64排螺旋CT冠脉成像在冠心病诊断中的应用

Preliminary evaluation of 64-slice spiral CT coronary angiograpy in patients with coronary artery disease

目的评价64排螺旋CT冠状动脉(冠脉)成像(CTA)在冠心病诊断中的应用价值。方法以选择性冠脉造影(SCA)结果为金标准,采用64排螺旋CT对68例疑诊冠心病患者的冠脉主干及主要分支272节段进行重建和分析。评价其诊断冠心病的灵敏度和特异度。结果CTA能够清晰显示冠脉主干及其分支狭窄、钙化、开口起源异常及桥血管病变,CTA发现钙化病变52节段,SCA仅发现钙化病变35节段。CTA诊断冠脉病变的灵敏度96．33％,特异度98．16％,阳性预测值97．22％,阴性预测值97．56％。其中对左主干、左前降支病变及>75％的病变灵敏度最高,分别达到100％和94．4％。结论CTA对冠脉狭窄病变、桥血管、开口畸形、支架管腔均显影良好,对冠心病诊断有较高的准确性,对钙化病变诊断率优于冠脉造影,可以作为冠心病高危人群无创性筛选检查及冠脉支架术后随访手段。

Objective To investigate the image quality and diagnostic accuracy using 64-slice spiral computed tomography （64-CTA） scanner in patients with suspected coronary artery disease. Methods Sixty eight patients with chest pain or post PTCA underwent CT coronary angiography （CTA） and selected coronary angiography （SCA）. The SCA results were served as “gold standard” to evaluate the diagnostic accuracy of CTA, while the sensitivity, positive predictive value （PPV） and negative predictive value （NPV） were calculated, respectively. Results 64-slice spiral CT could clearly demonstrate the coronary arterial trunk and branchs with stenosis, calcifications abnormal orifise origination and bridge vascular disease; especially with high accuracy in revealing calcification and even with quantification. The sensitivity, specificity, PPV and NPV of the degree of stenosis more than 75% for coronary artery segments evaluatedby CTA were significantly higher than those of the degree of stenosis less than 50% for coronary artery segments （P 〈 0.01 ）, Conclusion CTA is a safe, simple and reliable noninvasive method for screening coronary artery disease in patients with chest pain. Moreover, 64-slice spiral CT could demonstrate not only the more delicate delineation of coronary arterial changes with 3D reconstruction and volume renderting but also the presence and quantity of calcium deposited on the vascular wall.