64层螺旋CT冠状动脉成像技术与冠心病的诊断

64-slice spiral computed tomography to detect coronary artery calcification and vascular reconstruction of coronary arteries and coronary heart disease

目的探讨64层螺旋CT冠状动脉(冠脉)成像技术在冠心病诊断中的应用价值。方法临床初诊疑为冠心病103例,既往无冠脉成形术和搭桥术史,行冠脉64层螺旋计算机断层摄影术(MSCT)后,回顾性分析重建心电门控轴位图像,对所有冠脉及其分支进行重建,计算冠脉钙化积分并估计管腔狭窄程度,来预测冠心病。冠脉造影确诊冠心病者80例,排除23例,根据造影结果判断MSCT对冠心病的预测价值。结果(1)冠心病组的钙化积分明显高于同年龄段的非冠心病组;(2)两组的冠脉钙化积分均随着年龄的增长而增高;(3)钙化血管支以左前降支最多见,且随着钙化血管支数的增加,钙化积分逐渐增高;(4)64层MSCT具有较高的时间和空间分辨率,重建冠状动脉,直径>1.5mm血管存在的>50%的狭窄,男性诊断敏感性为92.16%,特异性为83.33%,阳性预测值为89.36%,阴性预测值为88.89%;女性诊断敏感性为91.57%,特异性为92.30%,阳性预测值为88.46%,阴性预测值为90.32%。结论在患者心率<80次/分钟时,64层MSCT即可获得较好的图像质量用于评价冠脉并判断其狭窄程度,是检查冠脉有无狭窄的无创伤性方法。

Objective To evaluate the role of 64-slice spiral computed tomography in the diagnosis of coronary artery disease （CAD）. Methods 103 patients who were suspected of CAD without percutaneous transluminal coronary angioplasty or surgery with coronary artery bypass grafting, were consecutively investigated using 64-slice spiral computed tomography. After the retrospectively ECG-gated axial imaging reconstruction, different process were used to reconstruct every segment of the coronary artery. By calculating coronary artery calcification scoring and the presentation of vascular stenosis by reconstruction of the coronary artery, we can predict whether a patient had CAD or not. Selective coronary angiography （SCA） were carried out within 2 weeks after MSCT scanning,we compare the result of MSCT with that of SCA to investigate the value of 64-MSCT in the diagnosis of CAD. Results Patients with CAD have higher calcification scores than patients without CAD with substantial difference. CAC scores elevated in both groups with the process of aging. The majority of calcification happened in the left anterior descending artery （LAD）, and, the more the segment involved in calcification, the higher the CAC scores. 64-MSCT have a good temporal and spatial resolution and can reconstruct coronary artery and branches with a diameter ≥ 1.5 mm to identify≥50% obstructive stenosis with acceptable sensitivity and pecificity. Sensitivity,specificity,positive predictive value and negative predictive value were male ：92. 16% ,83.33% ,89.36% ,88.89% ; female：91.57% ,92.30%, 88.46%, 90.32%, respectively. Conclusion When the heart rates were less than 80 beats per minute , good coronary imaging quality could be acquired using 64-slice MSCT.