64层CT冠状动脉成像与冠状动脉造影的影像对比研究

Comparative study between 64-slice computed tomographic angiography and coronary angiography for detecting coronary artery diseaes

目的探讨64层CT冠状动脉成像技术在冠心病诊断中的应用价值及与冠状动脉造影影像比较。方法72例临床疑似和诊断冠心病患者,行64层螺旋CT冠状动脉成像扫描和冠状动脉造影检查。结果共分析了72例患者的全部血管节段(936个),单支血管病变18例,双支血管病变7例,3支血管病变11例,其中62个节段因图像质量问题无法进行比较,冠状动脉造影共发现117处狭窄。64层螺旋CT冠状动脉成像扫描发现117处狭窄中的96处(占82%),该组研究的敏感性83%,特异性98%,阳性预测值87%,阴性预测值98%。64层螺旋CT对于冠状动脉疾病的诊断准确率为90%。结论64层CT冠状动脉成像扫描作为无创的检查在显示血管近端狭窄和冠状动脉造影差异无统计学意义,但在血管远端及分支显示不如冠状动脉造影。

Objective To evaluate the clinical values of 64-slice computed tomographic coronary angiography（CTA）for the diagnosis of coronary artery disease by compared with coronary angiography（CAG）. Methods During Sept. 2006 to Sept. 2007,we retrospectively analyzed the data of 72 patients who were suspected to have coronary artery disease undergoing 64-slice CTA and CAG within a time frame of one week in our hospital, in order to evaluate the accuracy of 64-slice CTA in detecting mild to severe stenosis of the coronary arteries by taking CAG as the references. Results All 72 patients showed diagnostic image quality （heart rate： 64.1±9.2 beats/min,calcium mass：86±156 mg）. Thirteen coronary segments were evaluated in each patient. 62 of 936（6.6%） segments showed a nondiagnostic image quality. All segments were included in the analysis. A total of 117 relevant lesions （diameter stenosis 〉50%） were detected using CAG,and 96 of 117 （82%） were detected by multi-slice spiral computed tomography （MSCT）. Sensitivity, specificity,.and positive and negative predictive values for the whole study group were as follows： 83%, 98%, 87% ,and 98%,respectively. The correct clinical diagnosis of presence or absence of significant coronary artery diseaes （CAD）was obtained in 65 of 72（90%） patients. All stenoses were detected by MSCT in 52 of 72（72%） patients. Conclusion 64-slice CTA has high accuracy in detecting mild to severe stenosis of the coronary arteries, but lesions in distal segments and those of the LCX coronary artery are not sufficiently well detected.