128层螺旋CT冠状动脉成像与选择性冠状动脉造影诊断冠心病价值的比较

Diagnostic value of 128-slice CT coronary angiography in comparison with invastve coronary angiography

目的评价128层螺旋CT（MSCT）冠状动脉成像诊断冠状动脉疾病的价值。方法对临床怀疑或确诊冠心病的非选择性连续78例患者进行128层MSCT冠状动脉成像，其中有15例患者既往置入冠状动脉支架。以选择性冠状动脉造影结果作为评价标准，探讨128层MSCT在诊断冠状动脉疾病及评价支架后再狭窄的临床价值。结果基于冠状动脉血管节段分析，879个冠状动脉节段中有821节段（93％）进入统计学分析，128层MSCT诊断冠状动脉病变的敏感性87％，特异性97％，阳性预测值83％，阴性预测值97％。对15例共置入22个支架的患者中，有4个（18％）支架MSCT图像显示支架伪影，图像模糊，未能判断支架内血管腔通畅情况，其余18个支架MSCT结果与选择性冠状动脉造影比较，MSCT诊断支架再狭窄的敏感性为100％，特异性77％，阳性预测值63％，阴性预测值100％。结论128层MSCT冠状动脉成像对冠状动脉疾病的诊断和支架再狭窄的评价具有较高价值，可以作为一项无创检查技术用于对临床怀疑为冠心病的患者进行筛查。

Objective To observe the diagnostic value of non-invasive 128-slice computed tomography coronary angiagraphy （CTA） in comparison with invasive coronary angiography. Methods 128- slice CTA and invasive coronary angiography were performed in 78 unselected consecutive patients （63 patients with suspected coronary artery disease and 15 patients with previous coronary stenting, 56 males, mean age 61 ± 10 years） and 〉 50% reduction of minimal lumen diameter was defined as significant coronary stenosis. Results Fifty-eight out of 879 segments （7%） from CTA were not assessable because of irregular rhythm, vessel calcification or tachycardia. Compared with invasive coronary angiography, segmentbased analysis from the 821 segments showed the sensitivity by CTA was 87%, specificity 97%, PPV 83% and NPV 97%. Four out of 22 stents implanted in 15 patients were not assessable by CTA because of poor image quality. Compared with invasive coronary angiography, the sensitivity of diagnosing in-stent restenosis by CTA was 100%, specificity 77%, PPV 63% and NPV 100% for the remaining 18 stents. Conclusions One hundred and twenty-eight-alice CTA has a high accuracy for detecting coronary artery disease and instent restenosis after coronary stenting and could be considered as a valuable noninvasive technique for screening coronary artery disease in suspected patients.