冠状动脉狭窄和粥样硬化斑块血管造影、MRA和CTA的对比研究

Comparison of Coronary Angiography,CTA and MRA in Detecting Coronary Stenosis and its Plaques

目的:以冠状动脉血管造影(CA)为参照,比较冠状动脉MRA和CTA诊断狭窄的准确性,探讨斑块的MRA表现。材料和方法:30例冠心病患者在2周内接受冠状动脉MRA、CTA和CA检查。MRA使用呼吸导航触发的高分辨三维FIESTA序列,CTA检查使用64排螺旋CT。以CA为诊断金标准,评价MRA和CTA检测≥50%狭窄血管的患者,回顾性分析冠状动脉斑块的MRA表现。结果:MRA和CTA判断狭窄的敏感性、特异性和准确性分别为83.0%、86.9%、86.1%和85.1%、87.2%、86.8%。斑块的MRA复杂信号是MRA高、低估冠脉狭窄的主要原因,钙化是导致CTA高估狭窄的主要原因,MRA可以校正CTA对钙化所致狭窄的错误判断。结论:高分辨三维FIESTA序列MRA显示冠状动脉狭窄的效能与CTA接近,MRA对显示钙化斑块导致的管腔狭窄比CTA有优势;斑块的MRA表现比较复杂,给狭窄的判断带来困难,也为斑块性质的判断提供机会。

Purpose： To evaluate the efficacy of coronary MRA and CTA in detecting coronary stenosis and its plaques using coronary angiography （CA） as reference. Materials and Methods： 30 patients with suspected coronary artery disease received coronary MRA, CTA and CA examinations. Coronary MRA was acquired using respiratory navigator-gated high resolution 3-dimensional FIESTA sequence and CTA was acquired on 64-MDCT. The efficacies of MRA and CTA in detecting coronary stenosis were referred to 50% lumen loss on CA and the imaging findings of plaques on MRA were retrospectively interpreted. Results： The sensitivity, specificity and accuracy of MRA and CTA in grading stenosis was 83.0%, 86.9%, 86.1% and 85.1%, 87.2%, 86.8%, respectively. On MRA, the complicated plaque signal pattern misguided the stenosis grading. On CTA, the calcified plaque is the cause for over-estimation but it could be corrected on MRA. Conclusions： High resolution 3-dimensional FIESTA MRA and CTA had close efficacies in detecting coronary stenosis and MRA showing advantage over CTA in evaluating the calcified plaques. Coronary plaques showed variable signal patterns on MRA, making the stenosis detec-tion difficult but providing opportunity for plaque characterization.