64层螺旋CT对急性冠脉综合征患者斑块成分的研究

Evaluation of plaque texture by 64-slice spiral computed tomography in patients with acute coronary syndrome

目的评价心电门控的64层螺旋CT检测急性冠脉综合征(ACS)患者冠状动脉内斑块成分的价值及其局限性。方法对经选择性冠状动脉造影证实为冠心病的85例患者(ACS组49例,非ACS组36例)进行64层螺旋CT冠状动脉成像,对主要冠状动脉内的斑块成分进行评价。斑块的CT值用Hounsfield units(HU)表示。结果两组之间的斑块数量无差别,在靶病变中ACS组斑块的平均CT值(24±15)HU低于非ACS患者斑块的平均CT值(86±14)HU,两者比较差异有统计学意义(P<0.01)。在非靶病变血管有斑块的40例ACS患者中,靶病变冠脉节段的斑块CT值(20±18)HU低于非靶病变冠脉节段的斑块CT值(47±17)HU,两者比较差异有统计学意义(P<0.01)。ACS组Ⅱ型斑块CT值(25±13)HU低于Ⅰ型斑块(46±17)HU,同时,非ACS组Ⅱ型斑块CT值(64±10)HU也低于Ⅰ型斑块(88±14)HU,两者比较差异均有统计学意义(P<0.01)。在Ⅰ型病变和Ⅱ型病变中,ACS组斑块CT值均低于非ACS组,两者比较差异均有统计学意义(P<0.01)。结论64层螺旋CT能够有效检测冠心病患者冠状动脉斑块的成分并提示其稳定性受到图像质量和评价方法的影响,其临床应用具有一定的局限性。

Objective To evaluate the primary clinical value of 64-slice spiral computed tomography（MSCT） in detecting the plaque texture in the patients with acute coronary syndrome（ACS）. Methods 85 patients（49 ACS,36 non-ACS） with angiographically coronary artery disease underwent 64-slice spiral computed tomography. The texture of plaques in main coronary artery was evaluated and its CT density was expressed as Hounsfield unit（HU）. Results The number of plaques did not differ between two groups, however,in the culprit lesion of ACS group, the minimum CT den：sity（24 ± 15） HU was lower than that of non-ACS group （86±14） HU（P〈0.01）. Similarly,in 40 ACS patients with multiple plaques,the minimum plaque density（20±18） HU was lower in the culprit coronary segment than in the non-culprit segment（47 ±17）IHU（P〈0.01）. CT density of type 11 plaques（25 ±13） HU was lower than type Ⅰ plaques（46±17）HU in ACS group（P（0.01） ,and likewise in non-ACS group,CT density of type Ⅱ plaques（64±10） HU was lower than type plaques（88±14） HU（P〈0.01 ）. CT density of plagues of ACS group was lower than non-ACS group in both type Ⅰ lesion and type Ⅱ lesion. Conclusion 64-slice spiral CT can sufficiently detect vulnerable plaques from coronary plaques in the patients with coronary artery disease,but its clinical use may presently be limited due to image quality and evaluation means to a certain extent.