64层CT冠状动脉成像、磁共振多技术扫描评价冠心病的对比研究

A comparative study between multimodality MR imaging and 64-slice spiral CTA on evaluation of coronary artery disease

目的比较64层螺旋CT冠状动脉造影(CTA)和磁共振心脏多技术扫描对冠心病(CHD)的诊断结果。方法28例拟行冠状动脉造影(CAG)的冠心病患者,于术前一周完成64层螺旋CTA及磁共振心脏多技术扫描,分别与CAG进行对照。结果64层螺旋CTA与CAG对各支冠状动脉狭窄程度的显示具有较好的一致性(P<0.05)。64层螺旋CTA判断中、重度狭窄血管(≥50%)的敏感度、特异度、准确度、阳性预测值、阴性预测值为87.88%、98.73%、95.54%、96.67%、95.12%。磁共振多技术扫描左室增大8例,室壁明显变薄7例。在476个节段中,29个节段(6.09%)运动减弱或不运动,9个节段(1.89%)出现矛盾运动或室壁瘤。冠状动脉轻、中、重度狭窄组的心肌磁共振灌注及延迟扫描序列阳性显示率为26.32%、89.47%、100%。MRI间接判断中、重度狭窄血管(≥50%)的敏感度、特异度、准确度、阳性预测值、阴性预测值为93.75%、86.54%、89.29%、81.08%、95.74%。结论64层螺旋CTA和MR心肌灌注显示冠心病中、重度狭窄血管与CAG的结果差异无明显统计学意义;两种方法的准确度无明显差异,对冠心病的诊断各具优势。

Objective To compare the image results between 64-slice spiral CTA and cardiac multimodality MR scanning in detecting coronary artery disease. Methods All the 28 patients with coronary artery disease were underwent 64-slice CT coronary angiography （CTA） and cardiac multimodality MR scanning one week before coronary angiography（CAG）. The results were compared with CAG. Results 64-slice spiral CTA had high consistency with CAG in discovering stenosis degree of coronary artery （P〈0.05）. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of medium and severe stenosis （≥50% ） of coronary artery of 64-slice spiral CTA were 87.88%, 98.73%, 95.54%, 96.67%, 95.12%. The cardiac multimodality MR scanning showed left ventricle volumes of 8 cases enlarged and the ventricle walls of 7 cases thinned.In all the 476 segments, 29 segments （6.09%） were hypokinetic or akinetic, and 9 segments （1.89%） were paradoxical motions or ventricular aneurysms. The positive rate of mild, medium and severe stenosis of coronary artery of MR myocardial perfusion and delayed scanning images were 26.32%, 89.47%, 100%. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of medium and severe stenosis （≥50%） of coronary artery which were inferred according to the coronary anatomic distribution of myocardial blood supplying by MRI indirectly were 93.75%, 86.54%, 89.29%, 81.08%, 95.74%. Conclusion The results of detecting medium and severe coronary stenosis by 64-slice spiral CTA and MR myocardial perfusion had no statistical significance compared with CAG.The accuracy of the two methods had no difference, and they have each dominance in the diagnosis of CHD.