16层CT与导管法造影在显示冠状动脉狭窄中的对照研究

Control study in showing the coronary artery stenosis by 16-slice CT and catheter angiography

目的探讨16层CT冠状动脉成像在显示冠状动脉狭窄中的应用价值和限度。方法回顾性分析52例临床诊断或可疑冠心病患者的16层CT冠状动脉成像检查结果,并将16层CT检查结果与导管法冠状动脉造影结果进行对照。结果在52例患者的冠状动脉直径≥2 mm的580节段中,CT图像能满足管腔评价为507节段(占87.41%)。在CT图像能满足管腔评价的冠状动脉节段中,16层CT显示中度或中度以上狭窄(≥50%)的敏感度、特异度和阳性、阴性预测值分别为87.88%、98.17%和76.32%、95.96%,若将CT图像不能满足管腔评价的中度或中度以上狭窄的5个节段包括在内,其敏感度为81.69%;16层CT显示高度狭窄(≥75%)的敏感度、特异度和阳性、阴性预测值分别为83.78%、99.35%和91.18%、98.7%,若将CT图像不能满足管腔评价的高度狭窄的2个节段包括在内,其敏感度为79.49%。结论16层CT在对冠状动脉中、高度狭窄的初步诊断及介入治疗的筛选方面,可部分取代导管法冠状动脉造影。

Objective To discuss the clinical value and limit in showing the coronary artery stenosis by 16-slice CT coronary angiography. Methods To analyse retrospectively the results of 16-slice CT coronary angiography of 52 cases that were clinical diagnosised and suspected of the coronary heart disease, and compare with the results of catheter angiography. Results In 580 segments of 52 cases that the diameter of coronary artery was larger than or equal to 2 mm, there were 507 segments （87.41%） whose CT image could meet the lumen evaluation. In these coronary artery segments whose CT image could meet the lumen evaluation, the sensitivity, specificity, positive and negative predictive value in showing of moderate or moderately above stenosis （≥50%） by 16-slice CT was 87.88%, 98. 17% , 76. 32% and 95. 96%. If including the 5 moderate or moderately above stenosis segments whose CT image not meet the lumen evaluation, the sensitivity was 81.69%. The sensitivity, specificity, positive and negative predictive value in showing of high stenosis （≥75%） by 16- slice CT was 83.78%, 99.35%, 91.18% and 98.7%. If including the 2 high stenosis segments whose CT image not meet the lumen evaluation, the sensitivity was 79.49%. Conclusion The 16-slice CT can partially replace the catheter coronary angiography in screening of initial diagnosis and interventional therapy for moderate and high coronary artery stenosis.