64排CT对冠状动脉旁路移植术后桥血管病变的诊断研究

Diagnostic study on the coronary artery bypass grafts lesions using 64 multi-slice computed tomography angiography

目的评价64排螺旋CT血管造影（MSCTA）对冠状动脉旁路移植术（CABG）术后桥血管病变诊断的准确性。方法2005年7月至2007年4月，共228例患者于CABG术后复查64-MSCTA，其中31例患者（82支桥血管）因有心绞痛或CT结果提示桥血管损害，进一步行冠状动脉造影（CAG）。结果所有桥血管均获得评价。64-MSCTA共发现13支桥血管闭塞，均得到CAG证实。CAG发现15支桥血管严重狭窄，64-MSCTA发现14处，漏诊1处，误诊1处。64-MSCTA诊断冠状动脉桥狭窄的灵敏度、特异度、阳性预测值、阴性预测值和与CAG符合率分别为93．3％、98．1％、93．3％、98．1％和97．1％；诊断桥血管病变的灵敏度、特异度、阳性预测值、阴性预测值和与CAG符合率分别为96．4％、98．1％、96．4％、98．1％和97．6％。结论64-MSCTA可以准确评价术后桥血管通畅情况。

Objective To evaluate the diagnostic accuracy in the assessment of coronary artery bypass grafts using 64 multi-slice computed tomography angiography （64-MSCTA） technology. Methods There were 228 patients post coronary artery bypass grafting （CABG） underwent 64-MSCTA from July 2005 to April 2007. Thirty-one patients with 82 bypass grafts performed coronary angiography （CAG） because of angina or grafts lesion showed by 64-MSCTA. Results All bypass grafts could be visualized by 64-MSCTA. Thirteen bypass graft occlusions and fourteen significant stenesis were detected by 64-MSCTA and confirmed by CAG. One venous grafts distal anastomosis was missed and another one was miss diagnosed as stenesis. One false negative and one false positive CT-finding resulted in a sensitivity of 93.3%, a specificity of 98. 1%, a positive predictive value of 93. 3%, a negative predictive value of 98. 1% and an accuracy of 97. 1% for grafts stenesis. As to the grafts lesion, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy for grafts occlusion were 96.4%, 98. 1%, 96.4% , 98. 1% and 97. 6%, respectively. Conclusion 64-MSCTA demonstrates high diagnostic accuracy in the assessment of graft patency and suitable for the follow-up of patients post CABG.