无常规心率控制下64排螺旋CT诊断冠状动脉狭窄的应用价值

64 Row MDCT Coronary Angiography in Diagnosing Coronary Stenosis without Control of Heat Rate

目的以有创性冠状动脉造影(ICA)为“金标准”,评估无常规心率控制下64排螺旋CT冠状动脉成像(CTA)诊断冠状动脉狭窄的可靠性。资料与方法35例患者先后行64排螺旋CT冠状动脉CTA和ICA,CTA扫描前所有患者均未常规控制心率。在未获知ICA结果的情况下,两位观察者独立对CTA结果作出评价。以冠状动脉管腔狭窄程度≥50%作为确定冠状动脉狭窄存在的标准。结果ICA共显示75处冠状动脉管腔狭窄。64排螺旋CT冠状动脉CTA诊断冠状动脉狭窄的敏感度、特异度、阳性预测值及阴性预测值分别为:97.3%(73/75),98.9%(468/473),93.6%(73/78)和99.6%(468/470)。结论在无常规心率控制条件下,64排螺旋CT冠状动脉CTA诊断冠状动脉狭窄仍具有很高的准确性。

Objective To estimate the accuracy of 64-row MDCT coronary artery angiography without control of heart rate for detecting coronary stenosis in comparison with invasive coronary angiography. Materials and Methods 35 patients were performed with both 64-row MDCT （GE Lightspeed VCT） coronary angiography （CTA） and conventional invasire coronary angiography （ICA）. There was no routine heart rate control before the CTA examination. Two observers were unaware of the results of ICA to evaluate the CT images independently. Coronary stenoses were classified as significant if the mean lumen diameter reduction was more than 50% in CTA or ICA images. Results ICA demonstrated 75 segments with significant stenoses in the 35 patients. Sensitivity, specificity, positive and negative predictive values of CTA for detecting significant stenoses on a segment-level analysis for all patients were 97.3% （73 of 75） , 98.9% （468 of 473） , 93.6% （73 of 78） , and 99.6% （468 of 470）. Conclusion 64-row MDCT coronary angiography has high accuracy in detecting coronary stenosis without routine heart rate control .