bpm and the scan time was 11.9 ±1.3 s. In the evaluation of image quality with VRT images, 77% patients＇ images were excellent, 18% sufficient, and 5% non-diagnostic. All of the first, most of the second and third, and parts of the fourth subsegment branches could be shown with MPR, MIP and VRT reconstruction images. MPR and MIP displayed better visualization than VRT in showing small branches. Compared with CCA, the sensitivity, specificity, positive and negative predictive value of CTA to identify over 50% stenosis were 93% , 98% , 87% and 99% , respectively. Conclusion 64-slice spiral CT coronary angiography is a noninvasive and fast method that allows reliable diagnosis of coronary artery stenosis with high image quality.