64层螺旋CT在急性冠脉综合征的临床应用价值

The value of 64-slice computed tomography angiography in diagnosis of acute coronary syndrome

目的评价64层螺旋CT对急性冠脉综合征(ACS)的价值。方法对34例因胸痛及心电图显示急性缺血就诊疑似ACS的患者进行64层螺旋CT及冠状动脉造影检查(CAG)。其中男性22例,平均年龄在57.72±8.88岁。以CAG结果为诊断的"金标准",比较64层螺旋CT对ACS的准确性。依据CT值的不同将冠脉斑块分为三类:富含脂类斑块(亦称软斑块);钙化斑块;混合斑块为脂类和钙化共存的斑块。其中64层螺旋CT显示为临界不稳定斑块所致的ACS的患者,行血管内超声检查(IVUS),以IVUS为金标准比较其对斑块性质诊断的准确性。结果 64层螺旋CT对诊断冠脉狭窄的阳性预测值为92.3%,阴性预测值为94.6%,敏感性85.3%,特异度为96.7%,假阳性3.4%,假阴性14.6%。在斑块性质的判断方面对软斑块的敏感性为83%。结论 64层螺旋CT对急性冠脉综合征患者是一种安全、有效、无创的检查,同时在判断冠脉斑块性质方面有较高的准确性。

Objective： To evaluate the value of 64-slice computed tomography angiography （SCTA） in the diagnosis of acute coronary syndrome. Methods： Thirty-four patients clinically suspected of acute coronary syndrome （ACS） underwent SCTA and coronary angiography（CAG） examination, of which 22 were male and 12 were female. Ages ranged from 37 to 76 years（57.72 ± 8. 88）. The SCTA and CAG were compared. Coronary plaque was grouped into three categories： lipid-rich plaque （also known as the soft patch） , calcified plaque, and mixed plaque in CT. The accuracy of SCTA in coronary artery intermediate unstable plaque was compared to that of the intravascular unhrasound （IVUS）. Results： Compared with CAG, the SCTA positive predictive value was 93.3%, negative predictive value was 94. 6%, sensitivity 85.3%, specificity 96. 7% , 3.4% false positive and false negative 14. 6%. Compared to IVUS,64 multi-dector CTA judged of were 83% in soft plaque. Conclusion ： The 64 SCTA is a non-invasive and safe technique in acute coronary syndrome, and it is an accurate way to determine the character of coronary artery plaque.